This generous biopsy shows chronic gastritis with prominent intestinal metaplasia and small lymphocytic infiltration. Specific diagnostic concerns include Helicobacter gastritis and lymphoproliferative disorder. Helicobacter can be identified on high power microscopy and on Giemsa stain. I do not see any nuclear atypia, expansile growth or formation of lymphoepithelial lesions by the infiltrating lymphocytes, so my index of suspicion for MALT lymphoma is very low. Immunohistochemical stains are helpful in this regard, and molecular testing (Ig gene rearrangement) may be considered if clinical suspicion remains high. There is some necrotic debris (photos 1 and 2) to support active ulceration.

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活检切片显示慢性胃炎伴有显著的肠化和小淋巴细胞浸润，诊断要考虑HP相关性胃炎和淋巴组织增生性病变。HP可以在高倍镜下看到，或用Giemsa染色显示。浸润的小淋巴细胞没有看到任何核的异型性、膨胀性生长或形成淋巴上皮病变，因此MALT的倾向可能性较小，此时免疫组化有帮助。如果临床仍然高度怀疑的话，可以做Ig基因重排。图1和图2显示坏死碎屑，提示活动性溃疡。