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病理怎样报告萎缩性胃炎？
| 性别 | 男 | 年龄 | 20 | 临床诊断 | 萎缩性胃炎 |
|---|---|---|---|---|---|
| 一般病史 | 萎缩性胃炎 | ||||
| 标本名称 | 萎缩性胃炎 | ||||
| 大体所见 | 萎缩性胃炎 | ||||
经常有病人拿来报告单，要我们给予解释，活检胃粘膜 萎缩指胃固有腺减少，分为两种类型：① 化生性萎缩：胃固有腺被肠化或被假幽门化生腺体替代；② 非化生性萎缩：胃固有腺被纤维或纤维肌性组织替代，或炎性细胞浸润引起固有腺数量减少。
直到现在，消化界的同仁都还认为：萎缩性胃炎的诊断仍主要依靠病理检查,即胃固有腺体有减少时才能确诊。凭内镜发现黏膜下血管显露、皱襞变平甚至消失,或者黏膜呈颗粒或小结节状,而无病理组织学依据时,不能肯定为萎缩，还是要按照病理学依据诊断萎缩性胃炎。胃镜取材要取胃角和胃体下部小弯侧。这是因为萎缩或肠化生经常以胃角部最重,该部位也是不典型增生的好发部位萎缩程度以胃固有腺减少各1/3来计算。轻度：固有腺体数减少不超过原有腺体的1/3；中度：固有腺体数减少介于原有腺体的1/3～2/3之间；重度：固有腺体数减少超过2/3，仅残留少数腺体，甚至完全消失。局限于胃小凹区域的肠化不能算萎缩。黏膜层出现淋巴滤泡不算萎缩，应观察其周围区域的腺体情况来决定。一切原因引起黏膜损伤的病理过程都可造成腺体数量减少，如取自溃疡边缘的活检，不一定就是萎缩性胃炎。标本过浅未达黏膜肌层者可参考黏膜层腺体大小和密度以及间质反应情况推断是否萎缩，同时加上取材过浅的评注，提醒临床仅供参考。
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标签：病理 胃炎
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引自《Surgical.Pathology.of.the.GI.Tract,.Liver,.Biliary.Tract.and.Pancreas》第二版：
The border between gastritis with focal atrophy and atrophic gastritis has not been well defined (Fig. 12-15). This issue is important because scattered foci of intestinal metaplasia are found in the antrum of most subjects with H. pylori gastritis, as well as in a small percentage of noninfected adults. Clearly, it is not appropriate to classify these individuals as having atrophic gastritis, a diagnosis that implies altered gastric function and an increased risk of cancer. In the absence of established guidelines, we suggest that a diagnosis of MAG be made only when there is evidence of atrophy within intestinal metaplasia in at least 50% of multiple biopsy specimens (a minimum of two from the antrum and two from the corpus or fundus).
Several pathology workshops have been devoted to developing a reproducible method for grading atrophy in mucosal biopies.[10], [11] If present, it is recommended that atrophy be evaluated according to its two subtypes—nonmetaplastic or metaplastic. Nonmetaplastic atrophy is defined as the presence of an area of lamina propria that was normally occupied by glands native to the region from which the biopsy was obtained but is now collapsed into thin, gland-depleted mucosa, either with or without fibrosis. Metaplastic atrophy is defined as replacement of native glands by intestinal-type glands in the antrum and/or the corpus, or pyloric (“pseudopyloric”) glands in the corpus (i.e., metaplasia = atrophy). In both cases, the degree of gland loss may be graded as mild, moderate, or severe, which corresponds to a scale of 1 to 3
简单来说，国内跟国外的标准差别在两个地方：
1、肠化性萎缩：国内认为有肠化即是萎缩，国外认为要超过50%的标本中出现肠化（取材标本包括2个胃窦、2个胃底/体，其中半数出现肠化）
2、非肠化性萎缩：国内标准中，认为炎细胞浸润（没有涉及有无纤维组织增生）所导致的单位面积内腺体减少也是萎缩，国外标准中没有这一条。
- The More We See, The Less We Know!
