48 yo male, abdominal pain,
weight loss. Scan and gastric endoscopy show large thickened fundic
folds. Suspicion of lymphoma; biopsy in favor of adenocarcinoma.
Total gastrectomy performed.
Total gastrectomy specimen opened
along the greater curvature, shows enlarged and thickened gastric
folds, extending from the corpus to the esophageal surgical section.
The stomach is characterized grossly by markedly hypertrophic rugae
resembling cerebral convolutions.Close-up demonstrates a pseudo-polypod
pattern of the fundic folds contrasting with the preserved antral
Gross section discloses the
thickening of the folds, and their projection in the lumen.
at low power.Higher magification demonstrates the sawtooth appearance
of the hyperplastic gastric surface and crypts epithelium.
Low power view
of the antral mucosa discloses preserved architecture with moderate
chronic inflammatory changes.
Some areas of hyperplasia
show cystic pattern, and extension to submucosa thru the muscularis
The lesser curvature
area demonstrates a larger fold, with ulcerative changes.Section
from this area shows a compact glandular pattern with no invasion
of the submucosa.
At higher magnification
a complex branching glandular pattern is observed mixed with the
hyperplastic glands. Closer view of the previous area, disclosing
irregular branched glands varying in size surrounding a hyperplastic
Higher magnification, on the unusual
relation of the atypical epithelium, with the hyperplastic surface
EARLY GASTRIC CARCINOMA IN
AN HYPERTROPHIC GASTROPATHY (MENETRIERS DISEASE) .
- In 1888 Mentrier described
polyadnomes en nappe also known as hypertrophic or hyperplastic
gastropathy, giant hypertrophic gastritis, and giant hypertrophy
of gastric rugae
- accompanied by hypochlorhydria
or achlorhydria and often by impressive hypoproteinemia.
- Radiographically and grossly,
the condition can be confused with malignant lymphoma and carcinoma.
- lack of antral involvement
is characteristic of the disease
- Microscopically, there is
a striking foveolar hyperplasia, accompanied by tortuosity.
The glandular content is diminished, and the stroma is edematous
- Carcinoma may develop in
a stomach affected by Mentrier's disease, but the incidence is
differently appreciated by authors.
- Helicobacter Pylori is incriminated.
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Successful symptomatic management
of a patient with Menetrier's disease with long-term antibiotic
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Am J Gastroenterol
Remission of Menetrier's
disease after a prolonged period with therapeutic eradication of
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J Clin Gastroenterol
Healing of cimetidine-resistant
Menetrier's disease by eradication of Helicobacter pylori infection.
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Helicobacter pylori as a
pathogenic factor in Menetrier's disease.
Badov D, Lambert JR, Finlay
M, Balazs ND
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Menetrier's disease associated
with Helicobacter pylori infection: resolution of enlarged gastric
folds and hypoproteinemia after antibacterial treatment.
Kawasaki M, Hizawa K, Aoyagi
K, Nakamura S, Fujishima M
Ann Gastroenterol Hepatol
(Paris) 1996 Nov-Dec;31(6):341-5
Menetrier disease associated
with a gastric adenocarcinoma. Apropos of 2 cases.
Jouini M, Ksontini R, Kacem
MJ, Haouet S, Ammous A, Gargouri F, Houissa H, Ben Safta Z, Ammar
AB, Belaid S
Eur J Gastroenterol Hepatol
Early gastric cancer in a
patient with Menetrier's disease, lymphocytic gastritis and Helicobacter
Johnson MI, Spark JI, Ambrose
NS, Wyatt JI