Signet ring cell cancer in a patient with Russell body gastritis--a possible diagnostic pitfall

[Duodenitis Russell bodies. Review of the entity and associations beyond H. pylori]

Plasma cells known as "Mott cells" present non-secretable accumulations of immunoglobulins called "Russell bodies". Its presence is related to hematological neoplasms, but it can appear in chronic inflammatory processes. The most common occurrence within the digestive tract is the gastric antrum associated with H. pylori infection. Our patient is added the rare extragastric cases where the association with H. pylori is inconsistent. We have found a frequent appearance of lower digestive and urological neoplasms in relation to these cases, justified by the expression of circulating cytokines in the tumor area that lead to the overactivation of plasma cells. This possible association could lead us to know data about the tumor environment and serve us for early diagnosis or future therapeutic targets.

Distribution and Clinicopathological Features of Mott Cells (Plasma Cells Containing Russell Bodies) in Gastric Cancer: Presence of Mott Cells Is Associated with Favorable Prognosis

Gastric cancer (GC) is still one of the leading causes of cancer-related mortality. We previously reported the relationship between histological heterogeneity of tumor cells and molecular features in GC. The tumor microenvironment also has a crucial role in GC progression and therapeutic resistance. In this study, we focused on the tumor microenvironment, especially inflammatory cells in GC. Using GC tissue slides, we investigated the distribution and clinicopathological significance of inflammatory cell counts including eosinophils, neutrophils, lymphocytes, and plasma cells. Additionally, we investigated the relationship between Mott cells (plasma cells containing Russell bodies) and clinicopathological features. In neoplastic gastric mucosa, a high number of plasma cells was associated with low T-grade, early stage, and good prognosis. We then focused on Mott cells and found that their presence in neoplastic gastric mucosa was associated with lower T and N grades, early stage, and Helicobacter pylori infection and was inversely associated with CD44 and EGFR expression. Additionally, the presence of Mott cells was associated with good prognosis in advanced GC and was an independent favorable prognostic predictor. The presence of Mott cells in GC might be one useful prognostic predictor, and Mott cells might have an important role in the carcinogenesis of H. pylori infection.

Surveillance of Russell body inflammation of the digestive tract: a case report and review of literature

Introduction

Russell body inflammation of the digestive tract (RBIDT) is a rare chronic inflammation of the digestive tract mucosa that commonly presents as Russell body gastritis (RBG). This disease is usually associated with Helicobacter pylori (HP) infection. However, it can also occur in individuals without HP infection and with specific immune profiles, as seen in HIV and hepatitis C infections. The aetiology and pathogenesis of this disease remain controversial. Given the rarity of the disease and the diversity of the immunophenotypes, there is a high probability of misdiagnosis.

Case presentation

A male patient with RBG and HP infection was included in this study. The case of RBG with an unusual morphology of Mott cells that mimics stamped ring cells.Endoscopy performed during the follow-up revealed regression of the lesion 1 week after anti-HP treatment.

Conclusions

A case of RBG with a high likelihood of misdiagnosis of signet ring cell carcinoma (SRC) has been reported in this study along with a review of the relevant literature and an overview of RBIDT.

Malignant gastrointestinal stromal tumor in association with Russell body gastritis-A case report

Russell body gastritis (RBG) is an unusual form of chronic inflammation characterized by accumulation of plasma cells containing Russell bodies (RB) in the gastric mucosa. Although its pathogenesis has not been fully evaluated, there is evidence to support a strong association with Helicobacter pylori infection. Only four cases of RBG in association with malignant epithelial gastric tumors were reported. We report the first case of RBG in peritumoral mucosa of a malignant gastrointestinal stromal tumor in association with coccoid form of Helicobacter pylori and a follow-up.

Surveilling Russell body Helicobacter pylori-negative gastritis: A case report and review of literature

BACKGROUND

Russell body gastritis (RBG) is very rare type of chronic inflammation of gastric mucosa. The pathologic hallmark of the disease is Russell bodies (RB) which represent accumulation of eosinophilic cytoplasmic inclusions in endoplasmic reticulum of mature plasma cells (Mott cells). Most published cases are associated with Helicobacter pylori (H. pylori) infection because of correlation between plasma cell activation and antigenic stimulation. There are insufficient data about H. pylori-negative RBG and very little is known about the natural course of the disease.

