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Calretinin, an immunochemical stain to facilitate Hirschsprung's disease
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Veröffentlicht: | 26. April 2013 |
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Introduction: The histological study of the rectal biopsy remains the gold standard for the diagnosis of Hirschsprung’s disease. To decrease errors histochemical and immunohistochemical stains are used to help identify ganglion cells or define nerve fibers.
Barshack reported in 2004 that calretinin is absent in colonic nerve fibers of patients with HD, while it is present in patients without the disease. The Centro Colorectal para Niños de México y Latinoamérica provides care to HD patients with previous diagnostic and technical errors. The objective of this review was to establish the usefulness of calretinin as an immunohistochemical technique.
Material and methods: A retrospective review was done of the biopsy materials of twelve patients admitted with the suspected diagnosis of HD. These materials were already processed with the H-E protocol , and were reported as HD in eight patients and normoganglionic in four. The paraffin blocks were subject to immunohistochemistry with S-100 protein and calretinin.
The biopsy materials, including H-E, S-100 and calretinin for all of them, were reviewed by three Pathologists in an independent and blind fashion.
Results: The review of the H-E materials in this study resulted in overdiagnosis of HD by two of the three pathologists. Regarding the use of S100 protein, it resulted in under-diagnosis ranging from three to seven cases. With the calretinin stain none of the pathologists reported under or over diagnosis.
Conclusion: Calretinin has the advantage of its expression in mature and immature cells, both in the nerve cell body and its prolongations. The calretinin-antibody proved to be an efficient immunohistochemical tool to facilitate the diagnosis of HD, emphasizing the following points: it does not demand experience in its interpretation; it identifies mature and immature nerve cells; it is enough to observe its positivity in the neuritis.