Facharzt FMH Pathologie Practice Questions - Facharzt FMH Für Pathologie Spécialiste FMH En Pathologie Exam

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Gastric biopsies from a 55-year-old woman with severe vitamin B12 deficiency show complete loss of specialized parietal and chief cells with extensive pseudopyloric and intestinal metaplasia strictly limited to the oxyntic mucosa of the body and fundus. The antral mucosa demonstrates preserved architectural structure with no active inflammation and an increased gastrin-positive G-cell population. Chromogranin A immunohistochemistry reveals linear and micronodular hyperplasia of enterochromaffin-like (ECL) cells in the corpus. What is the diagnosis and the underlying mechanism responsible for the ECL hyperplasia?

Autoimmune atrophic gastritis (AAG); hypergastrinemia driven by achlorhydria causes trophic ECL cell stimulation. Helicobacter pylori pangastritis; direct bacterial CagA toxin stimulation of mucosal endocrine cells. MEN1 syndrome; primary germline loss of menin in ECL neuroendocrine progenitors. Zollinger-Ellison syndrome; autonomous gastrin secretion by a duodenal/pancreatic gastrinoma causing parietal cell hypertrophy.

Correct Answer:

Autoimmune atrophic gastritis (AAG); hypergastrinemia driven by achlorhydria causes trophic ECL cell stimulation.

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