Korean J Gastroenterol.  2018 Mar;71(3):143-152. 10.4166/kjg.2018.71.3.143.

Identification of Nodular Gastritis among Patients Diagnosed with Lymphofollicular Gastritis on a Gastric Biopsied Specimen

Affiliations
  • 1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. sunyoung@kuh.ac.kr
  • 2Department of Pathology, Konkuk University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Nodular gastritis (NG) is a well-known endoscopic finding observed in patients with a Helicobacter pylori infection, which may lead to invasive gastric cancer. Lymphofollicular gastritis consists of lymphoid follicles or lymphoid cell aggregates, and is common in children. The aim of this study was to identify patients with NG from those in whom gastric biopsied specimens showed lymphoid follicles and lymphoid cell aggregates.
METHODS
Subjects, whose gastric biopsy specimens showed lymphoid follicles or lymphoid cell aggregates, were included in this study. The inclusion criterion was that they underwent a serum pepsinogen assay on the day of upper gastrointestinal endoscopy. NG was diagnosed if the endoscopy findings revealed regular-sized, multiple, colorless subepithelial nodules.
RESULTS
Among 108 subjects who showed lymphoid follicles or lymphoid cell aggregates, 13 (12.0%) revealed NG on endoscopy, and all these subjects showed positive Giemsa staining. Patients diagnosed with NG were younger (p=0.012) and showed a female predominance (p=0.001) compared to those without NG. The mean serum pepsinogen levels were higher (p=0.001) and lymphoid follicle-dominant subjects were more common (p<0.001) in the NG subjects than in those without NG. Logistic regression analysis revealed a younger age (p=0.041) and female gender (p=0.002) to be significant independent risk factors for NG.
CONCLUSIONS
NG should be distinguished from lymphofollicular gastritis because only 12% of patients showing gastric biopsy findings of lymphoid follicles and lymphoid cell aggregates demonstrated NG on endoscopy. NG is an endoscopic finding that is more common in women and in the younger population, irrespective of the biopsy findings and gastric secretory ability.

Keyword

Gastritis; Lymphocyte; Lymphoid tissue

MeSH Terms

Azure Stains
Biopsy
Child
Endoscopy
Endoscopy, Gastrointestinal
Female
Gastritis*
Helicobacter pylori
Humans
Logistic Models
Lymphocytes
Lymphoid Tissue
Pepsinogen A
Risk Factors
Stomach Neoplasms
Azure Stains
Pepsinogen A

Figure

  • Fig. 1. Lymphoid follicle-dominant type. (A) On the upper gastrointestinal endoscopic findings, multiple 2 mm-sized, colorless subepithelial nodules were noticed. The findings were consistent with nodular gastritis of the small-granular type. (B) On the endoscopic findings, multiple 5 mm-sized, flat subepithelial nodules can be seen on the antrum. These findings are consistent with nodular gastritis of the large-nodular type. (C) On the gastric biopsied specimen of (A) taken from the proximal antrum, lymphoid follicles with prominent germinal centers were noticed with few lymphoplasma cell infiltration (H&E stain, ×40). The mucosa was expanded by prominent germinal centers reaching up to the superficial layer of the lamina propria. (D) On the gastric biopsied specimen of (B) from the proximal antrum, two lymphoid follicles were noticed with few lymphoid cell aggregates. The germinal centers were smaller and deeper than the first case (H&E stain, ×40).

  • Fig. 2. Lymphoid cell aggregate-dominant type. (A) The endoscopic findings of the antrum are consistent with nodular gastritis of the small-granular type. (B) The endoscopic findings are consistent with nodular gastritis of the large-nodular type. (C) On the biopsied specimen of (A), diffuse lymphoplasma cell infiltration can be observed as lymphoid cell aggregates (H&E stain, ×40). Infiltrated lymphoplasma cells on the superficial layer of the lamina propria are expanding the nodular mucosa. (D) On the biopsied specimen of (B) from the antrum, lymphoid cell aggregates can be seen on the deeper layer of lamina propria without a germinal center (H&E stain, ×40).


