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Calretinin immunohistochemistry versus improvised rapid Acetylcholinesterase histochemistry in the evaluation of colorectal biopsies for Hirschsprung disease.
[hirschsprung disease]
Acetylcholinesterase
(
AChE
)
histochemistry
on
rectal
mucosal
biopsies
accurately
diagnoses
Hirschsprung
disease
(
HD
)
,
but
is
not
widely
employed
as
it
requires
special
tissue
handling
and
pathologist
expertise
.
Calretinin
immunohistochemistry
(
IHC
)
has
been
reported
to
be
comparable
to
AChE
staining
with
the
loss
of
expression
correlating
with
aganglionosis
.
The
aim
was
to
evaluate
calretinin
IHC
as
a
primary
diagnostic
tool
in
comparison
to
the
improvised
rapid
AChE
technique
in
the
diagnosis
of
HD
.
A
total
of
74
rectal
biopsies
(
18
fresh
frozen
-
18
cases
,
56
formalin
fixed
-
33
cases
)
from
51
cases
of
suspect
HD
were
evaluated
with
hematoxylin
and
eosin
/
AChE
/
Calretinin
.
Ten
biopsies
each
from
ganglionated
and
aganglionated
segments
served
as
positive
and
negative
controls
.
Ileal
(
3
)
,
appendiceal
(
3
)
and
ring
bowel
(
2
)
biopsies
were
also
included
.
Two
pathologists
blinded
to
the
clinical
details
evaluated
the
histomorphology
with
AChE
and
calretinin
.
Observations
were
statistically
analyzed
and
Cohen
's
k
coefficient
employed
to
assess
agreement
between
two
pathologists
and
calretinin
and
the
AChE
.
The
study
confirmed
HD
in
26
and
non-
HD
in
25
cases
.
There
were
7
neonates
,
5
low
level
biopsies
and
14
"
inadequate
"
biopsies
.
The
results
of
calretinin
were
comparable
with
AChE
with
a
statistically
significant
measure
of
agreement
of
k
=
0
.
973
between
the
two
.
One
false-
positive
case
of
HD
was
noted
with
calretinin
.
The
advantages
and
disadvantages
of
calretinin
versus
AChE
are
discussed
.
Calretinin
is
a
reliable
single
immune
marker
for
ruling
out
HD
by
its
specific
positive
mucosal
staining
of
formalin
fixed
rectal
biopsy
.
The
improvised
AChE
staining
remains
indispensable
to
confirm
HD
on
fresh
biopsies
and
thus
,
along
with
calretinin
IHC
maximizes
the
diagnostic
accuracy
of
HD
in
difficult
cases
.
Diseases
Validation
Diseases presenting
"reliable single immune marker"
symptom
hirschsprung disease
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