Multinucleated stromal giant cells in the gastroesophageal junctional and gastric mucosa: a retrospective study
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RESEARCH
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Multinucleated stromal giant cells in the gastroesophageal junctional and gastric mucosa: a retrospective study Taha Sachak, Wendy L. Frankel, Christina A. Arnold and Wei Chen*
Abstract Background: Atypical multinucleated stromal giant cells (MSGCs) are occasionally encountered in the esophagogastric mucosa. This study aims to investigate the origin and clinical association of MSGCs in the upper gastrointestinal tract. Methods: Three hundred sixty-one contiguous biopsies and 1 resection specimen from the stomach and gastroesophageal junction (GEJ) were identified from archives for morphologic and immunohistochemical studies. Results: MSGCs were identified in 22 cases (6%: 7 gastric, 15 GEJ). Patients’ average age was 53 years. There was no sex predilection. 77% cases had only 1 or 2 MSGCs per 10 high power fields. MSGCs were located in the lamina propria of the gastric or GEJ mucosa, with an accentuation in the subepithelial zone. The median number of nuclei in a MSGC was 5 (ranging from 3 to 16). The nuclei were touching/overlapping, often arranged into “wreath”, “caterpillar”, or “morula” configurations. MSGCs expressed smooth muscle actin, desmin, while negative for cytokeratin AE1/3, CD68, S100, chromogranin, and CD117. The most common clinical history was epigastric pain, gastroesophageal reflux, and Barrett esophagus. The most common associated pathologic diagnoses included reactive (chemical) gastropathy (71% gastric biopsies) and gastroesophageal reflux (73% GEJ specimens). Conclusions: MSGCs in the esophagogastric mucosa show smooth muscle/myofibroblast differentiation by immunohistochemistry and likely represent a reactive/reparative stromal reaction associated with gastroesophageal reflux and reactive (chemical) gastropathy. Keywords: Multinucleated stromal giant cells, Reactive changes, Gastroesophageal reflux disease, Chemical gastropathy
Introduction Reactive/reparative changes of the gastrointestinal tract are commonly observed in the daily practice of surgical pathology, secondary to infection, inflammation, foreign body, and others. Multinucleated cells are often seen in this setting. One of the most well-known multinucleated giant cells is the Langhans giant cell, the hallmark of tuberculosis and sarcoidosis. Langhans giant cells are formed by the fusion of multiple macrophages, and feature peripherally placed nuclei surrounding central ample cytoplasm that may contain lipid-rich material. Similarly, foreign-body giant cells are also derived from * Correspondence: [email protected] Department of Pathology, The Ohio State University Wexner Medical Center, S301 Rhodes Hall, 450 W. 10th Ave, Columbus, OH 43210, USA
fused macrophages that engulf endogenous (such as cholesterol, keratin, fat) or exogenous substances (such as suture, talc, fungus, food particles). Squamous epithelium and hepatocytes can also become multi-nucleated in reactive conditions or secondary to viral infection. Benign multinucleated stromal giant cells are well known to exist at various sites, most co
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