Reference

References

1. Hong SN, Jo S, Jang JH, et al. Clinical characteristics and the abdominal profiles of inflammatory cytokines/cytokine regulatory factors in asymptomatic patients with nodular gastritis. Dig Dis Sci. 2012; 57:1486–1495.
2. Kamada T, Tanaka A, Yamanaka Y, et al. Nodular gastritis with Helicobacter pylori infection is strongly associated with diffuse-type gastric cancer in young patients. Dig Endosc. 2007; 19:180–184.
Article
3. Jun TY, Kim SH, Kim OG, et al. A case of gastric signet ring cell carcinoma in young adult with nodular gastritis; on follow-up without Helicobacter pylori eradication. Korean J Helicobacter Up Gastrointest Res. 2014; 14:113–116.
4. Miyamoto M, Haruma K, Yoshihara M, et al. Five cases of nodular gastritis and gastric cancer: a possible association between abdominal gastritis and gastric cancer. Dig Liver Dis. 2002; 34:819–820.
5. Kitamura S, Yasuda M, Muguruma N, et al. Prevalence and abdominal of nodular gastritis in Japanese elderly. J Gastroenterol Hepatol. 2013; 28:1154–1160.
6. Sipponen P, Price AB. The Sydney system for classification of abdominal 20 years ago. J Gastroenterol Hepatol. 2011; 26(Suppl 1):31–34.
7. Rugge M, Genta RM. Staging and grading of chronic gastritis. Hum Pathol. 2005; 36:228–233.
Article
8. Miyamoto M, Haruma K, Hiyama T, et al. High incidence of B-cell monoclonality in follicular gastritis: a possible association abdominal follicular gastritis and MALT lymphoma. Virchows Arch. 2002; 440:376–380.
9. Okamura T, Sakai Y, Hoshino H, Iwaya Y, Tanaka E, Kobayashi M. Superficially located enlarged lymphoid follicles characterise nodular gastritis. Pathology. 2015; 47:38–44.
Article
10. Nagata T, Ishitake H, Shimamoto F, et al. Histopathological study of the relationship between lymphoid follicles and different abdominal types of nodular gastritis. Rinsho Byori. 2014; 62:1031–1039.
11. Nakashima R, Nagata N, Watanabe K, et al. Histological features of nodular gastritis and its endoscopic classification. J Dig Dis. 2011; 12:436–442.
Article
12. Lee SP, Lee SY, Kim JH, Sung IK, Park HS, Shim CS. Link between serum pepsinogen concentrations and upper gastrointestinal endoscopic findings. J Korean Med Sci. 2017; 32:796–802.
Article
13. Lee SY. Endoscopic gastritis, serum pepsinogen assay, and Helicobacter pylori infection. Korean J Intern Med. 2016; 31:835–844.
Article
14. Shimatani T, Inoue M, Iwamoto K, et al. Gastric acidity in patients with follicular gastritis is significantly reduced, but can be abdominalized after eradication for Helicobacter pylori. Helicobacter. 2005; 10:256–265.
15. Choi HS, Lee SY, Kim JH, el al. Combining the serum pepsinogen levels and Helicobacter pylori antibody test for predicting the abdominal of gastric neoplasm. J Dig Dis. 2014; 15:293–298.
16. Hayashi S, Imamura J, Kimura K, Saeki S, Hishima T. Endoscopic features of lymphoid follicles in Helicobacter pylori-associated chronic gastritis. Dig Endosc. 2015; 27:53–60.
17. Sokmensuer C, Onal IK, Yeniova O, et al. What are the clinical abdominals of nodular gastritis? Clues from histopathology. Dig Dis Sci. 2009; 54:2150–2154.
18. Shiotani A, Kamada T, Kumamoto M, et al. Nodular gastritis in Japanese young adults: endoscopic and histological observations. J Gastroenterol. 2007; 42:610–615.
Article
19. Kim SG, Jung HK, Lee HL, et al. Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition. Korean J Gastroenterol. 2013; 62:3–26.
Article
20. Kim JW, Lee SY, Kim JH, et al. Nodule regression in adults with nodular gastritis. Gastroenterology Res. 2015; 8:296–302.
Article
21. Sakaguchi M, Amemoto K, Honda M, et al. Clinical evaluation of nodular gastritis: follow-up by endoscopy and histopathology. Gastroenterol Endosc. 2006; 48:2477–2485.
22. Chen MJ, Shih SC, Wang TE, Chan YJ, Chen CJ, Chang WH. Endoscopic patterns and histopathological features after abdominal therapy in Helicobacter pylori-associated nodular gastritis. Dig Dis Sci. 2008; 53:1893–1897.
23. Dwivedi M, Misra SP, Misra V. Nodular gastritis in adults: clinical features, endoscopic appearance, histopathological features, and response to therapy. J Gastroenterol Hepatol. 2008; 23:943–947.
Article
24. Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015; 64:1353–1367.
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