Characterization of neuroendocrine cell hyperplasia in autoimmune gastritis: improving H&E-based diagnosis through systematic training

Sep 30, 2026

Study evaluates morphological features of enterochromaffin-like (ECL) cell hyperplasia in autoimmune gastritis (AIG) to strengthen diagnostic performance when relying on hematoxylin and eosin (H&E) sections rather than chromogranin A (CgA) staining. Seventy-three AIG patients from June 2023 to June 2024 were reviewed, comparing ECL identification on H&E versus CgA and assessing pathologist concordance before and after systematic training. Inflammation, atrophy, and intestinal metaplasia did not predict hyperplasia type, while training significantly improved detection accuracy and reduced missed diagnoses for clinical monitoring.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Materials and methods

Patient selection and clinicopathological review

Results

Conclusions

Wang et al. BMCGastroenterology (2026) 26:9 [https://doi.org/10.1186/s12876-025-04375-z](https://doi.org/10.1186/s12876-025-04375-z) BMC Gastroenterology RESEARCH Open Access Characterization of neuroendocrine cell hyperplasia in autoimmune gastritis: improving H&E-based diagnosis through systematic training Lining Wang 1, Huizhong Xue 1, Lu Wang 1, Shanshan Li 1, Meng Zhao 1 and Xiaogang Liu 1* Abstract Background The incidence of autoimmune gastritis (AIG) is low, and our understanding of the proliferation of neuroendocrine cells, specifically enterochromaffin-like (ECL) cells, is insufficient because of the reliance on chromogranin A (CgA) staining for diagnostic assistance. The purpose of this study was to analyze the morphological characteristics of neuroendocrine cell hyperplasia in H&E-stained sections and improve pathologists’ diagnostic accuracy in its identification. Methods A total of 73 patients with AIG were reviewed in a single center-the Department of Pathology of Chuiyangliu Hospital affiliated with Tsinghua University from June 2023 to June 2024. We characterized patients with AIG, compared the identification of ECL hyperplasia between H&E-stained sections and CgA-stained sections, and analyzed the diagnostic concordance rate of pathologists before and after training on the diagnosis of ECL hyperplasia using H&E-stained sections. Results Age, sex and histopathological findings, such as the degree of inflammation, atrophy, and intestinal metaplasia, were not significantly related to the type of ECL hyperplasia. Fifty-three patients (72 . 6%) were confirmed by CgA staining to have ECL hyperplasia, and linear and micronodular forms were the most common types. After being trained on the morphology associated with ECL hyperplasia, pathologists with different years of experience significantly improved their ability to identify neuroendocrine cells in patients with AIG. Conclusions A better understanding of the morphological assessment of ECL hyperplasia using H&E-stained sections is necessary to improve the understanding and diagnosis of ECL hyperplasia, to avoid missed diagnoses, and to facilitate subsequent clinical monitoring and treatment. Keywords Autoimmune gastritis, Enterochromaffin-like cell hyperplasia, Chromogranin A, Hematoxylin and eosinstained, Pathologist training, Diagnostic accuracy *Correspondence: Xiaogang Liu [chinalark@163.com](chinalark@163.com) 1Department of Pathology, Chuiyangliu Hospital affiliated with Tsinghua University, Beijing 100022, China © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Wang et al. BMC Gastroenterology (2026) 26:9 Introduction Autoimmune gastritis (AIG), also referred to as type A gastritis, is a form of gastritis stemming from abnormal autoimmune function [1]. Clinically, it frequently manifests as iron deficiency anemia, pernicious anemia, or neurological symptoms and is often accompanied by other autoimmune diseases. End

FAQs

Why is chromogranin A (CgA) staining a limitation in diagnosing ECL hyperplasia in autoimmune gastritis?

The study notes that understanding and proliferation assessment of ECL cells is insufficient because diagnostic assistance relies on CgA staining; smaller ECL hyperplasia forms can be overlooked on routine H&E alone.

How was the study designed to compare H&E-based and CgA-based identification of ECL hyperplasia?

A total of 73 AIG patients were reviewed at a single center, and ECL hyperplasia identification was compared between H&E-stained sections and CgA-stained sections. Pathologists’ diagnostic concordance was also measured before and after training.

What effect did systematic morphological training have on diagnostic accuracy?

After training on morphology associated with ECL hyperplasia, pathologists with different experience levels significantly improved their ability to identify neuroendocrine cells in AIG patients.

Sep 30, 2026

Upload by Rainbow Cat