Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2017; 9(8): 417-424
Published online Aug 16, 2017. doi: 10.4253/wjge.v9.i8.417
Russell body gastritis with Dutcher bodies evaluated using magnification endoscopy
Kenji Yorita, Takehiro Iwasaki, Kunihisa Uchita, Naoto Kuroda, Koji Kojima, Shinichi Iwamura, Yutaka Tsutsumi, Akinobu Ohno, Hiroaki Kataoka
Kenji Yorita, Naoto Kuroda, Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi 780-8562, Japan
Takehiro Iwasaki, Kunihisa Uchita, Koji Kojima, Shinichi Iwamura, Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi 780-8562, Japan
Yutaka Tsutsumi, Department of Pathology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
Akinobu Ohno, Pathology Section, University of Miyazaki Hospital, Miyazaki 889-1601, Japan
Hiroaki Kataoka, Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1601, Japan
Author contributions: Yorita K performed pathological diagnosis, collected and analyzed the data, and wrote the paper; Iwasaki T, Uchita K, Kojima K and Iwamura S performed the clinical diagnosis, endoscopic submucosal resection of the lesion, and clinical follow-up; Kuroda N, Tsutsumi Y, Ohno A and Kataoka H performed the pathological diagnosis.
Institutional review board statement: This case report was approved by the institutional review board of the Japanese Red Cross Kochi Hospital.
Informed consent statement: The patient described in this case report provided written informed consent.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Kenji Yorita, MD, PhD, Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi 780-8562, Japan. kenjiyorita@gmail.com
Telephone: +81-88-8221201 Fax: +81-88-8221056
Received: November 29, 2016
Peer-review started: December 1, 2016
First decision: February 20, 2017
Revised: March 13, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: August 16, 2017
Processing time: 254 Days and 14 Hours
Abstract

Russell body gastritis (RBG) is an unusual type of chronic gastritis characterized by marked infiltration of Mott cells, which are plasma cells filled with spherical eosinophilic bodies referred to as Russell bodies. It was initially thought that Helicobacter pylori (H. pylori) infection was a major cause of RBG and that the infiltrating Mott cells were polyphenotypic; however, a number of cases of RBG without H. pylori infection or with monoclonal Mott cells have been reported. Thus, diagnostic difficulty exists in distinguishing RBG with monoclonal Mott cells from malignant lymphoma. Here, we report an unusual case of an 86-year-old-Japanese man with H. pylori-positive RBG. During the examination of melena, endoscopic evaluation confirmed a 13-mm whitish, flat lesion in the gastric antrum. Magnification endoscopy with narrow-band imaging suggested that the lesion was most likely a poorly differentiated adenocarcinoma. Biopsy findings were consistent with chronic gastritis with many Mott cells with intranuclear inclusions referred to as Dutcher bodies. Endoscopic submucosal dissection confirmed the diagnosis of RBG with kappa-restricted monoclonal Mott cells. Malignant lymphoma was unlikely given the paucity of cytological atypia and Ki-67 immunoreactivity of monoclonal Mott cells. This is the first reported case of RBG with endoscopic diagnosis of malignant tumor and the presence of Dutcher bodies.

Keywords: Russell body gastritis; Mott cell; Dutcher body; Mucosa-associated lymphoid tissue lymphoma; Plasmacytoma; Magnification endoscopy with narrow-band imaging

Core tip: We report Russell body gastritis (RBG) evaluated by magnification endoscopy with narrow band imaging and pathological evaluation by endoscopic submucosal dissection. The endoscopic features of RBG are exclusively inflammatory; however, our detailed endoscopic evaluation led to misdiagnosis of the lesion as poorly differentiated adenocarcinoma. The histological features of RBG were also unique because the presence of Mott cells with light chain restriction and Dutcher bodies suggested malignant lymphoma. Pathologists should be aware of the existence of this pathological entity, and clinicians should consider RBG as a differential diagnosis in cases where detailed endoscopic examination reveals poorly differentiated early gastric cancer.