Lymphatic abnormalities in protein-losing gastropathy, especially in Ménétrier's disease

Histopathologic and lymphographic studies were performed in 4 patients with protein-losing gastropathy to elucidate the degree of lymphatic disorders and their contribution to clinical features. Histologic examination of gastric mucosa showed various degrees of hyperplasia of the surface epithelium and cystic dilatation of glands, which were considered to be characteristic findings of protein losing gastropathy. Moreover, in 3 of 4 patients there were edematous change of the lamina propria or the submucosa, and marked lymphangiectasia was seen in the submucosa of 3 patients and in the lamina propria of the other. Performed lymphograms showed an increase in the number of lymphatic vessels and lymph nodes in the iliopelvic and lumbar regions of 2 of the patients. This high incidence of lymphatic abnormalities in patients with protein-losing gastropathy suggested that such systemic lymphatic disorders were an important etiologic factor. However, such abnormalities in lymphatic system were not demonstrated in all cases of protein-losing gastropathy. Therefore, lymphatic disorders were not considered to be the primary cause of gastric protein loss, but the important factor that modifies the variety of lost protein and its clinical features.