TY - JOUR
T1 - Gastric Glandular Siderosis but not Lamina Propria Siderosis is Associated with High Serum Ferritin Levels
AU - Sarwate, Mrinal
AU - Khaitan, Neha
AU - Alpert, Lindsay
AU - Tavberidze, Nika
AU - Zhang, Wei
AU - Panarelli, Nicole
AU - Hu, Shaomin
N1 - Publisher Copyright:
© Copyright 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Three histologic patterns of gastric siderosis (GS) are described: pattern A (predominantly in lamina propria stromal cells - gastric lamina propria siderosis [GLPS]), pattern B (mostly extracellular crystalline iron) and pattern C (predominantly in glandular epithelium - gastric glandular siderosis [GGS]). This study aimed to analyze the association of GGS with clinicopathologic features using 3 cohorts. Cohort #1 consisted of 76 gastric siderosis cases. Upon classifying the cases into 3 groups by percentage of glandular involvement (negative, 1% to 5%, ≥5% GGS), the degree of GGS was positively associated with serum ferritin levels (P=0.002), transferrin saturation (P=0.003), and history of blood transfusion (P=0.009). After excluding cases with coarse extracellular crystalline iron, cohort #1 was reclassified into 3 groups by degree of GLPS (no, rare [discernible at ×20 or ×40], overt [readily visible at low power]). The degree of GLPS was positively correlated with oral iron pill use (P=0.01), but not serum ferritin levels or transferrin saturation. Cohort #2 contained 31 gastric samples from patients with hereditary hemochromatosis, most received phlebotomy treatment. GGS was identified in 2 (6.4%) patients; both had high ferritin levels. Cohort #3 included 38 gastric samples from patients with cirrhosis. Three (8%) cases showed GGS; serum ferritin level was available for 1 case and was elevated. These results indicate that GGS is associated with systemic iron overload, while GLPS is correlated with oral iron pill use. The identification of GGS, especially when it's ≥5%, should trigger further workup for potential systemic iron overload and underlying etiologies.
AB - Three histologic patterns of gastric siderosis (GS) are described: pattern A (predominantly in lamina propria stromal cells - gastric lamina propria siderosis [GLPS]), pattern B (mostly extracellular crystalline iron) and pattern C (predominantly in glandular epithelium - gastric glandular siderosis [GGS]). This study aimed to analyze the association of GGS with clinicopathologic features using 3 cohorts. Cohort #1 consisted of 76 gastric siderosis cases. Upon classifying the cases into 3 groups by percentage of glandular involvement (negative, 1% to 5%, ≥5% GGS), the degree of GGS was positively associated with serum ferritin levels (P=0.002), transferrin saturation (P=0.003), and history of blood transfusion (P=0.009). After excluding cases with coarse extracellular crystalline iron, cohort #1 was reclassified into 3 groups by degree of GLPS (no, rare [discernible at ×20 or ×40], overt [readily visible at low power]). The degree of GLPS was positively correlated with oral iron pill use (P=0.01), but not serum ferritin levels or transferrin saturation. Cohort #2 contained 31 gastric samples from patients with hereditary hemochromatosis, most received phlebotomy treatment. GGS was identified in 2 (6.4%) patients; both had high ferritin levels. Cohort #3 included 38 gastric samples from patients with cirrhosis. Three (8%) cases showed GGS; serum ferritin level was available for 1 case and was elevated. These results indicate that GGS is associated with systemic iron overload, while GLPS is correlated with oral iron pill use. The identification of GGS, especially when it's ≥5%, should trigger further workup for potential systemic iron overload and underlying etiologies.
KW - gastric glandular siderosis
KW - gastric lamina propria siderosis
KW - gastric siderosis
KW - hereditary hemochromatosis
KW - systemic iron overload
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U2 - 10.1097/PAS.0000000000002080
DO - 10.1097/PAS.0000000000002080
M3 - Article
C2 - 37357943
AN - SCOPUS:85168221633
SN - 0147-5185
VL - 47
SP - 1052
EP - 1058
JO - American Journal of Surgical Pathology
JF - American Journal of Surgical Pathology
IS - 9
ER -