Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2020; 26(33): 5050-5059
Published online Sep 7, 2020. doi: 10.3748/wjg.v26.i33.5050
Surveilling Russell body Helicobacter pylori-negative gastritis: A case report and review of literature
Milena Peruhova, Monika Peshevska-Sekulovska, Viktoriya Georgieva, Gabriela Panayotova, Dorian Dikov
Milena Peruhova, Monika Peshevska-Sekulovska, Viktoriya Georgieva, Gabriela Panayotova, Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
Dorian Dikov, Department of General and Clinical pathology, Grand Hôpital de l'Est Francilien, Jossigny 77600, France
Author contributions: Peshevska-Sekulovska M, Georgieva V and Panayotova G were the clinicians involved in patient diagnostics, management, therapy and follow-up; Peshevska-Sekulovska M reviewed the literature and wrote the draft; Peshevska-Sekulovska M and Georgieva V contributed to reviewing the literature and manuscript drafting; Dikov D performed histopathological testing, interpreted the histopathological and immunohistochemical findings; Peruhova M was responsible for the critical revision of the manuscript for relevant intellectual content; all of the authors approved the final version of the paper prior to submission.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Milena Peruhova, MD, Assistant Professor, Chief Doctor, Department of Gastroenterology, University Hospital Lozenetz, Kozyak 1 Street, Sofia 1407, Bulgaria. mperuhova@gmail.com
Received: May 20, 2020
Peer-review started: May 20, 2020
First decision: July 29, 2020
Revised: August 3, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: September 7, 2020
Processing time: 106 Days and 18.7 Hours
Abstract
BACKGROUND

Russell body gastritis (RBG) is very rare type of chronic inflammation of gastric mucosa. The pathologic hallmark of the disease is Russell bodies (RB) which represent accumulation of eosinophilic cytoplasmic inclusions in endoplasmic reticulum of mature plasma cells (Mott cells). Most published cases are associated with Helicobacter pylori (H. pylori) infection because of correlation between plasma cell activation and antigenic stimulation. There are insufficient data about H. pylori-negative RBG and very little is known about the natural course of the disease.

CASE SUMMARY

A 51-year-old male patient underwent endoscopic screening for mild iron deficiency anemia. Gastroscopy revealed diffuse hyperemia, edema and nodularity of the fundic and corpus mucosa. Due to non-specific endoscopic findings and iron-deficiency anemia our preliminary diagnosis was diffuse type of gastric carcinoma or gastric lymphoma. Biopsy specimens of gastric mucosa showed inflammatory infiltrate rich in Mott cells, consisting entirely of cytoplasmic RB. Absence of nuclear atypia and mitosis of the plasma cells, polyclonal pattern of the Mott cells and negative staining for cytokeratins favored diagnosis of RBG. The patient was treated with proton-pump inhibitor for 8 wk. Long-term clinical and endoscopic surveillance was scheduled. Albeit, there was no improvement in endoscopic features of the gastric mucosa in three consecutive gastroscopies, histopathological findings demonstrated that the chronic inflammatory infiltrate in the fundic mucosa is less pronounced, rich in plasma cells, with almost absent RB and Mott cells.

CONCLUSION

The prognosis of this entity is uncertain, that is why these patients are subjects of continuous follow up.

Keywords: Russell body gastritis; Helicobacter pylori-negative; Treatment; Mature plasma cells; Case report

Core tip: We report a long-term follow up in a patient with Helicobacter pylori (H. pylori)-negative Russell body gastritis. Endoscopic findings include vast spectrum of nonspecific features without significant improvement in three consecutive gastroscopies. On the other hand, histology report showed tendency from decrease up to complete extinction of Russell bodies and Mott cells over time and under the influence of treatment. So far little is known about its etiology and pathogenesis, thus larger studies must be conducted. In this article, we summarize the most important clinical, endoscopic and histopathologic findings and associated conditions with H. pylori-negative Russell body gastritis, published in the literature so far.