Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2010  |  Volume : 53  |  Issue : 2  |  Page : 380--382

Eosinophilic gastritis masquerading as gastric carcinoma


Mrinalini Kotru, Seema Aggarwal, Sonal Sharma, Usha Rani Singh 
 Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Shahdara, Delhi - 110 095, India

Correspondence Address:
Seema Aggarwal
Department of Pathology, University College of Medical Sciences & GTB Hospital, Delhi - 110 095
India




How to cite this article:
Kotru M, Aggarwal S, Sharma S, Singh UR. Eosinophilic gastritis masquerading as gastric carcinoma.Indian J Pathol Microbiol 2010;53:380-382


How to cite this URL:
Kotru M, Aggarwal S, Sharma S, Singh UR. Eosinophilic gastritis masquerading as gastric carcinoma. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Jul 14 ];53:380-382
Available from: http://www.ijpmonline.org/text.asp?2010/53/2/380/64310


Full Text

Sir,

Eosinophilic gastritis (EG) is a rare form of chronic gastritis. It is often a part of ill-defined group of conditions called eosinophilic gastroenteritis (EGE), [1] which have presence of eosinophilic infiltrates in their wall as a common denominator. [1] Stomach is the most common site of involvement, followed by proximal small intestines. It occurs in all age groups, but children are affected more commonly than adults. There is a significant gender difference, males are more commonly affected. [1] It has a variable presentation, depending on the site of involvement.

We studied four cases of EG involving the gastric antrum, which presented as gastric malignancy on gross inspection [Table 1].

Microscopy findings comprised of mucosal ulceration, submucosal edema with infiltration of eosinophils in the submucosa and the muscularis propria [Figure 1].

Eosinophilic gastroenteritis (EGE) refers to disorders of the stomach and/or small bowel characterized pathologically by tissue edema without vasculitis and by infiltration of gut wall with eosinophils. The diagnostic criteria being: presence of gastrointestinal symptoms, microscopic evidence of an eosinophilic infiltrate in one or more areas of the gastrointestinal (GI) tract (20 or more eosinophils per high-power field and exclusion of other causes of eosinophilia or involvement of other organs. [1]

Pathogenesis of this disorder is obscure. However, etiological emphasis is given to an allergic reaction. Other etiologies suggested are chronic inflammation and foreign body reaction. It is associated with peripheral blood eosinophilia in nearly 30-80% of the cases. [1]

In our series, none of the patients showed peripheral blood eosinophilia. Stool examination in all the cases did not show presence of any parasites.

Preclinical studies have identified a contributory role for the cytokine IL-5 and the eotaxin, providing a rationale for specific disease therapy. [3] However, none of our patients had history of any known allergy, parasitic infestation or bronchial asthma suggesting to us that there could be some other cause of this condition. All the four cases in our study had a history of analgesic abuse and two were alcoholic and chronic smokers, raising a question that these agents might have plausible role in the etiopathogenesis of this disorder. However, this causal role needs to be established in a larger study. Venkataraman et al. [4]new diagnoses of EGE over a 10-year period in India.

All these cases had posed a diagnostic dilemma to the surgeon who had diagnosed a malignancy clinically but on histopathology showed EGE.

Eosinophilic gastritis lacks specific symptoms and physical signs and may mimic both benign and malignant gastric diseases. Surgeons and pathologists should be aware of peculiar presentations of this condition. Endoscopic-guided biopsy followed by histopathology is indispensable for correct diagnosis, as this responds favorably to steroid therapy. [5]

References

1Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic Gastroenteritis: A clinic pathological study of patients with disease of the Mucosa, muscle layer, and subserosal tissues. Gut 1990;31:54-8.
2Ormeci N, Bayramoπlu F, Tulunay O, Yerdel MA, Onbayrak A, Uzunalimoπlu O. Cancer-like eosinophilic gastritis.Endoscopy 1994;26:509.
3Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004;113:11-28
4Venkataraman S, Ramakrishna BS, Mathan M, Chacko A, Chandy G, Kurian G, et al. Eosinophilic gastroenteritis--an Indian experience. Indian J Gastroenterol 1998;17:148-9.
5Yantiss RK, Odze RD. Optimal approach to obtaining mucosal biopsies for assessment of inflammatory disorders of the gastrointestinal tract. Am J Gastroenterol 2009;104:774-83.