Pathology Oncology Research

, Volume 8, Issue 4, pp 272–274 | Cite as

Atypical histiocytic infiltration simulating diffuse-type carcinoma in a gastric ulcer due to non-steroidal anti-inflammatory drugs

  • Julián Arista-Nasr
  • Juan Nuncio
  • Braulio Martinez
Case Report


A 83-year old man treated with naproxen during two years was admitted because of hypovolemia and peritoneal irritation. A panendoscopic study was performed and an ulcer localized at the large curvature of the stomach was disclosed. In the gastrectomy specimen the ulcer showed necrosis, edema, fibrosis, chronic inflammatory infiltrate with lymphocytes and plasma cells. Additionally, atypical cells with irregular and hyperchromatic nuclei or vacuolated cytoplasm were seen in the lamina propia and infiltrating the muscular layers; isolated signet-ring-like cells were also seen. Histochemical study with periodic acid-Schiff, mucicarmin, and colloidal stains revealed mucosubstances in these cells. A poorly differentiated carcinoma was initially diagnosed. However, the immunohistochemical study were positive for histiocytic markers (CD-68, S-100 protein) and negative for epithelial markers (cytokeratin; and epithelial membrane antigen). The positivity of mucus stains in the histiocytes could be explained in this case by phagocytosis of mucous substances released from broken hyperplastic glands in the vicinity of the ulcer. To our knowledge, atypical histiocytic infiltration in gastric ulcers has not been previously described; thus, it should be included in the group of gastric carcinoma mimicks.


atypical histiocytic gastric ulcer NSAID 


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  1. 1.
    Humphries TJ. Gastric xantomata: The need for recognition. J Clin Gastroenterol 4:275–276, 1982.PubMedCrossRefGoogle Scholar
  2. 2.
    Drude RB, Balart LA, Herrington JP, et al: Gastric xantoma: histologic similarity to signet ring cell carcinoma. J Clin Gastroenterol 4:217–221, 1982.PubMedCrossRefGoogle Scholar
  3. 3.
    Arista-Nasr J, Jimenez A, Keirns C, et al: The role of endoscopic biopsy in the diagnosis of gastric lymphoma. Hum Pathol 22:339–348, 1991.PubMedCrossRefGoogle Scholar
  4. 4.
    Zamboni G, Franzin G, Scarpa A, et al: Carcinoma-like signetring cells in gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Am J Surg Pathol 20:588–598, 1996.PubMedCrossRefGoogle Scholar
  5. 5.
    Arista-Nasr J, Romero-Lagarza P, Pichardo R. Artifactual signet-ring-like cells in endoscopic biopsy of gastric lymphoma. Arch Pathol Lab Med 121:623–625, 1997.PubMedGoogle Scholar
  6. 6.
    Taha AS, Nakshabendi I, Lee FD et al. Chemical gastritis and Helicobacter pylori related gastritis in patients receiving nonsteroidal anti-inflammatory drugs: comparison and correlation with peptic ulceration. J Clin Pathol 45:135–139, 1992.PubMedCrossRefGoogle Scholar
  7. 7.
    Lanza FL, Royer GL, Nelson RS: Endoscopic evaluation of the effect of aspirin, buffered aspirin and enteric-coated aspirin on gastric and duodenal mucosa. N Engl J Med 303:136–138, 1980.PubMedCrossRefGoogle Scholar
  8. 8.
    Dixon MF, O’Connor HJ, Axon ATR et al: Reflux gastritis: distinct histopathological entity?. J Clin Pathol 39:524–530, 1986.PubMedCrossRefGoogle Scholar
  9. 9.
    Quinn M, Bjarnason I, Price AB: Gastritis in patients on nonsteroidal anti-inflammatory drugs. Histopathology 23:341–348, 1993.PubMedCrossRefGoogle Scholar
  10. 10.
    El-Zimaity HMT, Genta RM, Graham DY: Histological features do not define NSAID-induced gastritis. Hum Pathol 27:1348–1354, 1996PubMedCrossRefGoogle Scholar
  11. 11.
    Ball PAJ, James AH: The histological background to gastric ulcer. Lancet 1:1365–1367, 1961PubMedCrossRefGoogle Scholar
  12. 12.
    Ogawa Y, Inada K, Tsutsumi Y: CD68 reactive histiocytosis complicating early gastric cancer. Pathol Int. 45:698–701, 1995.PubMedCrossRefGoogle Scholar

Copyright information

© Arányi Lajos Foundation 2002

Authors and Affiliations

  • Julián Arista-Nasr
    • 1
  • Juan Nuncio
    • 1
  • Braulio Martinez
    • 1
  1. 1.Department of PathologyInstituto Nacional de la Nutrición Salvador ZubiránMéxico, DFMexico

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