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Korsager LEH, Bjørn N, Ellebæk MB, Christensen LG, Qvist N. Full-Thickness Rectal Biopsy in Children Suspected of Having Hirschsprung's Disease: The Inconclusive Biopsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1619. [PMID: 37892282 PMCID: PMC10605644 DOI: 10.3390/children10101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
The diagnosis of Hirschsprung's disease relies on histologically proven aganglionosis and nerve trunk hypertrophy in rectal biopsies. Although the frequency of inconclusive biopsies is relatively low, it is a relevant clinical problem. The aim of the present study was to investigate whether a re-evaluation of archived full-thickness biopsies (FTBs) stained with hematoxylin and eosin (HE), together with immune histochemical (IHC) staining, would be diagnostic in biopsies otherwise deemed inconclusive at initial examination with HE only. A total of 34 inconclusive biopsies in 31 patients were identified. From each tissue block, three slices were cut and stained with HE, S100 and calretinin. A blinded pathologist examined the tissue samples. At re-evaluation, one patient was found positive for HD and 11 negative for HD with both HE and IHC staining, respectively. In all 12 cases, the result was confirmed by the final diagnosis at a 5-year follow-up. The rest of the cases were deemed inconclusive. A re-evaluation of the remaining tissue from the biobank might have saved one third of the children from a re-biopsy. The value of adding IHC to conventional HE staining is dubious.
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Affiliation(s)
- Leise Elisabeth Hviid Korsager
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark; (L.E.H.K.); (N.B.); (M.B.E.)
| | - Niels Bjørn
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark; (L.E.H.K.); (N.B.); (M.B.E.)
- Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, 5000 Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark; (L.E.H.K.); (N.B.); (M.B.E.)
- Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, 5000 Odense, Denmark
| | - Lene Gaardsmand Christensen
- Research Unit for Pathology, Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark;
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark; (L.E.H.K.); (N.B.); (M.B.E.)
- Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, 5000 Odense, Denmark
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Hawez T, Graneli C, Erlöv T, Gottberg E, Munoz Mitev R, Hagelsteen K, Evertsson M, Jansson T, Cinthio M, Stenström P. Ultra-High Frequency Ultrasound Imaging of Bowel Wall in Hirschsprung's Disease-Correlation and Agreement Analyses of Histoanatomy. Diagnostics (Basel) 2023; 13:diagnostics13081388. [PMID: 37189490 DOI: 10.3390/diagnostics13081388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
Hirschsprung's disease (HD) is characterized by aganglionosis in the bowel wall, requiring resection. Ultra-high frequency ultrasound (UHFUS) imaging of the bowel wall has been suggested to be an instantaneous method of deciding resection length. The aim of this study was to validate UHFUS imaging of the bowel wall in children with HD by exploring the correlation and systematic differences between UHFUS and histopathology. Resected fresh bowel specimens of children 0-1 years old, operated on for rectosigmoid aganglionosis at a national HD center 2018-2021, were examined ex vivo with UHFUS center frequency 50 MHz. Aganglionosis and ganglionosis were confirmed by histopathological staining and immunohistochemistry. Histoanatomical layers of bowel wall in histopathological and UHFUS images, respectively, were outlined using MATLAB programs. Both histopathological and UHFUS images were available for 19 aganglionic and 18 ganglionic specimens. The thickness of muscularis interna correlated positively between histopathology and UHFUS in both aganglionosis (R = 0.651, p = 0.003) and ganglionosis (R = 0.534, p = 0.023). The muscularis interna was systematically thicker in histopathology than in UHFUS images in both aganglionosis (0.499 vs. 0.309 mm; p < 0.001) and ganglionosis (0.644 versus 0.556 mm; p = 0.003). Significant correlations and systematic differences between histopathological and UHFUS images support the hypothesis that UHFUS reproduces the histoanatomy of the bowel wall in HD accurately.
