ECL (enterochromaffin-like) cell hyperplasia

ECL cell hyperplasia refers to an increase in the number of enterochromaffin-like (ECL) cells within the stomach lining. ECL cells are neuroendocrine cells that play an important role in the regulation of acid production in the stomach.

Where are ECL (enterochromaffin-like) cells normally found, and what do they do?

ECL cells are normally found in the stomach, particularly specialized oxyntic glands found in the fundus or body of the stomach. These cells are primarily involved in the secretion of histamine, a key regulator of gastric acid secretion by the parietal cells. ECL cells release histamine in response to stimulation by gastrin, a hormone produced by G-cells in the antrum of the stomach. Through these interactions, ECL cells play a central role in the digestive process by helping to control the stomach’s pH levels.

What medical conditions are associated with ECL (enterochromaffin-like) cell hyperplasia?

ECL cell hyperplasia is associated with several conditions that influence the stomach’s acid production:

  • Chronic atrophic gastritis: Especially in cases of autoimmune gastritis, where the loss of acid-secreting parietal cells leads to increased gastrin levels, stimulating ECL cell growth.
  • Zollinger-Ellison syndrome: This syndrome involves a gastrin-secreting tumor (gastrinoma) that causes excessive levels of gastrin, leading to ECL cell proliferation.
  • Prolonged use of proton pump inhibitors (PPIs): These drugs decrease stomach acid production, which can result in compensatory gastrin release and subsequent ECL cell hyperplasia.
  • Chronic Helicobacter pylori infection: Prolonged infection of the body of the stomach can lead to increased gastrin production and ECL cell hyperplasia.

What are the symptoms of ECL (enterochromaffin-like) cell hyperplasia?

ECL cell hyperplasia itself typically does not produce direct symptoms. Instead, the conditions associated with this change may lead to symptoms. ECL cell hyperplasia is generally seen in contexts where there is altered gastric acid secretion due to the overproduction of gastrin, the hormone that stimulates these cells.

Symptoms associated with conditions that cause ECL cell hyperplasia include:

  • Severe and recurrent peptic ulcers, abdominal pain, reflux, and diarrhea due to the excessive acid production stimulated by high levels of gastrin in Zollinger-Ellison syndrome.
  • Digestive issues include malabsorption (especially of iron and vitamin B12), mild abdominal discomfort, bloating, and possibly anemia from vitamin B12 deficiency in cases of chronic atrophic gastritis.

What is the significance of finding ECL (Enterochromaffin-like) cell hyperplasia in a biopsy?

Identifying ECL cell hyperplasia in a stomach biopsy is important for the following reasons:

  • Underlying conditions like chronic gastritis or hormonal imbalances affecting stomach function may be identified.
  • Patients with ECL cell hyperplasia have an elevated risk of developing neuroendocrine tumors (NETs), particularly with severe or prolonged hyperplasia.
  • Your doctor may choose to review the use of long-term acid suppression therapy PPIs.

What are the microscopic features of ECL (enterochromaffin-like) cell hyperplasia?

The microscopic features of ECL cell hyperplasia of the stomach, include:

  • Increased density of ECL cells within the stomach glands, often at the gland base.
  • Nodular hyperplasia: This type of hyperplasia is characterized by the formation of small nodules or clusters of ECL cells within the gastric mucosa. Important because it can be a precursor to neuroendocrine tumour development.
  • Linear hyperplasia: This type of hyperplasia involves a line-like increase of ECL cells along the gastric glands. Linear hyperplasia is associated with a lower overall risk of developing a neuroendocrine tumour.

Specific immunohistochemical stains used to confirm ECL cell hyperplasia include:

  • Chromogranin A: Positive staining confirms the neuroendocrine nature of ECL cells.
  • Synaptophysin: This also highlights the neuroendocrine properties of the cells.

About this article

Doctors wrote this article to help you read and understand your pathology report. Contact us with any questions about this article or your pathology report. Read this article for a more general introduction to the parts of a typical pathology report.

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