Granulomatous gastritis, as an unqualified term, is a diagnosis of last resort and should be attached to a case only after numerous alternatives have been considered.

Granulomas may be present in the gastric mucosa in Crohn disease, in sarcoidosis, a variety of infectious diseases (such as tuberculosis, histoplasmosis and anisakiasis), and as a reaction to endogenous and foreign materials.

Even when the histological appearances of the granulomas are nonspecific, important clues to the ultimate diagnosis are given by careful evaluation of their distribution and morphology.

In rare instances, granulomatous gastritis may be part of an immunemediated vasculitis syndrome, an accompaniment of gastric lymphoma, or take a xanthogranulomatous form akin to xanthogranulomatous cholecystitis. Only after excluding such causes should the diagnosis of isolated granulomatous gastritis be made.

Etiology

 infectious granulomatous gastritis

• Whipple disease
• tuberculosis
• syphilis

 active chronic gastritis

• Crohn gastritis

 sarcoidosis
 peptic ulcer
 gastric vasculitis

• gastric Wegener disease (#9176088#)

 gastric allergic granulomatosis
 gastric lymphomas

• gastric marginal zone B-cell lymphoma (gastric MALToma)

 gastric Langerhans hsitiocytosis
 adenocarcinoma area

References

 Maeng L, Lee A, Choi K, Kang CS, Kim KM. Granulomatous Gastritis: A Clinicopathologic Analysis of 18 Biopsy Cases. Am J Surg Pathol. 2004 Jul;28(7):941-945. PMID: #15223966#