COMMENT: The histologic features consisting of marked foveolar hyperplasia replacing parts of the fundal and body gastric mucosa are consistent with a diagnosis of Menetrier's disease. Menetrier's disease should also have a clinical correlative component including hypoproduction of gastric acid and protein loss. There is no evidence of lymphoma or carcinoma.
Menetrier's disease can be confused grossly and radiologically with malignant lymphoma and/or gastric carcinoma, which may be why this specimen was submitted to the Pathology Department as "gastric tumor". For the pathologist, it is important to recognize the lack of dysplasia in this disease and the occasional presence of "invasion" through the muscularis mucosa into the submucosa. This is not an invasive neoplasm, nor even a precancerous lesion. Rather, it is a hypertrophic gastropathy associated with hypochlorhydria (low gastric acid production) and hypoprotenemia (due to protein leaching out through the affected mucosa). In adults the disease is usually chronic and severe enough to require subtotal gastrectomy.
Contributed by Eric Schubert, MD and Charles A. Richert, M.D.