As its doppleganger in the colon, such epithelial misplacement may be superficial (gastritis cystica superficialis) or deep (gastritis cystica profunda), both of which are associated with wide cystic glands. Trauma from torsion of a pedunculated polyp, as in this patient, is thought to induce mechanical
disruption at the base of the polyp, promoting the deeper glands to migrate into the submucosa. A cuff of normal lamina propria usually surrounds these misplaced glands, with accompanying hemorrhage, and fibrosis in the vicinity of the “misplaced” glands. GCP has been thought to be a precursor of gastric cancer, although the number of such occurrences is small. As in the colon, one must be careful to distinguish the submucosal glands of GCP from invasive adenocarcinoma. To paraphrase St. Jerome, the scars of GW-572016 order others should have taught us diagnostic caution. Careful attention to the absence of an invasive growth pattern, a lack of cytological atypia, and stromal desmoplasia along with the history
of multiple diagnostic and surgical procedures help prevent a potential misdiagnosis. Lawrence J. Brandt, MD Associate Editor for Focal Points “
“A 61-year-old man Ruxolitinib datasheet was seen for weight loss of 20 kg over a 12-month period, mushy stools, and occasional watery diarrhea that contained fat globules. He did not describe joint pain or neurologic problems. On physical examination, the patient appeared malnourished, with loss of subcutaneous fat at the triceps, midaxillary line, and lower ribs; some wasting Vitamin B12 of the deltoid and quadriceps muscles and advanced temporal muscle wasting were present as well. Peripheral edema was absent, and the results of neurologic and joint examinations were
normal. The biochemical findings were consistent with advanced malabsorption syndrome. A complete blood cell count demonstrated microcytic hypochromic anemia (hemoglobin 6.8 g/dL, mean corpuscular volume (MCV) 65.90 fL) with a serum iron level of 2.1 μmol/L (normal range, 15-42 μmol/L). His serum albumin was also low (2.6 g/dL; normal range, 3.5-5.0 g/dL). Additionally, the patient had low values of serum lipids: cholesterol level 2.70 mmol/L (normal range, 3.1-5.7 mmol/L), triglyceride level 1.08 mmol/L (normal range, 0.34-2.3 mmol/L), high-density lipoprotein level 0.47 mmol/L (normal range, 0.90-1.42 mmol/L), and low-density lipoprotein level 1.65 mmol/L (normal range, 2.59-4.11 mmol/L). The result of a qualitative fecal fat test (Sudan III) was also positive, whereas tests for carbohydrate malabsorption were not available. The result of a celiac disease antibody panel was negative. Abdominal US demonstrated sporadically dilated loops of small bowel with diffusely thickened intestinal wall (up to 7 mm) but with normal peristalsis.