Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY.
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA.
Am J Clin Pathol. 2020 Nov 4;154(6):761-766. doi: 10.1093/ajcp/aqaa098.
Autoimmune metaplastic atrophic gastritis (AMAG) is an underrecognized entity, especially in its early stage. This study assessed whether the use of gastrin immunohistochemistry would increase sensitivity for diagnosing early AMAG.
Three-hundred gastric biopsies were prospectively stained for gastrin by immunohistochemistry. Inclusion criteria included well-oriented gastric mucosa with mucus glands and minimal plasma cell infiltrate not suspected to represent pyloric metaplasia. Patient age, sex, designated location of biopsy, presence or absence of intestinal metaplasia, and clinical information were not criteria. Any case with absence of gastrin-positive endocrine cells reflexed to chromogranin immunohistochemistry. Maloriented biopsies or cases with current Helicobacter infection were excluded.
The 298-patient study cohort comprised 222 females (mean age, 47 years; range, 16-80 years) and 76 males (mean age, 49 years; range, 7-80 years). Biopsies were designated as "antral/antral nodules" (61%), and the rest were labeled "gastric/random stomach" (39%). Nine cases (3%) exhibited absence of gastrin-positive endocrine cells; one of those showed endocrine cell hyperplasia by chromogranin staining.
Pathologists should be aware of the histologic features of early AMAG and meticulously analyze tissue regardless of specimen labeling. Gastrin immunostain is a supplemental diagnostic tool when encountering inflamed antral-appearing specimens.
自身免疫性变形萎缩性胃炎（AMAG）是一种认识不足的疾病，尤其是在早期阶段。本研究评估胃泌素免疫组织化学的应用是否会提高早期 AMAG 的诊断敏感性。
前瞻性地对 300 例胃活检标本进行胃泌素免疫组织化学染色。纳入标准包括具有黏液腺和最小浆细胞浸润的定向良好的胃黏膜，且不怀疑为幽门化生。患者年龄、性别、活检部位、是否存在肠化生以及临床资料均不是标准。任何缺乏胃泌素阳性内分泌细胞的病例均反射性地进行嗜铬粒蛋白免疫组织化学染色。定向不良的活检标本或当前存在幽门螺杆菌感染的病例被排除在外。
298 例患者的研究队列包括 222 名女性（平均年龄 47 岁；范围 16-80 岁）和 76 名男性（平均年龄 49 岁；范围 7-80 岁）。活检被指定为“胃窦/胃窦结节”（61%），其余则标记为“胃/随机胃”（39%）。9 例（3%）表现出缺乏胃泌素阳性内分泌细胞；其中 1 例通过嗜铬粒蛋白染色显示内分泌细胞增生。
病理学家应了解早期 AMAG 的组织学特征，并无论标本标记如何都要仔细分析组织。当遇到表现为炎症性胃窦样的标本时，胃泌素免疫染色是一种补充诊断工具。
