Menchaca-Cervantes C, Rodríguez-Velasco A, Ramón-García G, Rendón-Macías ME

Language: Spanish
References: 17
Page: 610-613
PDF size: 97.42 Kb.

ABSTRACT

Background: the confi rmatory diagnosis of Hirschsprung’s disease is made by histopathological study. However, this procedure is limited with only hematoxylin and eosin staining, especially in biopsies of premature babies or when non-expert pathologists make the evaluation. The immunohistochemistry from ganglia cell calretinin has been used to reduce the risk of misdiagnosis. Our objective was to show the benefi ts of this antibody in diagnosis of Hirschsprung’s disease in biopsy specimens.
Methods: we evaluated patients with histopathological diagnosis of Hirschsprung’s disease made by hematoxylin and eosin staining. We determined if there was enough paraffi n block for immunohistochemistry with two markers: calretinin and neurofi laments. Three controls of autopsy of children under 3 years of age with other diagnosis were included.
Results: of a total of 48 cases with histopathological diagnosis of Hirschsprung’s disease only 13 had adequate tissue for immunohistochemistry. The immunohistochemistry confi rmed the diagnosis in nine cases. In the other four cases there were initial misdiagnosis due to evidence of calretinin (ganglion cells) and, thus, Hirschsprung’s disease was discarded.
Conclusions: the use of immunohistochemistry allows confi rming the diagnosis of Hirschsprung’s disease and reduce the risk of a false-positive result with only hematoxylin and eosin staining.

REFERENCES

1. Grosfeld JL. Hirschsprung’s disease: a historical perspective 1961-2005. En: Holschneider AM, Puri P, editores. Hirschsprung’s disease and allied disorders. Third edition. New York: Springer; 2008.

2. Belkind-Gerson J, Madrazo-de la Garza JA, Coello- Ramírez P, García-Aranda A, Heller S, Lorrsa A. Enfermedad de Hirschsprung. Bol Med Hosp Infant Mex. 2002;59(12):800-9.

3. Hart J, Wilcox R, Weber CR. The gastrointestinal tract. En: Stocker JT, Dehner LP, editores. Pediatric pathology. Third edition. USA: Wolters Kluwer/Lippincott Williams & Wilkins; 2011. p. 592-96.

4. Reyes MM, Ponce CMA. Enfermedad de Hirschsprung: diagnóstico anatomopatológico y patogenia. Patologia. 1998;36:157-63.

5. Meir-Ruge W. Hirschsprung’s disease: its aetiology, pathogenesis and differential diagnosis. Curr Top Pathol. 1974;59:131-79.

6. Diamond IR, Casadiego G, Traubici J, Langer JG, Wales PW. The contrast enema for Hirschsprung disease: predictors of a false-positive result. J Pediatr Surg. 2007;42(5):792-5.

7. Lewis NA, Levitt MA, Zallen GS, Zafar MS, Iacono KL, Rossman JE, et al. Diagnosing Hirschsprung’s disease: increasing the odds of a positive rectal biopsy result. J Pediatr Surg. 2003;38(3):412-6.

8. Weinberg AG. Hirschsprung’s disease. A pathologist’s view. Perspect Pediatr Pathol. 1975;2: 207-39.

9. Fenoglio-Preiser CM. Gastrointestinal pathology: an atlas and text. Third edition. USA: Lippincontt Williams & Wilkins; 2008. p. 643-52.

10. Kapur RP. Immunohistochemistry and the diagnosis of Hirschsprung disease. Am J Clin Pathol. 2006; 126:9-12. Texto libre en http://ajcp.ascpjournals.org/ content/126/1/9.full.pdf

11. Memarzadeh M, Talebi A, Edalaty M, Hosseinpour M, Vahidi N. Hirschsprung’s disease diagnosis: comparison of immunohistochemical, hematoxilin and eosin staining. J Indian Assoc Pediatr Surg. 2009;14 (2):59-62.

12. Qualman SJ, Jaffe R, Bove KE, Monforte-Muñoz H. Diagnosis of Hirschsprung disease using the rectal biopsy: multi-institutional survey. Pediatr Dev Pathol. 1999;2(6):588-96.

13. De la Torre-Mondragón L. Enfermedad de Hirschsprung. Mitos y realidades a 120 años de su descripción. Acta Pediatr Mex. 2008;29(3):139-46.

14. Barshack I, Fridman E, Goldberg I, Chowers Y, Kopolovic J. The loss of calretinin expression indicates aganglionosis in Hirschsprung disease. J Clin Pathol. 2004;57(7):712-6. Texto libre en http://www. ncbi.nlm.nih.gov/pmc/articles/PMC1770342/

15. Kapur RP, Reed RC, Finn LS, Patterson K, Johanson J, Rutledge JC. Calretinin immunohistochemistry versus acetylcholinesterase histochemistry in the evaluation of suction rectal biopsies for Hirschsprung disease. Pediatr Dev Pathol. 2009;12(1):6-15.

16. Guinard VS, Bonnard A, De Lagausie P, Pascale PC, Alberti C, El Ghoneimi A, et al. Calretinin immunohistochemistry: a simple and effi cient tool to diagnose Hirschsprung disease. Mod Pathol. 2009;22(10):1379- 84. Texto libre en http://www.nature.com/modpathol/ journal/v22/n10/full/modpathol2009110a.html

17. Altamirano E, Drut R. Aganglionosis total segmentaria combinada con aganglionosis clásica. Patol Rev Latinoam. 2009;47(4):351-3.