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Role of calretinin immunohistochemical stain in evaluation of Hirschsprung disease: an institutional experience.
[hirschsprung disease]
The
use
of
calretinin
immunostain
(
IHC
)
in
the
evaluation
of
rectal
suction
biopsies
for
Hirschsprung
disease
(
HD
)
has
been
reported
by
Kapur
et
al
.
and
others
.
The
first
goal
of
this
article
is
to
report
our
institutional
experience
with
the
use
of
calretinin
in
specimens
for
evaluation
of
HD
.
The
second
goal
is
to
describe
the
pattern
of
expression
of
calretinin
in
the
junction
of
ganglionic-
to
-aganglionic
segment
of
pull
through
specimens
of
patients
with
a
previous
diagnosis
of
HD
on
suction
rectal
biopsy
.
Three
pathologists
at
University
of
Texas
at
Houston
evaluated
28
rectal
biopsy
specimens
from
2010
-
2011
.
The
patients
'
age
ranged
from
15
days
to
8
years
.
Twenty
-
three
cases
were
suction
biopsies
,
and
five
were
rectal
full
thickness
biopsies
.
Hematoxylin-eosin
(
H
&
E
)
stain
was
performed
on
at
least
80
levels
for
the
suction
biopsy
specimens
.
Calretinin
immunohistochemical
stain
was
performed
on
levels
40
-
42
in
all
cases
,
with
adequate
controls
.
The
H
&
E
slides
of
nine
pull
through
specimens
with
a
diagnosis
of
HD
on
a
suction
rectal
biopsy
that
was
evaluated
in
this
study
,
were
evaluated
.
Calretinin
IHC
was
performed
on
the
slide
(
s
)
showing
the
junction
of
aganglionic-
to
-normal
rectum
,
along
with
adequate
controls
.
The
presence
of
ganglion
cells
consistently
correlated
with
calretinin-
positive
thin
nerve
fibrils
in
the
lamina
propria
,
muscularis
mucosae
and
superficial
submucosa
.
These
nerve
fibrils
were
absent
in
the
aganglionic
segments
of
bowel
and
in
the
areas
without
ganglion
cells
from
the
junction
of
normal
with
diseased
rectum
.
Calretinin
was
strongly
expressed
in
the
submucosal
and
subserosal
nerve
trunks
in
the
ganglionic
segment
.
It
had
faint
expression
in
the
thick
nerve
trunks
from
the
areas
without
ganglion
cells
1
.
6
-
2
.
5
cm
proximal
to
the
normal
rectum
.
No
calretinin
expression
was
seen
in
the
nerve
trunks
in
the
rest
of
the
aganglionic
segment
.
The
pattern
of
expression
of
calretinin
in
rectal
suction
biopsies
in
HD
and
normal
rectum
coincide
with
the
ones
previously
described
in
the
literature
.
Calretinin
IHC
offered
additional
diagnostic
value
in
the
specimens
with
inadequate
amount
of
submucosa
and
rarely
seen
ganglion
cells
.
The
pattern
of
expression
of
calretinin
in
HD
pull-through
specimens
correlates
with
the
rectal
biopsy
ones
.
Faint
positivity
of
the
thick
submucosal
and
subserosal
nerves
in
the
absence
of
ganglion
cells
and
calretinin
positive
nerve
fibrils
,
is
characteristic
of
the
junction
of
the
aganglionic-
to
-normal
rectum
.
We
are
the
first
ones
to
document
this
finding
.