CASE SUMMARY

A 51-year-old male patient underwent endoscopic screening for mild iron deficiency anemia. Gastroscopy revealed diffuse hyperemia, edema and nodularity of the fundic and corpus mucosa. Due to non-specific endoscopic findings and iron-deficiency anemia our preliminary diagnosis was diffuse type of gastric carcinoma or gastric lymphoma. Biopsy specimens of gastric mucosa showed inflammatory infiltrate rich in Mott cells, consisting entirely of cytoplasmic RB. Absence of nuclear atypia and mitosis of the plasma cells, polyclonal pattern of the Mott cells and negative staining for cytokeratins favored diagnosis of RBG. The patient was treated with proton-pump inhibitor for 8 wk. Long-term clinical and endoscopic surveillance was scheduled. Albeit, there was no improvement in endoscopic features of the gastric mucosa in three consecutive gastroscopies, histopathological findings demonstrated that the chronic inflammatory infiltrate in the fundic mucosa is less pronounced, rich in plasma cells, with almost absent RB and Mott cells.

CONCLUSION

The prognosis of this entity is uncertain, that is why these patients are subjects of continuous follow up.

A case of Russell body gastritis with multifocal lesions

Russell body gastritis is an extremely rare gastritis characterized by abundant infiltration of plasma cells with Russell body and eccentric nuclei, known as Mott cells. An 81-year-old Japanese woman with Helicobacter pylori and hepatitis C virus infection complaining of abdominal discomfort underwent upper gastrointestinal endoscopy, which detected an elevated lesion 2 cm in diameter at the anterior wall of the gastric body. A histological examination of the lesion revealed the infiltration of numerous Mott cells with an abundant eosinophilic crystal structure and eccentric nuclei in the lamina propria, resulting in a pathological diagnosis of Russell body gastritis. Endoscopic submucosal dissection (ESD) was performed subsequently. The histological findings of the resected specimen were compatible with those of Russell body gastritis. Upper gastrointestinal endoscopy performed 2 months after endoscopic submucosal dissection revealed the presence of new multiple flat elevated lesions in the antrum up to 1 cm in diameter, distant from the site of endoscopic submucosal dissection. A histological examination revealed a few Mott cells in the biopsy specimens taken from the new lesions. In turn, H. pylori eradication therapy was performed 1 month after the detection of the new lesions. One year after the eradication therapy, follow-up upper gastrointestinal endoscopy revealed that multiple lesions had almost disappeared, and the histological examination of the gastric biopsy specimens confirmed the disappearance of Mott cells. We herein report a case of Russell body gastritis in which multifocal lesions were observed after endoscopic submucosal dissection, and which was subsequently treated by H. pylori eradication therapy.

Russell Body Barrett's Esophagus

We report an unusual case of Barrett's esophagus with prominent intramucosal Russell bodies, also known as Russell body Barrett's esophagus. We present this case to emphasize the importance of recognizing this unusual entity. It also represents a potential diagnostic pitfall because the distended plasma cells may be mistaken for signet ring cells of gastric adenocarcinoma or low-grade lymphoma. Hence, an awareness of this entity is important to avoid diagnostic confusion.

Analysis of clinical and histopathological findings in Russell body gastritis and duodenitis

INTRODUCTION

Russell body gastritis is considered as a rare, benign, incidental finding characterized by dense accumulation of plasma cells containing Russell bodies in the lamina propria. In this study, clinical and histopathological features of 12 cases of Russell body gastritis/duodenitis were presented.

MATERIALS AND METHODS

Clinical data, histopathological findings including Helicobacter pylori infection, Sydney system classification, Russell body density and immunohistochemical findings were evaluated in 11 gastric and 1 duodenal mucosal biopsy from 11 patients.

RESULTS

Six cases were male, 5 were female and the mean age was 72 (44-87). The most common site was antrum (10/12), one case was located in cardia and one in heterotopic gastric mucosa of duodenal bulb. H. pylori was detected in half of the cases. One of the cases was accompanied by gastric tubular adenoma, one by gastric well-differentiated adenocarcinoma and one by plasma cell neoplasm. In all cases, globules were positive with PAS stain.

CONCLUSION

Russell body gastritis must be kept in mind while reporting endoscopic biopsies because this entity may be misdiagnosed as signet ring carcinoma and may be associated with neoplasms. Absence of nuclear atypia, mucin stains, cytokeratins, plasma cell and hematolymphoid antigen markers are useful in differential diagnosis. Associated H. pylori infection, as well as rarely carcinomas, adenomas and plasma cell neoplasms, may be observed.

