H. pylori Negative Diffuse Russell Body Gastropathy

Abstract

Purpose: A 71-year-old male with a history of atrial fibrillation on warfarin and a normal colonoscopy 5 years ago presented with melena and a hemoglobin of 4.1 g/dL. He denied alcohol or NSAID use. No personal or family history of GI disease. EGD revealed diffuse finely nodular gastric mucosa (Figure 1). Biopsies were significant for plasma cells containing numerous round eosinophilic globules positive for CD 138 consistent with Russell bodies (Figure 2). CKMAK-6 and CKAE1+3 were negative confirming these were plasma cells and not epithelial in origin. The plasma cells were κ- and λ-immunostain positive supporting their polyclonal nature. There was no evidence of malignancy. Small bowel capsule endoscopy and abdominal CT scan were negative. Russell bodies are eosinophillic cytoplasmic inclusions within plasma cells resulting from the accumulation of immunoglobulins within the endoplasmic reticulum. Russell body gastritis is rare and was first reported in 1998. Russell bodies have been associated with H. pylori gastritis (in 7 of 10 reported cases), HIV gastritis, EBV, Barrett's esophagitis, duodenitis, histoplasmosis, TB, multiple myeloma, endocervical polyps, peridontitis, and actinic keratosis. There have been recent reported cases of Mott cell (a plasma cell containing Russell bodies) proliferation in gastric carcinoma encoded with EBV RNA, signet ring cell gastric cancer, and MALToma. The risk of malignancy with Russell bodies is unknown as there is no long term follow-up. This patient was unique in that he had diffuse nodularity with Russell bodies, and was H. pylori negative and without associated aspirin, NSAID, alcohol use, infection, or malignancy.Figure 1: No Caption available.Figure 2: No Caption available.