Current Concepts of Enzyme Histochemistry in Modern Pathology

Meier‐Ruge, W.; Bruder, Elisabeth

doi:10.1159/000132384

Cited by 31 publications

(21 citation statements)

References 110 publications

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“…The number and the thickness of AChE-positive nerve fibers are increased in the muscularis mucosae and lamina propria in rectal biopsies of most patients with HD. 12 Although used for decades, 13 AChE has several disadvantages. Acetylcholinesterase histochemistry requires the use of frozen tissue, interrupting the usual workflow of a surgical pathology laboratory.…”

Section: According To a Recent Consensus Article By The Gastro 2009mentioning

confidence: 99%

Hirschsprung Disease and Use of Calretinin in Inadequate Rectal Suction Biopsies

Gonzálo

Plesec

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Up to 17% of all rectal suction biopsies performed in the evaluation of Hirschsprung disease are considered inadequate. In most instances, inadequate biopsies contain too little submucosa or are taken within the anal transition zone. Objectives.—To examine the utility of calretinin stain in the workup of inadequate biopsies for patients with clinical suspicion of Hirschsprung disease. Design.—A retrospective analysis was conducted of all rectal suction biopsies performed in the evaluation of Hirschsprung disease during the previous 12 years that were considered “inadequate.” Seventeen cases were identified, and Hirschsprung disease status was determined by clinical or surgical follow-up. Immunohistochemistry for calretinin was performed for all cases containing columnar mucosa, which were evaluated without knowledge of clinical course. Results.—All 12 patients without Hirschsprung disease had calretinin-positive nerve fibers in the lamina propria or muscularis mucosae, and all 5 patients with Hirschsprung disease had no calretinin staining of nerves. Conclusions.—In this retrospective series, calretinin immunohistochemistry correctly predicted outcome in all instances. Although the gold standard for the diagnosis of Hirschsprung disease in rectal suction biopsies remains the evaluation of ganglion cells in a hematoxylin-eosin staining with sufficient submucosa, calretinin immunohistochemistry is quite helpful in triaging further workup based on clinical suspicion.

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Section: According To a Recent Consensus Article By The Gastro 2009mentioning

confidence: 99%

Hirschsprung Disease and Use of Calretinin in Inadequate Rectal Suction Biopsies

Gonzálo

Plesec

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…5,6 This technique, showing staining of extrinsic nerve fibers, provides quick results but requires frozen tissue samples. The last reports show good specificity of an abnormal acetylcholinesterase staining (up to 100%) but insufficient sensibility (as low as 85%).…”

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confidence: 99%

Calretinin immunohistochemistry: a simple and efficient tool to diagnose Hirschsprung disease

et al. 2009

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Diagnosis of Hirschsprung disease (HD) is quite entirely based on the histopathological analysis of suction rectal biopsies. This hematoxylin and eosin approach has some limitations, despite the help of acetylcholinesterase staining. The aim of this study was to assess the diagnostic value of calretinin immunochemistry as a simple and reliable method in the diagnosis of HD. A total of 131 initial rectal biopsies carried out for suspicion of HD in children were retrieved, and calretinin immunohistochemistry was carried out on paraffin-embedded biopsies. Diagnosis of HD was made when no staining was observed. The results were statistically analyzed in comparison with our standard method (histology and acetylcholinesterase staining). 130 biopsies were accurately diagnosed on the basis of the positivity or negativity of calretinin staining. The senior pathologists diagnosed all cases of HD with no false positives. Furthermore, 12 additional cases initially considered as doubtful for HD using the standard method, were accurately diagnosed using calretinin immunohistochemistry. The false negative was a case of HD with a calretinin-positive biopsy. We also demonstrate the ease of calretinin interpretation compared with acetylcholinesterase for the junior pathologist. Calretinin immunohistochemistry overcomes most of the difficulties encountered using the combination of histology and acetylcholinesterase staining, and detects almost all cases of HD with confidence, with no false positives. Thus, we demonstrate that calretinin is superior to acetylcholinesterase to complete histology and could advantageously substitute for acetylcholinesterase. Modern Pathology ( The diagnosis of Hirschsprung disease (HD) is based on a combination of clinical features, radiological appearance of the bowel and histological features on suction rectal biopsies, 1,2 that is, aganglionosis and abnormally large nerves. In practice, a definite diagnosis of HD, leading to surgical treatment, is quite entirely based on histological results. 3,4 Several efficient approaches have been devised to assess the diagnosis of HD using a combination of standard histology and histochemistry. Standard histology obtained from rectal suction biopsies that sample mucosa and underlying submucosa, demonstrating rectal aganglionosis, requires the analysis of 100 or more histological sections to ensure good specificity, and is therefore time consuming. Moreover, difficulties in analysis may arise in several situations: (1) when the site of biopsy is too distal, because of the physiological paucity of ganglion cells; (2) when the sample is too superficial with not enough submucosa; and (3) when there is difficulty in identifying ganglion cells with confidence, particularly in neonates.For these reasons, standard histology is frequently supplemented with acetylcholinesterase histochemistry. 5,6 This technique, showing staining of extrinsic nerve fibers, provides quick results but requires frozen tissue samples. The last reports show good specificity of an abnormal ac...

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“…Resection specimens were coiled caudocranially. For initial diagnosis material was frozen, serially cut and stained for acetylcholinesterase; afterwards, residual tissue was formalin‐fixed, paraffin‐embedded, cut and stained with H&E. Using the current gold standard proposed by Bruder et al ., 18 of the 37 patients were diagnosed with HD, 13 were regarded as healthy and for six the diagnosis remained histologically unclear.…”

Section: Methodsmentioning

confidence: 99%

Immunohistochemical panel for the diagnosis of Hirschsprung's disease using antibodies to MAP2, calretinin, GLUT1 and S100

et al. 2015

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Current Concepts of Enzyme Histochemistry in Modern Pathology

Cited by 31 publications

References 110 publications

Hirschsprung Disease and Use of Calretinin in Inadequate Rectal Suction Biopsies

Hirschsprung Disease and Use of Calretinin in Inadequate Rectal Suction Biopsies

Calretinin immunohistochemistry: a simple and efficient tool to diagnose Hirschsprung disease

Immunohistochemical panel for the diagnosis of Hirschsprung's disease using antibodies to MAP2, calretinin, GLUT1 and S100

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