J Pathol Transl Med.  2017 Jul;51(4):341-351. 10.4132/jptm.2017.04.03.

Rare Gastric Lesions Associated with Helicobacter pylori Infection: A Histopathological Review

• Joo M

• KMID: 2392573
• DOI: http://doi.org/10.4132/jptm.2017.04.03

Abstract

Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. However, some rare gastric lesions exhibiting distinctive histological features may also be associated with H. pylori infection, including lymphocytic gastritis, granulomatous gastritis, Russell body gastritis, or crystal-storing histiocytosis. Although diverse factors can contribute to their development, there is convincing evidence that H. pylori infection may play a pathogenic role. These findings are mainly based on studies in patients with these lesions who exhibited clinical and histological improvements after H. pylori eradication therapy. Thus, H. pylori eradication therapy might be indicated in patients with no other underlying disease, particularly in countries with a high prevalence of H. pylori infection. This review describes the characteristic histological features of these rare lesions and evaluates the evidence regarding a causative role for H. pylori infection in their pathogenesis.

Keyword

Helicobacter pylori; Stomach; Gastritis; Rare; Immunoglobulins

MeSH Terms

Adenocarcinoma
Gastritis
Helicobacter pylori*
Helicobacter*
Histiocytosis
Humans
Immunoglobulins
Lymphoma, B-Cell, Marginal Zone
Peptic Ulcer
Prevalence
Stomach
Stomach Diseases
Immunoglobulins

Figure

• 

  Fig. 1. Lymphocytic gastritis. (A) The biopsy specimen shows a marked increase in intraepithelial lymphocytes (IELs) (over 25 IELs per 100 epithelial cells) with a top-heavy distribution. (B) Most IELs are positive for CD3 immunostaining.

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  Fig. 2. Granulomatous gastritis. (A) The biopsy specimen demonstrates diffuse chronic active gastritis with confluent granulomas including multinucleated giant cells. (B) A well-defined granuloma is noted just below the surface foveolar epithelium. Some Helicobacter pylori organisms are seen (arrows).

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  Fig. 3. Russell body gastritis with concomitant mucosa-associated lymphoid tissue lymphoma. (A) Mott cells are plasma cells in which the cytoplasm is packed with multiple variable-sized Russell bodies. (B) The lamina propria of the gastric mucosa is expanded by extensive infiltration of Mott cells, consistent with Russell body gastritis. (C) Small- to intermediate-sized atypical lymphoid cells, morphologically consistent with centrocyte-like cells are admixed with Mott cells and destroy adjacent gastric glands to form a lymphoepithelial lesion (circle). (D) Immunostaining for cytokeratin highlights a lymphoepithelial lesion.

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  Fig. 4. Gastric crystal-storing histiocytosis. (A) The biopsy specimen demonstrates many large pinkish mononuclear cells in the lamina propria. (B) Higher magnification of mononuclear cells shows densely eosinophilic, refractile, needle-shaped, intracytoplasmic crystalline inclusions.

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