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Affiliation(s)
- Tebin Hawez
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
| | - Christina Graneli
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 223 63 Lund, Sweden
| | - Emilia Gottberg
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, 222 42 Lund, Sweden
| | - Rodrigo Munoz Mitev
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, 222 42 Lund, Sweden
| | - Kristine Hagelsteen
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
| | - Maria Evertsson
- Department of Biomedical Engineering, Skåne University Hospital Lund, The Faculty of Engineering, Lund University, 221 00 Lund, Sweden
| | - Tomas Jansson
- Department of Biomedical Engineering, Skåne University Hospital Lund, The Faculty of Engineering, Lund University, 221 00 Lund, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, 223 63 Lund, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, 221 85 Lund, Sweden
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Graneli C, Patarroyo S, Mitev RM, Gisselsson D, Gottberg E, Erlöv T, Jansson T, Hagelsteen K, Cinthio M, Stenström P. Histopathological dimensions differ between aganglionic and ganglionic bowel wall in children with Hirschsprung's disease. BMC Pediatr 2022; 22:723. [PMID: 36536313 PMCID: PMC9764572 DOI: 10.1186/s12887-022-03792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the validation of new imaging technology for children with Hirschsprung's disease (HSCR), basic anatomical parameters of the bowel wall must be established specifically for this patient group. AIM To explore differences in histoanatomical layers of bowel wall, comparing ganglionic and aganglionic bowel walls, and to examine if the bowel wall thickness is linked to patient weight. METHODS This was an observational study of bowel specimens from children weighing 0-10 kg, operated on consecutively during 2018-2020. Ganglionic and aganglionic bowel walls were measured in digitalized microscopy images from 10 sites per trans-sectional specimen and compared regarding the thickness of their histoanatomical layers. RESULTS Bowel walls were measured in 21 children. Full bowel wall thickness did not differ between aganglionic and ganglionic bowel (2.20 vs 2.04; p = 0.802) while weight at surgery correlated positively with both ganglionic and aganglionic bowel wall thickness (r = 0.688 and 0.849, respectively), and age at surgery with ganglionic bowel wall thickness (r = 0.517). In aganglionic segments, the muscularis externa layer was thicker compared to that in ganglionosis (0.45 vs 0.31 mm, p = 0.012) whereas the muscularis interna was thinner (0.45 vs 0.62 mm, p < 0.001). A diagnostic index was identified whereby a lower ratio of muscularis interna/externa thickness followed by a thinner muscularis interna differed between aganglionic and ganglionic bowel in all specimens. CONCLUSION Thicknesses of the bowel wall's muscle layers differ between aganglionic and ganglionic bowel walls in children with HSCR. These findings support a diagnostic index that could be validated for transfer to instant diagnostic imaging techniques. LEVEL OF EVIDENCE Diagnostic: 3.
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Affiliation(s)
- Christina Graneli
- grid.411843.b0000 0004 0623 9987Department of Pediatric Surgery, Children’s Hospital, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Sofia Patarroyo
- grid.411843.b0000 0004 0623 9987Department of Pediatric Surgery, Children’s Hospital, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Rodrigo Munoz Mitev
- grid.411843.b0000 0004 0623 9987Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - David Gisselsson
- grid.411843.b0000 0004 0623 9987Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Emilia Gottberg
- grid.411843.b0000 0004 0623 9987Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Tobias Erlöv
- grid.4514.40000 0001 0930 2361Department of Biomedical Engineering, Faculty of Engineering, LTH, Lund University, Lund, Sweden
| | - Tomas Jansson
- grid.411843.b0000 0004 0623 9987Department of Biomedical Engineering, Department of Clinical Engineering, Clinical Sciences Lund, LTH, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kristine Hagelsteen
- grid.411843.b0000 0004 0623 9987Department of Pediatric Surgery, Children’s Hospital, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Magnus Cinthio
- grid.4514.40000 0001 0930 2361Department of Biomedical Engineering, Faculty of Engineering, LTH, Lund University, Lund, Sweden
| | - Pernilla Stenström
- grid.411843.b0000 0004 0623 9987Department of Pediatric Surgery, Children’s Hospital, Skåne University Hospital Lund, Lund University, Lund, Sweden
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Role of the Intermediate Filament Protein Peripherin in Health and Disease. Int J Mol Sci 2022; 23:ijms232315416. [PMID: 36499746 PMCID: PMC9740141 DOI: 10.3390/ijms232315416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Intermediate filaments are the most heterogeneous class among cytoskeletal elements. While some of them have been well-characterized, little is known about peripherin. Peripherin is a class III intermediate filament protein with a specific expression in the peripheral nervous system. Epigenetic modifications are involved in this cell-type-specific expression. Peripherin has important roles in neurite outgrowth and stability, axonal transport, and axonal myelination. Moreover, peripherin interacts with proteins involved in vesicular trafficking, signal transduction, DNA/RNA processing, protein folding, and mitochondrial metabolism, suggesting a role in all these processes. This review collects information regarding peripherin gene regulation, post-translational modifications, and functions and its involvement in the onset of a number of diseases.
