case_images: PMC9894002_01
case_images: Endoscopic findings in March 2019 show mucosal atrophy with vascular visibility in the greater and lesser curvature of the corpus (a, b), remnant oxyntic mucosa with diffuse redness and pseudopolyp-like lesions in the fornix (c), and mild atrophy in the antrum (d).
case_images: crg-2022-0017-0001-528388_f1.jpg
case_images: PMC9894002_01_crg-2022-0017-0001-528388_f1.jpg
case_images: F1
case_images: EGD showed extensive mucosal atrophy with marked vascular visibility in the entire area of the corpus except for the fornix, in which remnant oxyntic mucosa with diffuse redness and pseudopolyp-like lesions were observed (Fig. 1).
case_images: Endoscopic and histopathological findings in January 2020. a Endoscopic findings in the greater curvature of the middle corpus show reduced vascular visibility. b Hematoxylin and eosin (H&E) staining (x200) shows basal-predominant dense lymphocytic infiltration, foveolar hyperplasia, remaining fundic glands with decreased numbers of parietal and chief cells, and parietal cell pseudohypertrophy (black arrow). Immunostaining for H+/K+-ATPase (c), PGI (d), and MUC6 (e) (x200) shows degeneration of remaining parietal cells (c), destruction of chief cells (d), and PGI-positive/MUC6-positive pseudopyloric metaplasia (red arrow) (d, e). f Chromogranin A immunostaining (x200) shows linear hyperplasia of ECL cells (yellow arrows). ECL, enterochromaffin-like.
case_images: crg-2022-0017-0001-528388_f2.jpg
case_images: PMC9894002_01_crg-2022-0017-0001-528388_f2.jpg
case_images: F2
case_images: In January 2020 (7 months after eradication therapy), another EGD showed reduced vascular visibility in the greater curvature of the middle to upper corpus (Fig. 2a), in addition to disappearance of diffuse redness in the fornix. A biopsy specimen taken from the greater curvature of the middle corpus revealed basal-predominant dense lymphocytic infiltration of the lamina propria, resulting in obscured architecture of the fundic glands (Fig. 2b). Degeneration of parietal cells and destruction of chief cells were illustrated by immunostaining for H+/K+-ATPase and pepsinogen I (PGI) (Fig. 2c, d). PGI-positive/MUC6-positive pseudopyloric metaplasia was observed (Fig. 2d, e). Linear hyperplasia of enterochromaffin-like cells was demonstrated by chromogranin A immunostaining (Fig. 2f).
case_images: Endoscopic and histopathological findings in August 2021. a Endoscopic findings in the greater curvature of the middle corpus show improved gastric atrophy. b H&E staining (x200) shows regression of lymphocytic infiltration and recovery of fundic glands. Immunostaining for H+/K+-ATPase (c) and PGI (d) (x200) shows recovery of parietal and chief cells. d, e Immunostaining for MUC6 (x200) shows PGI-negative/MUC6-positive pyloric metaplasia (red circle). f Chromogranin A immunostaining (x200) shows linear hyperplasia of ECL cells (yellow arrow). ECL, enterochromaffin-like.
case_images: crg-2022-0017-0001-528388_f3.jpg
case_images: PMC9894002_01_crg-2022-0017-0001-528388_f3.jpg
case_images: F3
case_images: EGDs showed reduced gastric atrophy in the greater curvature of the middle to upper corpus (Fig. 3a). Recovery of the architecture of the fundic glands and regression of lymphocytic infiltration were revealed (Fig. 3b). PGI (Fig. 3c, d). PGI-negative/MUC6-positive pyloric metaplasia was observed (Fig. 3d, e). Chromogranin A immunostaining revealed reduced enterochromaffin-like cell hyperplasia (Fig. 3f).