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5月11日 2018

医网情深:纽约病理实习笔记—— H Pylori associated gastritis

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医网情深:纽约病理实习笔记—— H Pylori associated gastritis   WQQ       Helicobacter pylori (H pylori), is a gram-negative, microaerophilic bacterium, was initially identified in patients with chronic gastritis and gastric ulcers. It is also associated with duodenal ulcers and stomach cancer.       Up to 85% patients infected with H. pylori never experience symptoms or complications 1. Acute gastritis may present with abdominal pain or nausea2. A chronic condition, however, often shows non-ulcer dyspepsia, which may include abdominal pain, nausea, bloating, belching, vomiting or even black stool 3,4.       Endoscopic features:      1). Acute gastritis: normal or enlarged mucosal folds, erythema, or erosions (Fig A-1).      2). Active chronic gastritis: range from normal to varioliform gastritis. Erythema could be patchy or diffuse, or may be accompanied by hemorrhages. The mucosa may loss typical rugal fold pattern.      3). Chronic atrophic gastritis: characteristic finding is atrophy ranging from patchy or diffuse. If atrophy is extensive and involves the body, rugal folds deficiency and a prominent submucosal vascular network are visible (Fig A-2). Intestinal metaplasia may appear as pink or white, raised or nodular islands surrounded by pale mucosa and a prominent submucosal vascular network in the body, OR, small, irregular white or salmon-colored plaques in the antrum (Fig A-3).

Microscopic features:      1). Acute gastritis:  acute inflammatory cells (neutrophils) without evidence of chronic condition (mononuclear inflammation) (Fig A-4)      2). Active chronic gastritis: the prominent hallmark of chronic gastritis is significant mononuclear cell infiltration. And, neutrophils appear in the lamina propria and the gastric epithelium in the acute phase. Note the presence of germinal center and intraepithelial neutrophils in Fig A-5, Fig A-6. H. pylori can be identified by IHC as in Fig A-7.       3). Chronic atrophy gastritis: loss of gastric glands, functional epithelium replaced by fibrotic tissue partially or globally (Fig A-8). Intestinal metaplasia can be defined with the presence of goblet cells in prolonged condition (Fig A-9). However, isolated foci of goblet cells are not equivalent with atrophy. In addition, modified Giemsa stain also can be applied to the identification of H pylori (as seen in Fig A-10, Fig A-11). In fact, people have already compared the use of different stains in the detection of H pylori using a combination of tests to verify infection. The analysis showed the percentages are as the following: IHC (98%), McMullen’s (90%), then Giemsa (87%), and lastly HpSS (85%) 5. Even the antibody method is more reliable than the other methods based on the results. However, the differences in sensitivity between the four methods are minimal, and the conclusion to be drawn is that when H pylori are present careful examination will reveal the organisms, no matter which of these stains is used.      The lack of contrast is a disadvantage of the Giemsa technique, which requires strict pH staining solution and ideally should be adjusted for different fixatives6 (ref to the detailed Giemsa staining protocol). However, a careful observer should not have problems identifying the organisms.   Ref 1. Bytzer P, Dahlerup JF, Eriksen JR, Jarbøl DE, Rosenstock S, Wildt S (April 2011). "Diagnosis and treatment of Helicobacter pylori infection". Dan Med Bull. 58 (4): C4271. PMID 21466771. Archived from the original on 5 January 2014. Retrieved 7 August 2013 2. Butcher, Graham P. (2003). Gastroenterology: An Illustrated Colour Text. Elsevier Health Sciences. p. 25. ISBN 0-443-06215-3. 3. Butcher 2003, pp. 24–5 4. Ryan, Kenneth (2010). Sherris Medical Microbiology. McGraw-Hill. pp. 573, 576. ISBN 978-0-07-160402-4 5. Rotimi O, et al. (2000). Histological identification of Helicobacter pylori: comparison of staining methods. J Clin Pathol. 2000 Oct;53(10):756-9. 6.https://library.med.utah.edu/WebPath/HISTHTML/MANUALS/MGIEMSA.PDF 5/10/2018 美国纽约 美國病理會診中心: http://ampathology.com service@ampathology.com 美中醫學教育網/網絡老刀會: http://physicians.cmgforum.net http://dok.cmgforum.net 微信號:dok2401

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