gastric mucosal neuroendocrine anomalies

Endocrine cells of the gastric oxyntic mucosa, and especially the enterochromaffin-like (ECL) cells, are the progenitors of gastrin-promoted proliferative lesions whose tumorigenic potential largely depends on the background condition in which they arise.

Hypertrophic gastropathy due to the familial multiple endocrine neoplasia (MEN-1)-associated or sporadic Zollinger-Ellison syndrome (ZES), diffuse chronic atrophic gastritis restricted to the corpus-fundus (type A CAG), with or without associated pernicious anemia, and Helicobacter pylori-related multifocal chronic atrophic gastritis

The endocrine cell lesions have been classified as:
 pseudohyperplasia : cell clustering unassociated with cell proliferation.
 hyperplasia of enterochromaffin-like cells

• diffuse hyperplasia of enterochromaffin-like cells
• linear hyperplasia of enterochromaffin-like cells
• micronodular hyperplasia of enterochromaffin-like cells
• adenomatoid hyperplasia of enterochromaffin-like cells

 dysplasia of enterochromaffin-like cells

• enlarged
• adenomatous or fused micronodules of enterochromaffin-like cells
• microinfiltration of enterochromaffin-like cells
• nodular growth of enterochromaffin-like cells

 neoplasia of enterochromaffin-like cells (intramucosal carcinoid tumor or invasive carcinoid tumor).

The entire spectrum of endocrine cell proliferation, from hyperplasia to dysplasia and neoplasia, has been observed in MEN-ZES and diffuse type ACAG.

Both hyperplastic and pseudohyperplastic changes occur with some frequency in the Helicobacter pylori-related chronic gastritis associated with ulcer disease or dyspepsia.

However, because no progression to dysplastic or neoplastic lesions has thus far been documented in these latter conditions, their role in gastric endocrine cell tumorigenesis appears negligible. (7762735)

Etiology

 hypertrophic gastropathy due to the familial multiple endocrine neoplasia-associated Zollinger-Ellison syndrome ( (MEN1-associated ZES),
 hypertrophic gastropathy due to the sporadic Zollinger-Ellison syndrome (ZES),
 diffuse chronic atrophic gastritis restricted to the corpus-fundus (type autoimmune metaplastic atrophic gastritis or ACAG) or autoimmune metaplastic atrophic gastritis (AMAG), with or without associated pernicious anemia,
 Helicobacter pylori-associated chronic atrophic gastritis (Helicobacter pylori-related multifocal chronic atrophic gastritis)

Reference

 Hyperplastic, dysplastic, and neoplastic enterochromaffin-like-cell proliferations of the gastric mucosa. Classification and histogenesis. Solcia E, Fiocca R, Villani L, Luinetti O, Capella C. Am J Surg Pathol. 1995;19 Suppl 1:S1-7. PMID: 7762735