Wladimir V. Bogomoletz

Ménétrier's disease with lymphocytic gastritis: An unusual association with possible pathogenic implications

Ménétriers disease is a rare form of hypertrophic or hyperplastic gastropathy, characterized by conspicuous thickening of the gastric mucosal folds and foveolar (crypt) hyperplasia. The pathogenesis of Ménétriers disease remains unresolved. Lymphocytic gastritis is a newly described entity which corresponds endoscopically to varioliform gastritis and is marked by T-lymphocyte infiltration of the surface epithelium and crypts. Five surgical cases and one autopsy case combining the gross and microscopic features of Ménétriers disease and lymphocytic gastritis are presented. This unusual and hitherto previously undescribed association raises the possibility of a common pathogenesis for Ménétriers disease and lymphocytic gastritis.

Mucin histochemistry of heterotopic gastric mucosa of the upper esophagus in adults: Possible pathogenic implications

The mucin profile of 24 endoscopic biopsies of heterotopic gastric mucosa (HGM) of the upper esophagus in adults and a control group of ten cases of Meckels diverticula containing heterotopic gastric mucosa were studied with two combined histochemical methods: alcian blue pH 2.5/PAS and high iron diamine/alcian blue pH 2.5. The clinical and light microscopic features of the 24 HGM cases were also reviewed. In addition to overall secretion of neutral mucins by the 24 HGM cases, mucin histochemistry showed prominent secretion of acidic mucins in 19 of 24 HGM cases (79%), with sulphomucins in 11 of 24 HGM cases (45.8%). This mucin profile of HGM was unlike that of either normal gastric mucosa or heterotopic gastric mucosa in Meckels diverticula. Moreover, a comparison between the mucin profile and clinical features of HGM and Barretts esophagus showed certain similarities. The data suggest a physiopathologic link between HGM and Barretts esophagus.

Primary carcinoid tumor of the mesentery

A primary carcinoid tumor of the mesentery was associated with intestinal obstruction in a 74-year-old man. Increased levels of plasma pancreatic polypeptide were subsequently demonstrated. An autopsy performed four years later showed carcinoid metastatic dissemination and confirmed the primary mesenteric origin of the carcinoid tumor initially resected at surgery.

Campylobacter-like organisms in heterotopic gastric mucosa of the upper oesophagus.

Campylobacter-like organisms (CLO) are strongly associated in the stomach with active type B chronic gastritis, and several different studies have suggested a role for CLO in the natural history of the disease. CLO are closely apposed to gastric mucin secreting cells in the stomach, and they can also be found in areas of gastric metaplasia in the duodenum where they are supposed to be a key factor in the tendency of duodenal ulcers

Association d’une maladie de Ménétrier et d’une gastrite lymphocytaire: à propos d’une observation

RÉsumÉLes auteurs rapportent une observation récente de gastropathie hyperplasique combinant les caractères morphologiques de la maladie de Ménétrier et de la gastrite lymphocytaire. Ils soulignent les nombreuses similitudes cliniques et endoscopiques entre les deux affections. L’expression endoscopique habituelle de la gastrite lymphocytaire consiste en effet, comme celle de la maladie de Ménétrier, en une hyperplasie de la plicature à prédominance fundique (gastrite varioliforme diffuse ou corporéale). D’un point de vue clinique, on peut observer dans les deux cas de l’anorexie et de 1’amaigrissement ainsi que des œdèmes périphériques liés à une hypoprotéinémie.Cette similitude de présentation entraîne un risque sérieux de confusion diagnostique. D’autre part, la coexistence des stigmates morphologiques des deux entités chez un même patient soulève le problème d’une relation pathogénique éventuelle entre la maladie de Ménétrier et la gastrite lymphocytaire.SummaryThe authors report a recent observation combining the morphological features of Menetrier’s disease and lymphocytic gastritis. They emphasize the numerous similarities , clinical and endoscopic, between both conditions. The usual endoscopic expression of lymphocytic gastritis consists, as that of Menetrier’s disease, in a cerebroid hyperplasia of the gastric folds, predominating in the corporeal region (diffuse or corporeal varioliform gastritis). From a clinical point of view, anorexia and weight loss are frequent in both diseases while gravitational oedema due to hypoproteinemia can occasionally be observed.These similarities raise the possibility of diagnostic confusion between Menetrier’s disease and lymphocytic gastritis. The coexistence of histological features of both conditions is disturbing and raises the problem of a pathogenetic relationship between them.ResumenLos autores describen un caso reciente de gastropatia hiperplásica que mezclaba los caracteres morfológicos de la enfermedad de Menetrier y de la gastritis linfociatria. Destacan las numerosas semejanzas clínicas y endoscópicas entre ambas afecciones. La expresidn endoscopica habitual de la gastritis linfocitaria consiste, efectivamente, al igual que en la enferemedad de menetrier, en una hiperplasia de los pliegues, especialmente los fúndicos (gastritis varioliforme difusa o del cuerpo gástrico) Desde un punto de vista clínico, se puede observar, en ambos procesos, una anorexia y adelgazamiento asi como edema peiferico ligado a hipoproteinemia.Estas similitudes de presentación conllevan un riesgo de confusión que es importante. Por otra parte la coexistencia de signos morfológicos de ambas entidades en un mismo paciente plantea el problema de una posible relatión patogenica entre enfermedad de Menetrier y gastritis linfocitaria.

L’association gastrite lymphocytaire et gastrite varioliforme: une forme de gastropathie à plis géants consécutive à un œdème de la sous-muqueuse

RésuméLa gastrite lymphocytaire est d’un point de vue histologique, caractérisée à l’examen histologique par un infiltrat lymphocytaire dense de l’épithélium fovéolaire et de surface. En endoscopie, la gastrite lymphocytaire se présente fréquemment sous forme d’une gastrite varioliforme à plis muqueux épaissis, porteurs de petits nodules et d’érosions superficielles. Notre étude porte sur 5 macrobiopsies à l’anse diathermique et deux pièces de gastrectomie de patients présentant à l’endoscopie une gastrite varioliforme et une gastrite lymphocytaire à l’examen histologique. Les comptages lymphocytaires confirment les données précédentes fournies par les biopsies per endoscopiques. L’étude morphométrique montre que l’épaississement des plis muqueux est consécutif à un oedème de la sous-muqueuse. La gastrite lymphocytaire associée à la gastrite varioliforme constitue une entité anatomique à intégrer dans le groupe des gastropathies à plis géants.SummaryLymphocytic gastritis is characterized histologically by marked intraepithelial lymphocytic infiltration of surface and foveolar epithelium of gastric mucosa. Endoscopically, lymphocytic gastritis commonly shows varioliform gastritis with thickened mucosal folds bearing small nodules and surface erosions. Five snare biopsies and two gastrectomy specimens, all with endoscopic varioliform gastritis and histological lymphocytic gastritis, were studied. Lymphocyte counts confirmed previously reported data obtained with conventional forceps biopsies. Morphometry showed that the thickening of the mucosal folds was due to submucosal oedema. Lymphocytic gastritis combined with varioliform gastritis should be included in the group of giant fold diseases of the stomach.