G-cells
This 28 year old man with a history of reflux and vague abdominal discomfort treated with Prevacid (lansoprazole - proton pump inhibitor) underwent endoscopy.  Antral biopsies show increased numbers of cells in the gastric glands extending into the neck region with clear cytoplasm creating a halo effect around the nucleus.  H and E is shown below.  I think this could be classified as simple or diffuse ECL cell hyperplasia as it appears in Chandrasoma's textbook.  Serum gastrin is not yet available.  The patient is not anemic.

I am mystified over a couple of things though.  Firstly, I hadn't seen this halo like effect described for G cells.  I always thought they were indistinguishable on H and E from their neighbours.  Perhaps their plump appearance is attributable to being "turned on" to produce larger amounts of gastrin thus these cells are not only increased in number but each cell itself is abnormal or pathologic.   Finally was referred to a reference in the AFIP fascicle by a PATHO-Ler which gives a similar description.

Why don't we see this more frequently with the large numbers of patients taking these medications?

Now that my eye is a bit better trained I am starting to see these cells more often but only sporadic single cells.  It is worth noting that the histology is similar and could be potentially confused with lymphocytic gastritis.
 
 


 
 

Gastrin immunoperoxidase stain is shown below.  Back to home page.