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Have had histopathology. What does the findings suggest?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
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Dear Doc
Following our discussion which had been closed ; my Histopathology report 19 XXXXXXX 2013 is:

Quote

Diagnosis

Gastric biopsies: Chronic gastritis

Gross Description

The specimen is received in formalin, labelled with patient's data and designated ' gastric biopsy'. It consists of 6 pieces of tissues measuring 0.2cm to 0.3cm in greatest dimension. (A1(A,B antrum inked blue, C -insura inked yellow, D, E -lesser curve inked green) A2(F-greater curve inked blue); no reserve)

Microscopic Description

A total of four pieces of specialised acid secreting type, and two of transistional type gastric mucosa received, showa mild chronic inflammatory cell infiltrate in the lamina propia. No Helicobacter pylori organisms are identified, and there is no evidence of ulceration, intestinal metaplasia or dysplasis.



Unquote



Questions

1. What is this all all about in relation to melena?

2. Does this say anything about antrum gastritis?
Posted Sun, 18 Aug 2013 in Peptic Ulcer
 
 
Answered by Dr. Ketan Vagholkar 37 minutes later
Hi,
The histopathology diagnosis is suggestive of chronic gastritis. As there is no evidence of H pylori or malignancy you should be relieved of all stress.
Coming to your questions.
1. Chronic gastritis is associated with bleeding form the inflamed sites. This can lead to malena. You now need to take a course of symptomatic anti ulcer treatment .A surveillance endoscopy is required to monitor the healing of the lesion.
2. Antrum is a part of the stomach. The biopsies are taken from the parts specified i.e. lesser curve, greater curve and from the angle. There is no mention of the antrum. As the biopsies are negative for premalignant conditions like H pylori and metaplasia there is nothing to worry about.
I hope this answers your query.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 1 hour later
Thanks DOc
There is a biopsy taken from antrum, it is mentioned. You missed this point

What is your take then since it is mentioned?



 
 
Answered by Dr. Ketan Vagholkar 17 hours later
Hi,
The biopsies usually are taken from diseased areas of the organ or which appear to be suspicious. Histopathology of the specimens does not reveal any malignancy nor does it reveal any sort of premalignant cellular changes.
The only histological finding is the presence of inflammatory cells suggestive of long standing inflammation what is termed as chronic gastritis.
The findings in individual specimens is not mentioned in your question.
But it hardly matters as the final disgnosis based on study of all the specimens is negative for malignancy.
I hope this answers your doubt.
regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 5 hours later
Thanks Doc
Have read about antrum gastritis ; autoimmune could be one of several causes.

Would histopathology also investigate for any autoimmune disease in the course of the investigation as you mentioned '... nor does it reveal any sort of premalignant cellular changes...'
 
 
Answered by Dr. Ketan Vagholkar 3 hours later
Hi,
It is not possible to determine the autoimmune origin on histology. Autoimmune disorders are usually confirmed by various antibody and antigen reactions.
The only finding on histology in autoimmune disorders is chronic inflammation.
I hope this answers your query.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 13 hours later
Thanks Doc
1. Read from patho journals and web literature and from health professionals that pathologists do look for damage to parietal cells in histology. What do you think?

2. My full blood count, creatinine kinase , alpha feto, liver function tests are all normal in XXXXXXX 13 ; esr (Feb 2013) and 3 other quarterly blood count were also normal over the past 10 months or so.

Would you agree that abnormalities, if any, would also show up in blood work?
 
 
Answered by Dr. Ketan Vagholkar 6 hours later
Hi,
1. Damaged parietal cells may at times be difficult to diagnose. What matters in a histological evaluation is the presence of cells which exhibit cytological features of malignancy or cells heading towards malignant change.
2. Blood investigations do not suggest malignancy of the stomach. Anemia and presence of occult blood in stools may suggest abnormality requiring endoscopy.
I hope this answers your doubts.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 41 minutes later
Thanks Doc
1. That's what patho look out -I read -for the extent of damaged parietal cells pointing towards auto causes.

