Published online Dec 22, 2016.
https://doi.org/10.13029/jkaps.2016.22.2.23
The Usefulness of Calretinin Immunohistochemistry for Rectal Suction Biopsy to Diagnose Hirschsprung’s Disease
Abstract
Purpose
Hirschsprung’s disease (HD) is a congenital intestinal disorder with absence of ganglion cells in the intestinal muscle and submucosa. Diagnosis is based on histopathological study such as H&E, and acetylcholinesterase (AchE) immunohistochemistry. Calretinin immunohistochemistry was introduced as a new diagnostic method against limitations of other staining. The aim of this study is to investigate the usefulness of calretinin immunohistochemistry for the diagnosis of HD compared to H&E and AchE.
Methods
Ten patients with HD and 22 non-HD patients were included in the study. H&E staining, AchE and calretinin immunohistochemistry were performed in all 32 patients. All slides were evaluated by same single pathologist and the diagnostic value was calculated for each H&E stain, AchE immunohistochemical staining, and calretinin immunohistochemical staining.
Results
Calretinin method had sensitivity of 100% and specificity of 100% for diagnosis of HD. Its diagnostic accuracy was 100%. AchE staining showed 100% of specificity and 80% of sensitivity. Diagnostic accuracy of H&E staining was 56.3%.
Conclusion
We concluded that calretinin immunohistochemistry is a very useful and valuable method to diagnosis HD patient.
Fig. 1
Hirschsprung’s disease (HD) case shows diffuse proliferation of acetylcholinesterase (AchE) fibers (arrows) in lamina propria, muscularis mucosa, and submucosa (A), but complete absence of calretinin immunoreactive fibers (C). Non-HD case reveals many thin calretinin immunoreactive fibers (arrows; D), but no proliferation of AchE fibers (B). (A, B) AchE stain, ×100. (C, D) Calretinin stain, ×100.
Fig. 2
Hirschsprung’s disease case shows equivocal acetylcholinesterase (AchE) findings which have mild proliferation of AchE fibers in submucosa (A, B; AchE stain, ×100), but complete absence of calretinin immunoreactive fibers was observed (C, D; calretinin stain, ×100). This case is difficult to differentiate diagnosis for normal variation.
Table 1
Patient Profile
Table 2
Results of Calretinin Immunohistochemical Staining
Table 3
Cases of Repeated Biopsy
Table 4
Results of Acetylcholinesterase (AchE) Immunohistochemical Staining
Table 5
Results of H&E Staining
The content of this article was presented at the 30th Annual Meeting of the Korean Association of Pediatric Surgeons, Busan, June 2014.
CONFLICTS OF INTEREST:No potential conflict of interest relevant to this article was reported.
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