J Korean Assoc Pediatr Surg. 2016 Dec;22(2):23-28. Korean.
Published online Dec 22, 2016.
Copyright © 2016 by the Korean Association of Pediatric Surgeons
Original Article

The Usefulness of Calretinin Immunohistochemistry for Rectal Suction Biopsy to Diagnose Hirschsprung’s Disease

Jaeyeop Jeong,1 Sang Pyo Kim,2 Eunyoung Jung,1 and Soon-Ok Choi1
    • 1Department of Pediatric Surgery, Donsgan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
    • 2Department of Pathology, Donsgan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Received June 01, 2016; Revised July 11, 2016; Accepted July 21, 2016.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords
Hirschsprung disease; Calbindin 2; Acetylcholinesterase; Hematoxylin; Diagnosis

Figures

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.

Tables

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

Notes

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.

References

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