Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Virchows Arch. 2020 Apr;476(4):551-559. doi: 10.1007/s00428-019-02734-2. Epub 2020 Jan 2.
Lymphocytic gastritis (LG) is an uncommon reaction pattern of gastric injury characterized by intraepithelial lymphocytosis of the surface foveolar epithelium and chronic inflammation in the lamina propria. It most commonly occurs in association with gluten-sensitive enteropathy, Helicobacter pylori gastritis, non-steroidal anti-inflammatory drugs, and microscopic colitis. While the topography of LG has been described in gluten-sensitive enteropathy and H. pylori infection, no definite morphologic features have been used to further subcategorize LG based on possible etiologies. Furthermore, new immunotherapy agents have been associated with lymphocytic infiltrate in the gastrointestinal tract, but their association with LG has not been reported. Cases of LG were collected from our institution in the period between August 2011 and September 2017. The topography of LG and morphologic features such as glandular microabscesses, intestinal metaplasia, lymphoid aggregates, surface vs pit distribution of lymphocytes, and number of intraepithelial lymphocytes per 100 epithelial cells were assessed for each case using the updated Sydney System where applicable. Twenty-seven cases of LG were identified in the recent 6-year period at our institution. Gluten-sensitive enteropathy is the main reported cause of LG followed by NSAID injury. Cases of LG associated with gluten-sensitive enteropathy are antral predominant, those associated with H. pylori are body predominant, and those occurring in the setting of NSAID injury show pangastritis. Glandular microabscesses are observed in all cases of LG associated with H. pylori, and not in the setting of GSE or NSAID injury. In addition, a case of LG associated with melanoma immunotherapy has been identified. Topography and morphology of lymphocytic gastritis may point to the cause of injury, allowing for proper treatment of the underlying disease.
淋巴细胞性胃炎(LG)是一种少见的胃损伤反应模式,其特征为表面微凹上皮的上皮内淋巴细胞增多和固有层的慢性炎症。它最常与麸质敏感肠病、幽门螺杆菌胃炎、非甾体抗炎药和显微镜结肠炎相关。虽然 LG 的 topography 在麸质敏感肠病和 H. pylori 感染中已有描述,但尚无明确的形态学特征可用于根据可能的病因进一步对 LG 进行分类。此外,新的免疫治疗药物与胃肠道内的淋巴细胞浸润有关,但尚未报道其与 LG 的关系。在 2011 年 8 月至 2017 年 9 月期间,我们机构收集了 LG 病例。使用更新的悉尼系统评估了 LG 的 topography 和形态特征,如腺体微脓肿、肠上皮化生、淋巴样聚集、淋巴细胞在表面和陷窝的分布以及每个上皮细胞内的上皮内淋巴细胞数量。在我们机构的最近 6 年期间,共发现 27 例 LG。麸质敏感肠病是 LG 的主要报道原因,其次是 NSAID 损伤。与麸质敏感肠病相关的 LG 病例以胃窦为主,与 H. pylori 相关的 LG 病例以胃体为主,而 NSAID 损伤相关的 LG 病例则表现为全胃炎。与 H. pylori 相关的所有 LG 病例中均可观察到腺体微脓肿,而在 GSE 或 NSAID 损伤的情况下则没有。此外,还发现了一例与黑色素瘤免疫治疗相关的 LG 病例。LG 的 topography 和形态学可能提示损伤的原因,从而可以对潜在疾病进行适当的治疗。