Pathologic Differentiation Between Different Types of Hyperplastic Gastropathies

There are several different types of hyperplastic gastropathy which can often be distinguished based on the anatomic and pathologic features.

General features of hyperplastic gastropathy:

(1) large or giant rugal folds

(2) hyperplasia of the mucosa, defined as a thickness > 1.5 mm

Descriptors:

(1) localized vs diffuse

(2) involvement of the body and greater curvature of the stomach vs antrum

(3) changes in the foveolar epithelium (hyperplasia, normal or atrophy)

(4) changes in the specialized glandular epithelium (hyperplasia, normal or atrophy)

(5) associated findings

(5a) hypersecretory for gastric acid with peptic ulcer

(5b) protein loss with hypoproteinemia and hypoalbuminemia

(5c) changes in serum gastrin

(5d) relation to stoma, ulcer, anastomosis or partial gastrectomy

(5e) parietal cell hyperplasia

Location	Foveolar Cells	Specialized Glands	Other	Type
body and greater curvature; not in antrum	normal	hyperplastic, with increased parietal cells	peptic ulcer, serum gastrin elevated	Zollinger- Elison
body and greater curvature; not in antrum	hyperplastic	atrophic	protein loss	Menetrier's
body and greater curvature; not in antrum	hyperplastic	hyperplastic; parietal cells not increased	peptic ulcer, gastrin not elevated	hypertrophic hypersecretory
body and greater curvature; not in antrum	hyperplastic	hyperplastic to mild atrophy; parietal cells not increased	protein loss, occasional peptic ulcer	hypertrophic hypersecretory with protein loss
localized, may involve the antrum	hyperplastic		adjacent to stoma, ulcer, anastomosis, etc	localized hypertrophy

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