JPC SYSTEMIC PATHOLOGY

DIGESTIVE SYSTEM

September 2024

D-M03 (NP)

 

 

SIGNALMENT (JPC #1758202): 7-year old German shepherd dog

HISTORY: Incidental finding

 

MICROSCOPIC DESCRIPTION: Stomach, fundus: Multifocally, mucosal epithelial cells are markedly hyperplastic, forming additional rugal folds between pre-existing gastric furrows and markedly thickening gastric pits. Hyperplastic cells pile up to five layers thick and demonstrate mild anisokaryosis. The subepithelial lamina propria is expanded by multifocal aggregates of lymphocytes and plasma cells that often transmigrate the gastric mucosal epithelium.

 

MORPHOLOGIC DIAGNOSIS: Stomach, fundic mucosa: Hyperplasia, multifocal, chronic, moderate, with lymphoplasmacytic infiltration, German shepherd, canine.

 

ETIOLOGY: Unknown

 

CONDITION: Chronic hypertrophic gastritis

 

GENERAL: 

• Idiopathic condition of dogs (also described in primates, horses, pigs, and rodents)

• An umbrella term that covers several entities with distinctly different histologic appearances and behaviors

• Menetrier-like disease
• Zollinger-Ellison syndrome-like disease

 

PATHOGENESIS: 

• Unknown
• The cause in dogs is unknown but may be due to:
• Immune mediated response to underlying food intolerances
• Chronic irritation from retained gastric fluid and reflux of bile
• Possibly heritable

• One reported case of Ménétrier-like disease in a Labrador retriever with concurrent gastric sarcoma (Romanucci, J Vet Diagn Invest, 2021)

 

 

TYPICAL CLINICAL FINDINGS: 

 

TYPICAL GROSS FINDINGS:

• Exaggerated or thickened rugal folds (over an area 4-10 cm in diameter) in the fundic region
• Pyloric hypertrophy
• Marked cystic dilation of mucous glands

 

TYPICAL MICROSCOPIC FINDINGS:

• Foveolar and glandular epithelial hyperplasia

• +/- progressive or total loss of parietal cells, which are replaced by mucous cells of various degrees of differentiation (Ménétrier-like disease)
• +/- hyperplasia and hypertrophy of parietal cells that crowd out chief cells and mucous neck cells (Zollinger-Ellison syndrome-like disease)

• Lymphoplasmacytic infiltration
• Mononuclear cells infiltrating the lamina propria between glands and near the muscularis mucosae with superficial edema 

 

ADDITIONAL DIAGNOSTIC TESTS:

• Gastroscopy/laparotomy with histopathology (full thickness biopsies preferred)
• Radiographic contrast studies for outflow obstruction

 

DIFFERENTIAL DIAGNOSIS:

• Hypertrophic pyloric gastropathy: Small breed dogs; focal, eosinophilic infiltrate
• Adenomatous polyps: Raised, sessile, or pedunculated polypoid masses
• Paraneoplastic syndromes from excess gastrin; ulcers may be present:

• Mast cell tumors 
• Renal dysfunction 
• Pancreatic islet cell tumors (Zollinger-Ellison syndrome)
• Gastrinomas

• Lymphoma: Sheets of lymphocytes
• Leiomyoma: No inflammatory infiltrate, well demarcated
• Giant hypertrophic gastritis (Ménétrier’s disease in humans): 

• Basenji, Beagle, Boxer, Bull terrier, Cairn terrier
• Diffuse cerebriform mass of redundant mucosa
• The histology typically shows elongated, tortuous foveolae, with reduction of chief and parietal cell glands and often with cystic dilatations that may extend into muscularis mucosae and submucosa
• Present with hypoproteinemia

 

COMPARATIVE PATHOLOGY: 

Hypertrophic gastritis in other species:

 

Parasitic gastritis that may cause hypertrophic gastritis:

• Non-human primates: Nochtia nocti
• Cattle: Ostertagia ostertagi
• Sheep: Ostertagia circumcincta
• Horse: Trichostrongylus axei; Habronema spp.
• Pig: Hyostrongylus rubidus
• Cat: Ollulanus tricuspis

 

REFERENCES:

1. Romanucci M, Crisi PE, Giordana MV, Di Tommaso M, Simeoni F, Della Salda L. Hypertrophic gastropathy associated with gastric sarcoma in a dog. J Vet Diagn Invest. 2021;33(1):112-115.
2. Spagnoli ST, Gelberg HB. Alimentary System and the Peritoneum, Omentum, Mesentery, and Peritoneal Cavity. In: Zachary JF, ed. Pathologic Basis of Veterinary Disease. 7th ed. St. Louis, MO: Elsevier; 2022:435. 
3. Strait K, Else JG, Eberhard ML. Parasitic Diseases of Nonhuman Primates. In. Abee CR, Mansfield K, Tardif S, Morris T, eds. Nonhuman Primates in Biomedical Research: Volume 2: Diseases. 2nd ed. San Diego, CA: Elsevier; 2012:234-235.
4. Uzal FA, Plattner BL, Hostetter JM. Alimentary system. In: Maxie MG, ed. Jubb, Kennedy, and Palmer’s Pathology of Domestic Animals. Vol 2. 6th ed. St. Louis, MO: Elsevier Ltd; 2016:53, 100-101.

 

 

 

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