J Korean Assoc Pediatr Surg.  2016 Dec;22(2):23-28. 10.13029/jkaps.2016.22.2.23.

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

• Jeong J
• Kim SP
• Jung E
• Choi SO

• KMID: 2363019
• DOI: http://doi.org/10.13029/jkaps.2016.22.2.23

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.

Keyword

Hirschsprung disease; Calbindin 2; Acetylcholinesterase; Hematoxylin; Diagnosis

MeSH Terms

Acetylcholinesterase
Biopsy*
Calbindin 2*
Diagnosis
Ganglion Cysts
Hematoxylin
Hirschsprung Disease
Humans
Immunohistochemistry*
Sensitivity and Specificity
Suction*
Acetylcholinesterase
Hematoxylin

Figure

• 

  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.

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