Definition/General
Introduction:
Normal gastric cytology demonstrates the characteristic cellular morphology of healthy gastric mucosa
Understanding normal patterns is essential for pathological diagnosis
Gastric cytology is obtained through lavage, brushing, or fine needle aspiration.
Origin:
Gastric mucosa consists of specialized glandular epithelium
Surface mucous cells line the surface and foveolae
Mucous neck cells in the neck region
Chief cells produce pepsinogen
Parietal cells secrete hydrochloric acid.
Classification:
Normal gastric cells classified by anatomical region and cell type
Cardia: Mucus-secreting glands
Fundus/Body: Oxyntic glands with parietal and chief cells
Antrum: Pyloric glands with mucus cells.
Epidemiology:
Normal gastric cytology shows age-related variations
Regional differences in cell populations
Hormonal influences affect glandular activity
Helicobacter pylori status influences morphology.
Clinical Features
Presentation:
Asymptomatic individuals
Screening procedures
Surveillance programs
Research studies
Quality control specimens.
Symptoms:
No symptoms in normal individuals
Normal digestion
No abdominal pain
Normal appetite
No nausea or vomiting.
Risk Factors:
No specific risk factors
Age-related changes
Dietary influences
Geographic variations
Genetic factors.
Screening:
High-risk population screening
Family history screening
Geographic high-risk areas
Occupational exposure screening.
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Gross Description
Appearance:
Pink, smooth mucosa
Rugae in fundus and body
Normal vascular pattern
No ulceration or masses
Clear gastric juice.
Characteristics:
Glistening mucosal surface
Prominent rugal folds
Normal peristalsis
Clear secretions
No inflammatory changes.
Size Location:
Normal anatomy: Cardia, fundus, body, antrum, pylorus
Regional mucosal differences
Smooth muscle walls.
Multifocality:
Uniform regional patterns
No focal lesions
Normal anatomical landmarks
Physiological variations.
Microscopic Description
Histological Features:
Surface mucous cells: Columnar with apical mucin
Parietal cells: Large, eosinophilic, central nuclei
Chief cells: Basophilic cytoplasm, basal nuclei
Mucous neck cells: Pale cytoplasm, basal nuclei.
Cellular Characteristics:
Surface cells: Columnar, 20-30 μm, apical mucin vacuoles
Parietal cells: Round, 25-35 μm, abundant eosinophilic cytoplasm
Chief cells: Pyramidal, 15-20 μm, basophilic cytoplasm
Uniform nuclear features.
Architectural Patterns:
Gastric pits (foveolae)
Tubular glands
Neck region with mucous neck cells
Base region with chief and parietal cells
Proper muscle layer.
Grading Criteria:
Adequate cellularity: Representative cell types present
Good preservation: Clear morphological details
Clean background: Minimal debris and contamination.
Immunohistochemistry
Positive Markers:
MUC5AC (surface mucous cells)
MUC6 (deep glands)
Pepsinogen I (chief cells)
H+/K+-ATPase (parietal cells)
CK7 (glandular epithelium)
CDX2 (intestinal metaplasia, absent in normal).
Negative Markers:
CK20 (intestinal marker)
CDX2 (intestinal marker)
Chromogranin (neuroendocrine)
Synaptophysin (neuroendocrine).
Diagnostic Utility:
Confirms gastric epithelial identity
Cell type identification
Normal differentiation markers
Baseline for comparison.
Molecular Subtypes:
Normal gastric phenotype
Regional variations
Age-related changes
No pathological subtypes.
Molecular/Genetic
Genetic Mutations:
No pathological mutations
Normal DNA repair
Intact tumor suppressor genes
Normal oncogene expression.
Molecular Markers:
Normal p53 expression
Normal proliferation markers
Normal apoptosis
Intact cell cycle control.
Prognostic Significance:
Baseline normal state
Reference standard
No progression risk
Quality control.
Therapeutic Targets:
No intervention required
Preventive measures
H
pylori screening
Lifestyle modifications.
Differential Diagnosis
Similar Entities:
Reactive changes
Intestinal metaplasia
Mild dysplasia
Inflammatory changes
Atrophy.
Distinguishing Features:
Normal: Typical cell types present
Normal: No atypia
Reactive: Nuclear enlargement
Metaplasia: Intestinal features
Dysplasia: Architectural distortion.
Diagnostic Challenges:
Regional variations
Age-related changes
Sampling adequacy
Processing artifacts.
Rare Variants:
Gastric heterotopia
Pancreatic metaplasia
Ciliated metaplasia.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Gastric cytology, [technique used], adequate cellularity
Diagnosis
Normal gastric cytology
Cellular Composition
Normal gastric epithelial cells: [surface, parietal, chief, mucous neck] cells
Cell Types
Cell types: [surface mucous cells], [parietal cells], [chief cells] present
Morphological Features
Morphology: [typical features] with [normal nuclear characteristics]
Background Findings
Background: [clean/minimal debris], [mucus], no inflammation
Adequacy Assessment
Specimen adequacy: [satisfactory for evaluation]
Special Findings
Special findings: [none], no H. pylori organisms identified
Final Diagnosis
Gastric cytology: Within normal limits