Endoscopic, Ultrasonographic, and Pathologic Correlation of Lymphocytic Gastritis

Abstract

Purpose: A 71 year old woman presented with weight loss, post-prandial epigastric pain, and mild chronic diarrhea. A CT scan of the abdomen demonstrated mild antral wall thickening. A subsequent upper endoscopy showed diffuse inflammation, friability, and non-distensibility of the distal stomach, worrisome for linitis plastica or lymphoma. Biopsies of the stomach demonstrated dense lymphoplasmacytic infiltration of the lamina propria, as well as patchy neutrophilic infiltrate in an apparent ulcer bed. Immunostains were not suggestive of a monoclonal process, and there was no evidence of Helicobacter pylori (H. pylori) colonization. The patient subsequently underwent endoscopic ultrasonography, which revealed diffuse wall thickening of the distal body and antrum of the stomach which was free of folds. The gastric wall measured up to 9 mm, which was mostly comprised of the mucosal layer (sonographic layers 1&2). Gastric biopsies demonstrated a dense infiltrate of lymphocytes in the lamina propria consistent with lymphocytic gastritis. Duodenal biopsies showed villous blunting, crypt hyperlasia, and increased intraepithelial lymphocytes in the lamina propria, suspicious for celiac disease. This case highlights the importance of a thorough duodenal examination during endoscopy including biopsies in patients who primarily present with gastric pathology. In addition, although, celiac's disease is often regarded as a problem with intestinal malabsorption, it can also present with gastric problems. To date, only one report has demonstrated EUS findings in a patient with LG, which demonstrated expansion of the deep mucosal layer (layer 2). In our patient, while a dedicated high-frequency miniprobe examination was not performed, images with the dedicated radial echoendoscope similarly demonstrate expansion of the mucosal layer. Furthermore, our pathological samples confirm the expansion of the mucosal layer with intraepithelial lymphocytes.Figure: No Caption available.