Russell Bodies and Russell Body Inflammatory Polyp in the Colorectum: A Review of Clinicopathologic Features

Colorectal mucosa with Russell bodies is a reactive inflammatory lesion composed of mature plasma cells, known as Mott cells which contain multiple intracytoplasmic eosinophilic globules. To the best of our knowledge, 3 case reports of colorectal Russell body containing lesions have been reported in the English literature (searched from 1980 to date), including just one case report of Colonic Russell body inflammatory polyp. Their importance lies in being aware of this unusual entity, recognizing it as well as the clinical scenario in which this typically arises and differentiating it from its malignant mimics that come in the histologic differential. This review discusses the clinical and endoscopic presentation, histopathologic features, ancillary studies, pathogenesis, differential diagnosis, prognosis, and treatment of this rare lesion.

Russell body gastritis with Dutcher bodies evaluated using magnification endoscopy

Russell body gastritis (RBG) is an unusual type of chronic gastritis characterized by marked infiltration of Mott cells, which are plasma cells filled with spherical eosinophilic bodies referred to as Russell bodies. It was initially thought that Helicobacter pylori (H. pylori) infection was a major cause of RBG and that the infiltrating Mott cells were polyphenotypic; however, a number of cases of RBG without H. pylori infection or with monoclonal Mott cells have been reported. Thus, diagnostic difficulty exists in distinguishing RBG with monoclonal Mott cells from malignant lymphoma. Here, we report an unusual case of an 86-year-old-Japanese man with H. pylori-positive RBG. During the examination of melena, endoscopic evaluation confirmed a 13-mm whitish, flat lesion in the gastric antrum. Magnification endoscopy with narrow-band imaging suggested that the lesion was most likely a poorly differentiated adenocarcinoma. Biopsy findings were consistent with chronic gastritis with many Mott cells with intranuclear inclusions referred to as Dutcher bodies. Endoscopic submucosal dissection confirmed the diagnosis of RBG with kappa-restricted monoclonal Mott cells. Malignant lymphoma was unlikely given the paucity of cytological atypia and Ki-67 immunoreactivity of monoclonal Mott cells. This is the first reported case of RBG with endoscopic diagnosis of malignant tumor and the presence of Dutcher bodies.

Rare Gastric Lesions Associated with Helicobacter pylori Infection: A Histopathological Review

Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. However, some rare gastric lesions exhibiting distinctive histological features may also be associated with H. pylori infection, including lymphocytic gastritis, granulomatous gastritis, Russell body gastritis, or crystal-storing histiocytosis. Although diverse factors can contribute to their development, there is convincing evidence that H. pylori infection may play a pathogenic role. These findings are mainly based on studies in patients with these lesions who exhibited clinical and histological improvements after H. pylori eradication therapy. Thus, H. pylori eradication therapy might be indicated in patients with no other underlying disease, particularly in countries with a high prevalence of H. pylori infection. This review describes the characteristic histological features of these rare lesions and evaluates the evidence regarding a causative role for H. pylori infection in their pathogenesis.

"Russell Body Gastroenterocolitis" in a Posttransplant Patient: A Case Report and Review of Literature

Russell bodies represent a cellular response to overstimulation of plasma cells, leading to the accumulation of abundant, nondegradable, condensed immunoglobulin in dilated rough endoplasmic reticulum cisternae. Russell body gastritis was first described 1998 by Tazawa and Tsutsumi. Since then only 39 cases involving the gastrointestinal tract have been reported in English literature, which include Russell body gastritis, duodenitis, and esophagitis. We report a case of a 44-year-old female with a history of diabetes mellitus, status post kidney and pancreas transplant who presented with multiple episodes of watery diarrhea associated with abdominal pain, nausea, and vomiting. Upper gastroendoscopic examination showed diffuse mild erythema in the gastric body and a clean-based duodenal ulcer. Lower gastroendoscopic examination was normal. Examination of multiple biopsies from duodenal, gastric, terminal ileum, and colonic mucosae revealed numerous plasma cells with abundant eosinophilic granular cytoplasm (Russell bodies) and eccentric nuclei, highlighted by PAS stain and CD 138 plasma cell marker. Helicobacter pylori stains were performed on gastric biopsies and were negative for organisms. To date, there are no cases described in English literature with multifocal Russell body infiltrates in gastrointestinal tract in a single patient including ileum and/or colon. This makes our case the first to be reported with these unique findings; thus, the spectrum of Russell body-associated chronic inflammation of the gastrointestinal tract would be more suitably referred to as "Russell body gastroenterocolitis."