2. I don't have anaemia, as evidenced in normal blood count ie haemoglobin . Does that provide any comfort?
 
 
Answered by Dr. Ketan Vagholkar 4 minutes later
Hi,
1. Irrespective of the etiology what matters is the effect leading to symptoms and its sequelae. Even if there happens to be autoimmune etiology it does not affect the treatment and the surveillance plan.
2. Yes abscence of anemia is good and reassuring sign.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 1 hour later
The point in No 1 is that I was told by healthcare professional that pathologist do comment on abnormalities in parietal cells if it was remarkable enough so as to help clinicians in diagnosis of auto origin. If no, pathologist report would be silent on this point.

Would you agree?
 
 
Answered by Dr. Ketan Vagholkar 1 hour later
Hi,
If a particular finding is going to affect the choice and course of treatment then it is worthwhile studying it in greater detail. When it comes to chronic ulcerative or inflammatory lesions of the stomach especially in the older age group what matters is whether the lesion is malignant or not. Once that is authentically confirmed rest then becomes just an academic discussion or exercise. If a lesion is stamped as non malignant and if there aren't any striking cellular abnormalities the report will not make a mention of it. This is because it has no clinical relevance or implication.
I hope this answers your doubt.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 8 minutes later
Thanks Docs
Just to be clear on what you are saying
'...and if there aren't any striking cellular abnormalities the report will not make a mention of it...'

That is to say if eg no remarkable damage to say the parietal cells (using my eg), the report will make mention of it?

 
 
Answered by Dr. Ketan Vagholkar 6 minutes later
Hi,
The report given by your pathologist is clear. It specifically mentions that there are no changes suggestive of any premalignant or malignant lesion. Besides mild chronic inflammatory changes there is no other problem.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 12 hours later
Thanks Doc
Please explain what you meant by reassuring? reassuring about ?:
'...Yes abscence of anemia is good and reassuring sign...'
 
 
Answered by Dr. Ketan Vagholkar 9 hours later
Hi,
Reassuring in the context of reports refers to a verification / confirmation/ strong supportive evidence that everthing is normally functioning.
Absence of anemia means that there is no source of chronic blood loss.
I hope this answers your query.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 16 hours later
Thanks Doc
Is the report suggestive of deep or diffuse lymphoplasmacytic infiltrates within lamina propria with foci of galnd infiltration/damage??
 
 
Answered by Dr. Ketan Vagholkar 8 hours later
Hi,
The report just mentions mild chronic inflammatory infiltrate. There is no mention of the cells. It is futile to read between the lines.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 4 minutes later
Then what is these infiltrates in your view?
 
 
Answered by Dr. Ketan Vagholkar 5 minutes later
Hi,
Infiltrate refers to the presence of cells in large numbers in a particular area.
One can diagnose the benign or malignant nature based on the predominant cell in the area of interest.
I hope this answers your doubt.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 1 hour later
Thanks Doc
According to best practice pathology standards per one source on the web, no gastritis be diagnosed if there are no mononuclear infiltrates(?)

Please comment
 
 
Answered by Dr. Ketan Vagholkar 46 minutes later
Hi,
In a histological evaluation of a gastric biopsy what matters or the cause for concern is whether malignant cells are seen. If there is no evidence of malignancy then the rest becomes an academic exercise.The treatment for the rest is purely symptomatic.
Regards
Above answer was peer-reviewed by
 
Follow-up: Have had histopathology. What does the findings suggest? 9 hours later
Dear Doc,
A. My point was to highlight a patho standard seen from a web source.

B. On your histology point, would you say that the pathologist has seen and has excluded:
1. diffuse in inflammatory in lamina propria glands of gastric corpus etc etc,
2. inflammatory destruction of glands,
3. Intestinal or pyloric metaplasia,
4. parietal cell pseudohypertrophy, and
5. linear ECL hyperplasias
 
 
Answered by Dr. Ketan Vagholkar 8 hours later
Hi,
A. There is nothing called as a ideal report. The report should be standardised to XXXXXXX the requirements of diagnosis for the clinician.
B. When one refers the tissue for histopathology, one has certain differential diagnosis in mind. When the report is available the referring clinician will see as to whether those components are seen on the slide by the pathologist. If yes then the report has served its purpose. If not then a discussion will ensue between the two to ascertain the pathological diagnosis after correlation with the clinical features or morphological features. So looking for a big checklist of irrelevant findings has no place in diagnosis.
I hope this answers your doubts.
Regards
Above answer was peer-reviewed by
 
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