Description of the normal gastric mucosa in anatomy education: How many leukocytes are acceptable?

Abstract

Textbooks covering normal human histology illustrate an allegedly normal gastric mucosa containing significant infiltrates of mononuclear cells in the lamina propria. This standard description seems to conflict with the pathologist's criterion for normality, which specifies only a few or a complete absence of inflammatory cells. Eventually, both anatomists and pathologists face the dilemma: how much infiltrate should their students and medical colleagues be told is acceptable for the gastric mucosa to be classified as normal? Summarizing the suggestions of experts in gastroenterology and our own experience, a simple approach could be to accept no more than five mononuclear and plasma cells per high power field as normal (400-fold magnification with a field area of 0.24 mm 2 ). The divergence of views on this topic illustrates the need for anatomists and pathologists to find a consensus about the definition of "normal" tissues.

RE.GA.IN.: the Real-world Gastritis Initiative–updating the updates

“…18 19 Histologically, there are two main types of gastric mucosa: oxyntic and mucosecreting pyloric. 20 A third mucosal type lies distally to the oesophagogastric junction. [15][16][17] This 'cardia' phenotype consists of foveolar epithelium with mucous glands and no parietal cells; its endoscopic landmarks and its nature (native vs metaplastic) are the subject of debate.…”

“…26 The normal lamina propria contains sparse resident lymphocytes, rare plasma cells and eosinophils, but no neutrophils (figure 2). 20 In the absence of histological evidence of changes to the mucosal structure (including inflammatory infiltrates, lymphoid follicles, atrophy, intestinal or pseudopyloric metaplasia, detectable organisms, hyperplastic or neoplastic changes), a histopathological diagnosis of 'gastric mucosa within normal limits' should be made. 27 2.1.2 Acute gastritis clinically identifies a broad spectrum of short-lasting (usually self-limited) symptomatic inflammatory changes of gastric mucosa resulting from either nontransmissible or transmissible agents.…”