Stomach

• A pattern of gastric mucosal injury characterized by increased intraepithelial lymphocytes (> 25 per 100 epithelial cells) and increased chronic inflammatory cells in the lamina propria

• ICD-10: K52.89 - other specified noninfective gastroenteritis and colitis

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• Small nodules with central erosions and enlarged rugal folds (“varioliform gastritis”)
  • Early studies suggested this finding in 80% of cases
  • Subsequent articles reported incidence of 4% to 30% (Pathol Case Rev 2008;13:167)
• Additional findings: small elevated plaques, superficial erosions, nodular appearance, thickened folds
• Unremarkable appearance in up to 50% of cases (J Clin Pathol 1995;48:939, Gut 1988;29:1258)
• Hypertrophic gastric folds has been described in cases of Ménétrier disease (Hum Pathol 1991;22:379)

• Defined by increased gastric intraepithelial lymphocytes (> 25 per 100 epithelial cells)
  • Intraepithelial lymphocytosis is typically greater in the surface epithelium
  • Most cases show around 35 - 75 surface intraepithelial lymphocytes per 100 epithelial cells (Gut 1990;31:282)
• Lymphoplasmacytic expansion of the lamina propria can be additionally seen
• Intraepithelial neutrophils may be seen, especially in the setting of H. pylori infection or mucosal erosion
• Lymphoepithelial lesions are not present

Contributed by Matthew Morrow, M.D.


Contributed by @RaulSGonzalezMD on Twitter

• Gastric lymphoma
  • Often causes a mass lesion, unlike lymphocytic gastritis
  • Patchy increased intraepithelial lymphocytes can be seen in MALT lymphoma (Korean J Pathol 2007;41:289)
  • Lymphocytes in MALT lymphoma are CD20+ B cells
  • Lymphoma may display an infiltrative pattern with lymphoepithelial lesions and architectural distortion
  • Cytologic atypia may be present
• Helicobacter pylori gastritis
  • Curved slender bacteria present in the superficial mucus layer and along the surface of gastric epithelial cells
  • Neutrophils and germinal centers may be seen
  • Chronic gastritis, such as mononuclear expansion of the lamina propria seen in lymphocytic gastritis, should prompt scrutiny for Helicobacter organisms
  • Helicobacter immunostain, Giemsa and silver stains highlight organisms

The image above is from an antral biopsy from a 9 year old boy. What additional histological finding is most likely to be present in this patient?


1. Increased intraepithelial eosinophils with eosinophilic microabscesses in the upper esophagus
2. Curved bacteria rods present in the superficial mucus layer of the stomach
3. Duodenal increased intraepithelial lymphocytes, crypt hyperplasia and villous blunting
4. Duodenal villous blunting, crypt hyperplasia and focal surface epithelial “tufting”

C. Lymphocytic gastritis is most commonly seen in a background of celiac disease in children (intraepithelial lymphocytes, crypt hyperplasia and villous blunting in the duodenum) and may portend a more severe disease course. Helicobacter infection (choice B) would be more likely in an adult patient.

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Reference: Lymphocytic gastritis

Aside from increased intraepithelial lymphocytes, what other histologic feature in the stomach is commonly described in lymphocytic gastritis?

1. Lymphoepithelial lesions
2. Lymphoplasmacytic expansion of the lamina propria
3. Loss of parietal cells
4. Increased subepithelial collagen deposition

B. Lymphoplasmacytic expansion of the lamina propria is also commonly seen in lymphocytic gastritis.

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Reference: Lymphocytic gastritis