Russell body gastritis/duodenitis: a case series and description of immunoglobulin light chain restriction

Russell body esophago-gastro-duodenitis is an unusual form of chronic inflammation, with only 22 cases being reported in PubMed. However, the prevalence and clinical significance remain unknown. This report describes the clinico-pathological characteristics of nine cases of Russell body gastritis (RBG) and one case of Russell body duodentitis (RBD), with nonspecific endoscopic appearance. The Mott cells (plasma cells with Russell bodies) showed κ light chain restriction in eight gastritis cases and λ light chain restriction in the duodentitis case, and there were no histological features that suggested lymphoma. Thus, a diagnosis of monoclonal RBG/RBD was made. Helicobacter pylori infection was found in 55.6% of RBG cases and in the RBD case. And, the clinical follow-up evaluations were uneventful. This report is the first study to describe this benign disease entity with monoclonality on a large-scale basis. In addition, the monoclonality of Mott cells cannot be used as evidence of an existing neoplastic lesion, and taken together, these findings may indicate a reactive process.

Helicobacter pylori-negative Russell body gastritis: does the diagnosis call for screening for plasmacytic malignancies, especially multiple myeloma?

Russell body gastritis (RBG) is a rare entity with unestablished pathophysiology, endoscopic findings, clinical manifestations and treatments. Literature is scarce on this clinical entity with unclear clinical significance. Of 18 cases reported, 12 tested (+) for Helicobacter pylori and improved with treatment, but it remains unclear whether this link is coincidental or bears some clinical significance. We describe a case of elderly woman who had a follow-up oesophagogastroduodenoscopy for chronic peptic ulcers, and biopsy showed positive immunohistochemical stains for κ and λ, indicating a polytypic population of plasma cells. Immunostaining for H pylori was negative. Biopsies were also (-) for gastric carcinoma, lymphoma and plasmacytoma. Considering her RGB-suggestive histology and her symptoms of bone pains and anaemia, multiple myeloma screening was considered clinically relevant. The purpose of this review was to educate clinicians and gastroenterologists about this unique entity and explore its association with multiple myeloma or other plamacytic malignancies.

Russell body gastroenteritis: an aberrant manifestation of chronic inflammation in gastrointestinal mucosa

First described in 1998, Russell body gastritis is a rare chronic inflammatory condition characterized by abundant intramucosal polyclonal plasma cells, which contain intracytoplasmic eosinophilic globules of immunoglobulins (Russell bodies) that displace the nucleus, with an accompanying chronic inflammatory infiltrate. Russell bodies represent a cellular response to overstimulation of plasma cells, leading to the accumulation of abundant, nondegradable, condensed immunoglobulin in dilated rough endoplasmic reticulum cisternae. Russell body gastritis usually occurs in the gastric antrum, but two cases of Russell body duodenitis have been recently described. Herein, we report an unusual case of Barrett esophagus with prominent lymphoplasmacytic infiltration and Russell bodies, which expands the current spectrum of Russell body gastritis/duodenitis. Given the various anatomic locations in which Russell body gastritis may arise, we suggest that “Russell body gastroenteritis” may be a more appropriate designation for this uncommon reactive condition.

Russell body duodenitis in a patient with retroperitoneal metastasis of ureteral cancer

Russell bodies are globular and eosinophilic inclusion bodies in the cytoplasm of mature plasma cells. Plasma cells whose cytoplasm is filled with Russell bodies are designated as Mott cells. Russell body duodenitis (RBD) is a unique form of chronic duodenitis that is characterized by infiltration of numerous Mott cells. RBD is very rare; only two cases have been reported to date. In this paper, we report a case of RBD in a patient with retroperitoneal metastasis of ureteral cancer. A 77-year-old man was admitted to our hospital complaining of appetite loss, vomiting, and upper abdominal distension. He had undergone left nephroureterectomy for ureteral cancer 4 years earlier. Upper digestive tract endoscopy revealed edema, stenosis, and punctate redness of the mucosa of the duodenum, and a biopsy was performed. Histological analysis showed that numerous Mott cells had infiltrated the lamina propria mucosae, and the condition was diagnosed as RBD. A mass lesion in the retroperitoneum adjacent to the duodenum was detected by abdominal computed tomography, and was diagnosed as metastatic urothelial carcinoma by biopsy. It is possible that chemokines produced by tumor cells caused RBD in this case.