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Topography, morphology, and etiology of lymphocytic gastritis: a single institution experience

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Abstract

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.

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Contributions

Raymond Yip, Hui-Min Yang, Lawrence Lee, and Lik Hang Lee conceived and designed the study. Raymond Yip, Hui-Min Yang, and Lawrence Lee performed histologic assessment and confirmation of diagnoses. Raymond Yip and Hui-Min Yang researched and analyzed the data. Raymond Yip, Hui-Min Yang, and Basil Horst wrote the manuscript. All authors edited and reviewed the manuscript and gave final approval for publication.

Funding

This study was funded by the Department of Pathology & Laboratory Medicine of the University of British Columbia.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada

    Raymond H. L. Yip, Lawrence H. Lee, David F. Schaeffer, Basil A. Horst & Hui-Min Yang

  2. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

    Raymond H. L. Yip, Lik Hang Lee, Basil A. Horst & Hui-Min Yang

  3. Department of Pathology and Laboratory Medicine, St. Paul’s Hospital, Vancouver, BC, Canada

    Lik Hang Lee

Authors
  1. Raymond H. L. Yip
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  2. Lawrence H. Lee
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  3. Lik Hang Lee
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  4. David F. Schaeffer
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  5. Basil A. Horst
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  6. Hui-Min Yang
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Correspondence to Raymond H. L. Yip.

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This study was approved by the Research Ethics Board at the Vancouver Coastal Health Research Institute.

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The authors declare that they have no conflict of interest.

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Yip, R.H.L., Lee, L.H., Lee, L.H. et al. Topography, morphology, and etiology of lymphocytic gastritis: a single institution experience. Virchows Arch 476, 551–559 (2020). https://doi.org/10.1007/s00428-019-02734-2

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  • DOI: https://doi.org/10.1007/s00428-019-02734-2

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