Stomach, Glandular Stomach, Neuroendocrine Cell - Hyperplasia
comment:Hyperplasia of the neuroendocrine cells consists of increased numbers of neuroendocrine cells in the mucosa. The neuroendocrine cells are attached to the mucosa basement membrane and are wedged between the mucous, parietal, and chief cells; some neuroendocrine cells have cytoplasmic extensions that reach the mucosa lumen. Because of their attachment to the basement membrane, hyperplasia will be noted primarily in the lower half of the mucosa. Neuroendocrine cells are difficult to recognize with H&E stains but are identifiable with special argyrophilic stains (Grimelius, Sevier-Munger), immunohistochemistry, or electron microscopy. Argyrophilic stains reveal small granules in the cytoplasm. Chromagranins are proteins that represent the predominant constituent of neurosecretory granules, so antibodies to Chromagranin A are used to identify neuroendocrine cells in tissue sections. Hyperplasia of the neuroendocrine cells of the glandular stomach can be induced with histamine 2 blockers or proton pump inhibitors and was seen in the NTP chronic methyleugenol gavage study. In addition, rats and mice in the methyleugenol study had an increase in neuroendocrine tumors of the glandular stomach. Hyperplasia of the neuroendocrine cells of the glandular stomach is not seen as a background lesion.
recommendation:Neuroendocrine hyperplasia should be diagnosed and graded whenever present. Grading should be based on the number of hyperplastic neuroendocrine cells present.
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