Histopathological Evaluation of Pediatric Intestinal Pseudo-Obstruction: Quantitative Morphometric Analysis of Pathological Changes in the Enteric Nervous System

Abstract

Background : This study was done to obtain comprehensive data on changes in the structural components of the enteric nervous system in pediatric patients with intestinal pseudo-obstruction (IPO). We evaluated routinely processed, in formalin-fixed tissues by quantitative morphometric analysis. In addition, we used formalin-fixed tissue to explore the possibility of using previously proposed diagnostic criteria to evaluate frozen serial sections for intestinal neuronal dysplasia (IND) type B and hypoganglionosis. Methods : We analyzed data for 19 IPO cases. Morphometric analysis for quantification of ganglia and ganglion cells (GCs) was done for the myentric and the submucous plexus. In addition, we determined the presence of immature GCs and the distribution of nerve fibers and interstitial cells of Cajal (ICC). Results : Nine patients showed combined hypoganglionosis, IND, and decreased ICC; others showed various combinations of these. Several morphometric factors were significantly different between patient groups as well as being different than the control group. Conclusions : Our pediatric IPO cases showed extensive overlapping of pathological findings. And the findings suggest the utility of using previously proposed morphometrically measured factors in multiple frozen sections as diagnostic criteria for IND type B and hypoganglionosis in formalin-fixed tissue.

Morphometric profile of large intestinal neuronal plexuses in normal perinatal autopsies and Hirschsprung disease

“…The number of ganglion cells/ganglion, again showed discordance among different studies. Our data were in concordance with the most recent studies by Kim et al . and Meier‐Ruge et al …”

“…The ganglion cells were significantly larger in the adult when compared to that of the neonates in our study, as would be expected. The length of the ganglion cells was similar to those measured in the study by Kim et al …”

“…The differences in ganglion cell size and number of ganglion cells/ganglion and interganglion distance between the control group and the normoganglionic zone of HSCR can be explained by the younger age of the control group as well as the possible autolytic changes in the autopsy specimens. Comparison has been made with other studies that have examined the morphometric profile of ganglion cells. When IHC with Hu C/D was used, there seemed to be more ganglion cells identified .…”

Histopathological and Immunohistochemical Findings in Congenital Pouch Colon: A Prospective Study

“…The mature ganglionic cells were identified by their large cell body with dispersed chromatin and a prominent nucleolus. If only part of a cell body with the typical cytoplasm was clearly identified, it was also counted [15] .…”

“…Compared with positive reaction in the submucosal vascular wall, the grading of the positive reaction was recorded as follows: 1 = a markedly reduced positive reaction, 2 = a mildly reduced positive reaction, and 3 = normal. We adopted the grading system used by Kim et al [15] . The total thickness of muscle layer (outer and inner circular muscle) was measured by DigiPro Image Analysis v4.0.…”