Published online Sep 7, 2020. doi: 10.3748/wjg.v26.i33.5050
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
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.
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.
The prognosis of this entity is uncertain, that is why these patients are subjects of continuous follow up.
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.