gastro-congress-2016_posters-accepted-abstracts

Volume 6, Issue 7(Suppl)

J Gastrointest Dig Syst 2016

ISSN: 2161-069X JGDS, an open access journal

Page 72

Gastro Congress 2016

October 24-25, 2016

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October 24-25, 2016 Valencia, Spain

Euro Global

Gastroenterology Conference

J Gastrointest Dig Syst 2016, 6:7(Suppl)

Calretinin Expression in Hirsch sprung Disease – A Potential Marker of Ganglion Cells

Mishal Sikandar

University of Health Sciences, Lahore, Pakistan

Statement of problem: Hirschsprung disease (HSCR) or congenital intestinal aganglionosis is a birth defect characterized by

complete absence of neuronal ganglion cells from a portion of the intestinal tract, mostly in a segment of rectum and variable

length of contiguous proximal, causing functional obstruction and colonic dilation proximal to affected segment. (Amiel and

Lyonnet, 2001) Routine diagnostic modalities like Haematoxylin & Eosin (H&E) and Acetylcholine Esterase (AChE) staining

as well as radiology-based clinical techniques have been conventionally used for identification of aganglionosis and presence

of hypertrophic nerve trunks in the affected segment as primary indicators of HSCR. (Kacar et al., 2012) However, these con-

ventional methods have their inherent deficiencies as H&E requires multiple trans-mural biopsies and the interpretation of

ganglion cells is often very difficult. (Tabbers et al., 2014) Similarly, AChE requires fresh frozen section for which the chances of

technical error are very high and this facility is not commonly available in Pakistan. The number of misdiagnosed results with

potential overtreatment stands in need for reliable staining to prevent harm from unnecessary surgery and mortality. Recently,

Immunohistochemical markers are being increasingly used and evaluated in Pathology laboratories. No immunohistochemi-

cal marker, either alone or in combination, has emerged from those researches that are as promising as Calretinin. Hence, this

study was designed with an aim to observe the immunohistochemical expression of Calretinin as a marker for aganglionosis

and to detect ganglion cells in the affected areas for better and more accurate diagnosis of the disease.

Methodology: This study was conducted at University of Health Sciences Lahore, Pakistan from February to September, 2016.

Colonic Biopsy Specimens from 73 patients collected mostly from Mayo Hospital, Lahore with established histopathologic

diagnosis of HSCR were considered for the study. Age range was 0.1-120months. There were 48(65.8%) cases who were ≤12

months old, 20(27.4%) were 12.1-60 months old and 5(6.8%) of the cases were 60.1-120 month old. The mean age of patients

was 12.52±9.21 months. There were 52(71.23%) male and 21(28.77%) female patients. The male to female ratio in this study

was 2.48:1. According to sign and symptoms and clinical examination, 69(94.5%) cases had mostly long standing constipation,

47(64.4%) cases had fever, 68(93.2%) cases had vomiting, 31(42.5%) cases had failure to thrive, 20(27.4%) cases had Enteroco-

litis and 63(86.3%) of the patients had palpable abdominal masses. Methodology involved staining of fresh sections with H&E

procedure for provisional histological diagnosis. The biopsies were then processed for immunohistochemical staining with

Calretinin and were observed for presence of ganglion cells.

Findings: All the ganglion cells took brownish-black stain and were easily identified, which were not being identified on H&E.

Ganglion cells were present and absent in 42(57.53%) and 31(42.47%) respectively. The study revealed that the Calretinin im-

munohistochemistry was very sensitive and specific for detecting ganglion cells.

Conclusion and significance: It was concluded that Calretinin provides a very reliable and cost effective adjunctive test to be

routinely used with H&E in the evaluation of Rectal Section Biopsies (RSBs) for HSCR. The use of Calretinin may help the

Pathologists in making accurate and reliable diagnosis for HSCR and consequently eliminating the need for repeated biopsies

and unnecessary surgeries.