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Autoimmune gastritis with neuroendocrine microcarcinoid tumors.
Haematoxylin & Eosin (H&E)
36 years
36-year old male patient with autoimmune gastritis and status post neuroendocrine tumor of the stomach.
Mucosa of gastric corpus with complete metaplastic glandular atrophy with loss of acid-secreting parietal cells and replacement by glands of the pyloric and pancreatic type. Severe chronic, focally minimal active inflammation and presence of intramucosal lymphoid follicles. Neuroendocrine cells in the mucosa forming clusters and rosettes which have a maximal diameter of 2.5 mm and hence are classified as microcarcinoid tumors.
An immunohistochemical stain for Chromogranin-A (a neuroendocrine marker) demonstrates a linear and micronodular ECL hyperplasia. In addition the 3 microcarcinoid tumors show an infiltration of the Lamina muscularis mucosae. There are no mitoses appreciable in conventional histology. Index of proliferation (Ki-67) is approximately 1%.
Patients with autoimmune gastritis have hypo-/achlorhydria and develop a compensatory hyperplasia of antral G cells with hypergastrinemia which in turn leads to ECL cell hyperplasia in the gastric corpus. At an early stage ECL cell hyperplasia occurs in a linear, micronodular or adenomatoid fashion. At a later stage dysplastic lesions (confluent micronoduli, microinvasive micronoduli and noduli with stroma formation) and eventually microcarcinoid tumors can develop. Microcarcinoid tumors are by definition <5mm and there is no angioinvasion and no invasion of the submucosa present.
Andrea Bodmer, University of Basel
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