994898

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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 region.

 

Gross section discloses the thickening of the folds, and their projection in the lumen.

Microscopic view 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 mucosa.

 

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 gland.

Higher magnification, on the unusual relation of the atypical epithelium, with the hyperplastic surface type epithelium.

 

 

DIAGNOSIS:

 

EARLY GASTRIC CARCINOMA IN AN HYPERTROPHIC GASTROPATHY (MENETRIER’S 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 and inflamed
  • Carcinoma may develop in a stomach affected by Mentrier's disease, but the incidence is differently appreciated by authors.
  • Helicobacter Pylori is incriminated.

References:

 

Digestion 1999 Jul-Aug;60(4):358-62

Successful symptomatic management of a patient with Menetrier's disease with long-term antibiotic treatment.

Raderer M, Oberhuber G, Templ E, Wagner L, Potzi R, Wrba F, Hejna M, Base W

Am J Gastroenterol 1999 Jan;94(1):272-3

Remission of Menetrier's disease after a prolonged period with therapeutic eradication of Helicobacter pylori.

Kaneko T, Akamatsu T, Gotoh A, Shimodaira K, Shimizu T, Kiyosawa K, Katsuyama T, Momose A

J Clin Gastroenterol 1998 Dec;27(4):348-50

Healing of cimetidine-resistant Menetrier's disease by eradication of Helicobacter pylori infection.

Shimoyama T, Fukuda S, Tanaka M, Mikami T, Yamagata R, Yoshimura T, Haga Y, Murata Y, Munakata A

Am J Gastroenterol 1998 Oct;93(10):1976-9

Helicobacter pylori as a pathogenic factor in Menetrier's disease.

Badov D, Lambert JR, Finlay M, Balazs ND

Am J Gastroenterol 1997 Oct;92(10):1909-12

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 1995 Feb;7(2):187-90

Early gastric cancer in a patient with Menetrier's disease, lymphocytic gastritis and Helicobacter pylori.

Johnson MI, Spark JI, Ambrose NS, Wyatt JI