Presentation
Chronic epigastric pain
Patient Data
Thickening of the gastric wall.
There is localized irregular segmental consolidation with an air bronchogram and ill-defined areas of pulmonary parenchymal haziness/ground glass opacities in the left lower lobe and atelectatic bands with bilateral minimal bilateral pleural effusion.
There is a significant thickening of the gastric wall and mucosa (wall thickness varies from 6mm to 2 cm), projecting into the gastric lumen, showing enhancement after IV contrast administration, and associated with mucosal edema and perigastric stranding of fat planes. A few lymph nodes are seen in the epigastric region (max. 18 x 6 mm).
The patient has a history of chronic epigastric pain, He was admitted with acute abdominal pain, ascites, hypoalbuminemia and lower extremity edema.
Liver and renal lab investigations were normal. Peritoneal tapping was done and the type of aspiration was chylous ascites.
Gastroscopy showed severe ulceration and congestion with hypertrophy in folds of the stomach mainly involving the body and mild atrophy in the duodenum. Biopsies were taken from all parts of the stomach and sent to histopathology to rule out lymphoma, Menetrier disease, and protein-losing gastropathy.
HISTOPATHOLOGY
SITE OF SPECIMEN
A. Duodenum
B. Gastric
GROSS EXAMINATION
A. Duodenum - Multiple fragments of tan, soft tissue ranging in size from 0.2 to 0.7 cm.
B. Gastric -Multiple fragments of pale to tan, soft tissue ranging in size from 0.2 to 0.7 cm.
All embedded as multiple pieces in two cassettes.
MICROSCOPIC EXAMINATION
A. Duodenum: Sections reveal fragments of duodenal mucosa with unremarkable alterations. No villous atrophy nor increased intraepithelial lymphocytosis is seen.
B. Gastric: Sections reveal fragments of gastric mucosa with hyperemia and regenerative changes with prominent foveolar hyperplasia and occasional lymphoid cell aggregates. Giemsa stain for Helicobacter pylori is negative.
CONCLUSION
A. Duodenum: The histomorphological features are consistent with unremarkable alterations.
B. Gastric: The histomorphological features are consistent with foveolar hyperplasia, in keeping with hypertrophic gastropathy (Menetrier disease). (Please see comments).
COMMENTS
Clinicopathological correlation is advised.
Follow-up is advised.
Case Discussion
Ménétrier disease is a rare disease. The imaging features have multiple differential diagnoses, like gastric lymphoma and any cause of chronic gastritis (infective, inflammatory, etc.).
Co-authors:
Vyomesh Pradumna MD, specialist radiologist.
Feras Mahmoud MD, specialist gastroenterologist.
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