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Pan W, Goldstein AM, Hotta R. Opportunities for novel diagnostic and cell-based therapies for Hirschsprung disease. J Pediatr Surg 2022; 57:61-68. [PMID: 34852916 PMCID: PMC9068833 DOI: 10.1016/j.jpedsurg.2021.10.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/17/2021] [Accepted: 10/28/2021] [Indexed: 12/26/2022]
Abstract
Despite significant progress in our understanding of the etiology and pathophysiology of Hirschsprung disease (HSCR), early and accurate diagnosis and operative management can be challenging. Moreover, long-term morbidity following surgery, including fecal incontinence, constipation, and Hirschsprung-associated enterocolitis (HAEC), remains problematic. Recent advances applying state-of-the art imaging for visualization of the enteric nervous system and utilizing neuronal stem cells to replace the missing enteric neurons and glial cells offer the possibility of a promising new future for patients with HSCR. In this review, we summarize recent research advances that may one day offer novel approaches for the diagnosis and management of this disease.
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Affiliation(s)
- Weikang Pan
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 185 Cambridge St, CPZN 6-215, Boston, MA 02114, USA; Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Allan M Goldstein
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 185 Cambridge St, CPZN 6-215, Boston, MA 02114, USA
| | - Ryo Hotta
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 185 Cambridge St, CPZN 6-215, Boston, MA 02114, USA.
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Terra SA, Gonçalves AC, Lourenção PLTDA, Rodrigues MAM. Challenges in the diagnosis of intestinal neuronal dysplasia type B: A look beyond the number of ganglion cells. World J Gastroenterol 2021; 27:7649-7660. [PMID: 34908804 PMCID: PMC8641051 DOI: 10.3748/wjg.v27.i44.7649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/26/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
Intestinal neuronal dysplasia type B (IND-B) is a controversial condition among gastrointestinal neuromuscular disorders. Constipation is its most common clinical manifestation in patients. Despite intense scientific research, there are still knowledge gaps regarding the diagnostic criteria for IND-B in the histopathological analysis of rectal biopsies. The guidelines published in the past three decades have directed diagnostic criteria for quantifying the number of ganglion cells in the nervous plexus of the enteric nervous system. However, it is very complex to distinguish numerically what is pathological from what is normal, mainly because of the difficulty in determining a reliable control group composed of healthy children without intestinal symptoms. Thus, a series of immunohistochemical markers have been proposed to assist in the histopathological analysis of the enteric nervous system. Several of these markers facilitate the identification of other structures of the enteric nervous system, in addition to ganglion cells. These structures may be related to the etiopathogenesis of IND-B and represent new possibilities for the histopathological diagnosis of this disease, providing a view beyond the number of ganglion cells. This review critically discusses the aspects related to the disease definitions and diagnostic criteria of this organic cause of constipation.
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Affiliation(s)
- Simone Antunes Terra
- Department of Pathology, Faculty of Medicine, São Paulo State University (UNESP), Botucatu 18618687, São Paulo, Brazil
| | - Anderson Cesar Gonçalves
- Department of Surgery and Orthopedics, Botucatu Medical School - São Paulo State University (UNESP), Botucatu 18618970, São Paulo, Brazil
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GaŁĄzka P, Chrzanowska M, StyczyŃski J. Clinical Spectrum and Outcomes of Neonatal Necrotizing Enterocolitis. In Vivo 2021; 35:585-591. [PMID: 33402513 DOI: 10.21873/invivo.12295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM The objective of the study was analysis of risk factors associated with outcome of necrotizing enterocolitis (NEC) in infants in a single-center study. PATIENTS AND METHODS All consecutive infants hospitalized for NEC over a period of 6 years were retrospectively analyzed for clinical course, infections, treatment and outcome. RESULTS Out of 76 patients, surgical management was applied in 56 (53 exploratory laparotomy, three initial peritoneal drain placement) and in 20 there was only a conservative approach. Segmental intestinal resection was performed in 41 patients. Survival from NEC in our cohort was 79%. We found that independent adverse risk factors of outcome of newborns and infants with NEC were gut perforation, infection, abdominal wall erythema, and development of acute kidney injury. CONCLUSION We underline the value of both surgical and conservative approach with careful management in this cohort of patients.
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Affiliation(s)
- PrzemysŁaw GaŁĄzka
- Department of General and Oncological Surgery for Children and Adolescents Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; .,Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Magdalena Chrzanowska
- Department of General and Oncological Surgery for Children and Adolescents Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Jan StyczyŃski
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
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