July 2015 Case of the Month

79 year-old man with chronic anemia, undergoing upper endoscopy.  Gastroenterologist describes a gastric ulcer in the endoscopy report.  What is your diagnosis?

4x
4x

Low power view shows gastric oxyntic-type mucosa with an erosion and layer of exudate with admixed grayish-brown material.

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10x
10x

Eroded area shows degenerating gastric pits with areas of hemorrhage and fibrin.

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Iron Stain
Iron Stain

An iron stain highlights the previously described smudgy gray-brown material.

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4x
4x

Low power view shows gastric oxyntic-type mucosa with an erosion and layer of exudate with admixed grayish-brown material.

press to zoom
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July 2015 Case of the Month

   Answer: Iron Pill Gastritis

The gastric biopsy shows a focal mucosal erosion with conspicuous grayish-brown amorphous material overlying the eroded area.  A background inflammatory exudate, hemorrhage, and reactive epithelial changes are noted.  An iron stain highlights the amorphous material, confirming the diagnosis of iron pill gastritis.  The patient had been taking ferrous sulfate tablets for his chronic anemia, resulting in gastric irritation.  Iron pill induced gastritis is postulated to cause corrosive mucosal injury similar to other chemical irritants.  It has been reported that the liquid form of iron supplementation does not cause gastric injury unlike the tablet formulation.