Mills Ch22 Stomach

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CHAPTER 22:  Stomach

FIGURE 22.16  Mild chronic superficial gastritis with chronic inflam- matory cells present in the superficial lamina propria in excess of nor- mal. This is a borderline biopsy sample and illustrates the least number of cells acceptable for a diagnosis of gastritis.

FIGURE 22.19  Helicobacter pylori organisms present in the mucous layer on the gastric mucosal surface.

Where gastritis has been present for some time, there may be atrophy of the mucosal glands, which can be accom- panied by an increase in inflammatory cells in the deeper layers of the mucosa. On an H&E section, this is seen as a separation of the glands with increased intervening lamina propria. However, minor degrees of atrophy may be diffi- cult to distinguish, particularly if there is biopsy artifact. In these instances, a reticulin stain can be useful in confirm- ing atrophy by demonstrating coarse condensation of fibers in the lamina propria (Fig. 22.20). Reactive gastropathy occurs when there is increased exfo- liation of cells from the mucosal surface. Chemical agents, especially refluxed bile and nonsteroidal anti-inflammatory drugs, are common causes. The gastric surface and foveolar epithelia show regenerative changes as described above, but the mucosa is not infiltrated by inflammatory cells. The more severe examples of reactive gastropathy may be characterized by a “corkscrew” appearance of the foveolae.

FIGURE 22.17  Gastritis showing cytoplasmic mucin loss with enlarged nuclei that contain prominent nucleoli.

FIGURE 22.20  Coarse condensation of mucosal fibers in atrophic gastritis (reticulin).

FIGURE 22.18  Gastric pits infiltrated by neutrophils in a case of Helicobacter pylori gastritis.