Gastric hyalinization associated with peptic ulceration

Gastric hyalinization, the severe hyaline thickening of the stomach wall that predominantly involves the submucosa, seems to have been described only in autopsy cases. Although initially thought to be a consequence of radiation or chemotherapy, subsequent studies suggested that it results from an artifactual postmortem chemical denaturation of the protein of the gastric submucosa, possibly related to an agonal tear in the gastric submucosa. We studied the clinicopathologic and ultrastructural findings in a case that had morphologic features of gastric hyalinization but that, in contrast with previous reports, was present in a surgically removed stomach and was associated with a small, chronic, peptic ulcer, with clinical manifestations of gastromegaly and borderline gastric retention. Ultrastructurally, the severe submucosal hyaline thickening that focally involved the muscularis and serosa largely consisted of proteinaceous material, ground substance, and collagen fibers, with occasional interspersed fibroblasts and myofibroblasts. This case indicated that gastric hyalinization can be a nonartifactual and clinically significant entity that may be associated with peptic ulcer disease and that should be distinguished from neoplastic (linitis plastica) and other processes.