Mills Ch22 Stomach

610

SECTION VII : AlimentaryTract

A

B

C

D

FIGURE 22.15  Biopsy artifacts: crushing, producing an apparent lamina propria infiltrate ( A ); crushing, result- ing in displacement (telescoping) of cells into pit lumen ( B ); biopsy-induced hemorrhage ( C ); and stretching, producing an appearance of superficial edema ( D ).

epithelia, where a number of useful diagnostic features may be identified, depending on the degree of activity of the inflammation. The earliest changes seen are a reduc- tion in the mucin content of the cytoplasm, an increase in nuclear size, and the presence of one or more prominent nucleoli (Fig. 22.17). At the base of the foveolae, there may be increased numbers of mitoses, reflecting a more rapid cell turnover. These findings are features of epithelial

damage and regeneration and are common to all forms of gastritis and to reactive gastropathy (chemical gastritis). In severe active H. pylori –related inflammation, the epithe- lium and the lamina propria are infiltrated by acute inflam- matory cells (Fig. 22.18), and organisms may be seen on the mucosal surface (Fig. 22.19). Optimum recognition of organisms is enhanced by using special stains (Giemsa, methylene blue, immunohistochemical stains).