Portal de Periódicos da CAPES

Gastric Granuloma with Eosinophilic Infiltration

1956; Radiological Society of North America; Volume: 66; Issue: 2 Linguagem: Inglês

10.1148/66.2.177

1527-1315

Marcus J. Smith,

Eosinophilic Esophagitis

Gastric granuloma with eosinophilic infiltration was first described in 1949 by Vanek (6), who reported 6 cases, all showing polypoid lesions of the antrum of the stomach. The literature has been reviewed in large part in an accompanying article, in this issue of Radiology, by Rigler, Blank, and Hebbel (4). No previous description of the lesion has appeared in the radiologic literature, although 21 cases are recorded, primarily for their pathologic interest. Two additional examples are presented here. It may be added that Polayes and Krieger (3) have described a similar process in the jejunum. Certain cases have been reported (1, 2, 5) in which there was extensive infiltration of the stomach with eosinophils without the features of a gastric granuloma. These cases were seemingly of allergic origin. In the cases to be presented here, as well as in those referred to by Rigler and his associates, there was no convincing history of allergy, either in the patient's medical background or as reflected by peripheral blood studies. Histologically, these granulomas are not related to the eosinophilic granuloma of bone or eosinophilic granuloma elsewhere in the body; in these latter conditions the basic cell is the histiocyte, rather than the fibroblast. It is difficult to distinguish granuloma with eosinophilic infiltration from gastric adenoma or other submucosal lesions such as leiomyoma, heterotopic pancreatic tissue, or even a small carcinoma. Histological examination in these instances is definitive. Case Histories Case I: F. K., a 54-year-old female, complained of epigastric pain, anorexia, and low-grade fever; for two years the pain had been relieved by alkalis. The blood count was normal, and agglutination and gastric acidity studies showed nothing of pathologic significance. A gastrointestinal examination revealed a small submucosal lesion in the prepyloric region. Two months later (Fig. 1) this appeared larger; there was no demonstrable peptic ulceration. A Billroth I gastrectomy was performed and the resected specimen (Figs. 2 and 3) showed a lesion of the mucosa 3 cm. above the pyloric ring, measuring 1.5 × 1.5 cm. and protruding 5 mm. above the mucosal surface. On section, the abnormal tissue, freely movable from the submucosal fat, was of an opaque, milky-gray color. Microscopically (Fig. 4) this was a granuloma lying in both the mucosa and submucosa and interrupting the muscularis mucosae. It was not encapsulated. Basically, it consisted of delicate fibrocytic tissue with many blood vessels. Large numbers of eosinophils were scattered diffusely through the lesion, with fewer numbers of plasma and lymphoid cells. The gastric mucosa elsewhere showed an accentuation of its scalloped outline, packing of the interglandular stroma by lymphoid and plasma cells, and a minimal, widely scattered intestinalization of the lining epithelium and that of the necks of the glands.