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Helicobacter pylori Associated Lymphocytic Gastritis in a Child.

Kim MJ, Eom DW, Park K - Pediatr Gastroenterol Hepatol Nutr (2014)

Bottom Line: After the 1st eradication therapy, H. pylori bacilli were still found, and urea breathing test was positive.Although the endoscopic finding was partially improved, clinical symptoms and histologic finding were persisted.Therefore the clinical and histopathologic evaluation should be considered as well as endoscopic findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Lymphocytic gastritis (LG) is a rare subtype of chronic gastritis. It is defined as dense proliferation of intraepithelial lymphocytes (IELs) more than 25 lymphocytes per 100 epithelial cells. The known major causes of LG are celiac disease and Helicobacter pylori infection. H. pylori associated LG (HpLG) has more enhanced cytotoxic and apoptotic tendencies than chronic H. pylori gastritis. A 12-year-old girl with postprandial epigastric pain was diagnosed HpLG on endoscopic biopsy. After the 1st eradication therapy, H. pylori bacilli were still found, and urea breathing test was positive. Although the endoscopic finding was partially improved, clinical symptoms and histologic finding were persisted. We could achieve the improvement of clinical symptoms and disappearance of IELs after the 2nd eradication. The discordant of histopathologic and endoscopic improvement occurred after the 1st eradication therapy of HpLG. Therefore the clinical and histopathologic evaluation should be considered as well as endoscopic findings.

No MeSH data available.


Related in: MedlinePlus

Histologic and immunohistochemistry findings. (A) More than 50 intraepithelial lymphocytes (IELs) per 100 epithelial cells were present in the intraepithelial layer (H&E, ×400). On immunohistochemical staining, (B) IELs were mostly positive for CD3 (×400) and (C) CD8 (×400). (D) After the 1st eradication, the number of IELs was decreased but still counted as 25-50 IELs per 100 epithelial cells (H&E, ×400). (E) Majority of IELs were positive for CD8 immunohistochemical staining (×200). (F) After the 2nd eradication, gastric mucosa was normalized (H&E, ×200).
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Figure 2: Histologic and immunohistochemistry findings. (A) More than 50 intraepithelial lymphocytes (IELs) per 100 epithelial cells were present in the intraepithelial layer (H&E, ×400). On immunohistochemical staining, (B) IELs were mostly positive for CD3 (×400) and (C) CD8 (×400). (D) After the 1st eradication, the number of IELs was decreased but still counted as 25-50 IELs per 100 epithelial cells (H&E, ×400). (E) Majority of IELs were positive for CD8 immunohistochemical staining (×200). (F) After the 2nd eradication, gastric mucosa was normalized (H&E, ×200).

Mentions: The patient underwent endoscopy based on out-patient clinic. Her endoscopic finding was diffuse varioliform gastritis as moderate nodular mucosal change on whole gastric region (Fig. 1A and Fig. 1B). The varioliform was more prominent on gastric body and angle than antrum. The gastric mucosal change was mild on antrum, but moderate on body and angle. Biopsy was done on five sites as guideline of 'the update Sydney system'. Atrophic mucosal change was not found on all biopsy samples. According to 'the update Sydney system', gastritis was grade 2 and stage 0. The histopathologic findings from gastric angle revealed the dense proliferation of IELs (more than 50 per 100 epithelial cells) without the gland destruction (Fig. 2A). And lymphoepithelial lesions as the characteristic histologic finding in of mucosa-associated lymphoid tissue (MALT) lymphoma were not found in lamina propria. On immunohistochemistry, these cells were mostly positive for CD3 (Fig. 2B) and CD8 (Fig. 2C), but negative for CD4 or CD20.


Helicobacter pylori Associated Lymphocytic Gastritis in a Child.

Kim MJ, Eom DW, Park K - Pediatr Gastroenterol Hepatol Nutr (2014)

Histologic and immunohistochemistry findings. (A) More than 50 intraepithelial lymphocytes (IELs) per 100 epithelial cells were present in the intraepithelial layer (H&E, ×400). On immunohistochemical staining, (B) IELs were mostly positive for CD3 (×400) and (C) CD8 (×400). (D) After the 1st eradication, the number of IELs was decreased but still counted as 25-50 IELs per 100 epithelial cells (H&E, ×400). (E) Majority of IELs were positive for CD8 immunohistochemical staining (×200). (F) After the 2nd eradication, gastric mucosa was normalized (H&E, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4209324&req=5

Figure 2: Histologic and immunohistochemistry findings. (A) More than 50 intraepithelial lymphocytes (IELs) per 100 epithelial cells were present in the intraepithelial layer (H&E, ×400). On immunohistochemical staining, (B) IELs were mostly positive for CD3 (×400) and (C) CD8 (×400). (D) After the 1st eradication, the number of IELs was decreased but still counted as 25-50 IELs per 100 epithelial cells (H&E, ×400). (E) Majority of IELs were positive for CD8 immunohistochemical staining (×200). (F) After the 2nd eradication, gastric mucosa was normalized (H&E, ×200).
Mentions: The patient underwent endoscopy based on out-patient clinic. Her endoscopic finding was diffuse varioliform gastritis as moderate nodular mucosal change on whole gastric region (Fig. 1A and Fig. 1B). The varioliform was more prominent on gastric body and angle than antrum. The gastric mucosal change was mild on antrum, but moderate on body and angle. Biopsy was done on five sites as guideline of 'the update Sydney system'. Atrophic mucosal change was not found on all biopsy samples. According to 'the update Sydney system', gastritis was grade 2 and stage 0. The histopathologic findings from gastric angle revealed the dense proliferation of IELs (more than 50 per 100 epithelial cells) without the gland destruction (Fig. 2A). And lymphoepithelial lesions as the characteristic histologic finding in of mucosa-associated lymphoid tissue (MALT) lymphoma were not found in lamina propria. On immunohistochemistry, these cells were mostly positive for CD3 (Fig. 2B) and CD8 (Fig. 2C), but negative for CD4 or CD20.

Bottom Line: After the 1st eradication therapy, H. pylori bacilli were still found, and urea breathing test was positive.Although the endoscopic finding was partially improved, clinical symptoms and histologic finding were persisted.Therefore the clinical and histopathologic evaluation should be considered as well as endoscopic findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Lymphocytic gastritis (LG) is a rare subtype of chronic gastritis. It is defined as dense proliferation of intraepithelial lymphocytes (IELs) more than 25 lymphocytes per 100 epithelial cells. The known major causes of LG are celiac disease and Helicobacter pylori infection. H. pylori associated LG (HpLG) has more enhanced cytotoxic and apoptotic tendencies than chronic H. pylori gastritis. A 12-year-old girl with postprandial epigastric pain was diagnosed HpLG on endoscopic biopsy. After the 1st eradication therapy, H. pylori bacilli were still found, and urea breathing test was positive. Although the endoscopic finding was partially improved, clinical symptoms and histologic finding were persisted. We could achieve the improvement of clinical symptoms and disappearance of IELs after the 2nd eradication. The discordant of histopathologic and endoscopic improvement occurred after the 1st eradication therapy of HpLG. Therefore the clinical and histopathologic evaluation should be considered as well as endoscopic findings.

No MeSH data available.


Related in: MedlinePlus