title: Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients.
abstract: Collagenous gastritis is a rare condition defined histologically by a superficial subepithelial collagen layer. This study further characterizes the morphologic spectrum of collagenous gastritis by evaluating a multi-institutional series of 40 patients (26 female and 14 male). The median age at onset was 16 years (range 3-89 years), including 24 patients (60%) under age 18. Twelve patients (30%) had associated celiac disease, collagenous sprue, or collagenous colitis. Hematoxylin and eosin slides were reviewed in biopsies from all patients and tenascin, gastrin, eotaxin, and IgG4/IgG immunohistochemical stains were applied to a subset. The distribution of subepithelial collagen favored the body/fundus in pediatric patients and the antrum in adults. There were increased surface intraepithelial lymphocytes (>25 lymphocytes/100 epithelial cells) in five patients. Three of these patients had associated celiac and/or collagenous sprue/colitis, while the remaining two had increased duodenal lymphocytosis without specific etiology. An eosinophil-rich pattern (>30 eosinophils/high power field) was seen in 21/40 (52%) patients. Seven patients' biopsies demonstrated atrophy of the gastric corpus mucosa. Tenascin immunohistochemistry highlighted the subepithelial collagen in all 21 specimens evaluated and was a more sensitive method of collagen detection in biopsies from two patients with subtle subepithelial collagen. No increased eotaxin expression was identified in 16 specimens evaluated. One of the twenty-three biopsies tested had increased IgG4-positive cells (100/high power field) with an IgG4/IgG ratio of 55%. In summary, collagenous gastritis presents three distinct histologic patterns including a lymphocytic gastritis-like pattern, an eosinophil-rich pattern, and an atrophic pattern. Eotaxin and IgG4 were not elevated enough to implicate these pathways in the pathogenesis. Tenascin immunohistochemistry can be used as a sensitive method of collagen detection.
authors.affiliation: 1] Gastrointestinal Pathology Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA [2] Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Arnason
authors.affiliation: 1] Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia [2] Envoi Pathology, Brisbane, QLD, Australia.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Brown
authors.affiliation: Department of Pathology, Children's Hospital Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Goldsmith
authors.affiliation: GastroEnterology Associates of Ocala, Ocala, FL, USA.
authors.forename: William
authors.initials: W
authors.lastname: Anderson
authors.affiliation: Sullivan Nicolaides Pathology, Brisbane, QLD, Australia.
authors.forename: Blake H
authors.initials: BH
authors.lastname: O'Brien
authors.affiliation: Providence Alaska Medical Center, Anchorage, AK, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Wilson
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Harland
authors.initials: H
authors.lastname: Winter
authors.affiliation: Gastrointestinal Pathology Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000150:complications / Q000473:pathology; D054413:Chemokine CCL11 / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D046729:Colitis, Collagenous / Q000150:complications / Q000473:pathology; D003094:Collagen / Q000378:metabolism*; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism / Q000473:pathology*; D005755:Gastrins / Q000378:metabolism; D005756:Gastritis / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000473:pathology*; D019063:Tenascin / Q000378:metabolism; D055815:Young Adult
chemical_list: D054413:Chemokine CCL11; D005755:Gastrins; D007074:Immunoglobulin G; D019063:Tenascin; D003094:Collagen