Marina L Reppucci1, Michael A Arnold2,3, Mark Lovell2,3, Karla Santos-Jasso4, Jill Ketzer1, Alberto Pena1, Luis de la Torre1, Andrea Bischoff5. 1. International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA. 2. Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, CO, USA. 3. Department of Pathology, University of Colorado, Aurora, CO, USA. 4. Department of Pediatric Surgery, Instituto Nacional de Pediatria, Mexico City, Mexico. 5. International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA. andrea.bischoff@childrenscolorado.org.
Abstract
PURPOSE: The use of the appendix for diagnosis of Total Colonic Aganglionosis (TCA) remains controversial. This study aimed to categorize the presence of ganglion cells in the appendix and determine its reliability as a histological specimen for the diagnosis of TCA. METHODS: This was a combined retrospective and prospective study. Permanent histological specimens of normal appendices removed during appendectomy for malrotation or falsely presumed appendicitis, and from patients with short segment Hirschsprung's disease (HD) or TCA were included. Permanent specimens of the appendix tip from Malone procedures were prospectively collected. All specimens were independently reviewed by two experienced pathologists in a standardized manner to assess for the presence of ganglion cells. RESULTS: A total of 112 appendices were evaluated. Nine came from patients with a diagnosis of TCA, and five from patients with HD. Ganglion cells were present in all specimens from patients with diagnoses other than TCA and were absent in all specimens from patients with TCA. CONCLUSION: In the correct clinical setting, the absence of ganglion cells in the appendix can allow for a reliable diagnosis of TCA.
PURPOSE: The use of the appendix for diagnosis of Total Colonic Aganglionosis (TCA) remains controversial. This study aimed to categorize the presence of ganglion cells in the appendix and determine its reliability as a histological specimen for the diagnosis of TCA. METHODS: This was a combined retrospective and prospective study. Permanent histological specimens of normal appendices removed during appendectomy for malrotation or falsely presumed appendicitis, and from patients with short segment Hirschsprung's disease (HD) or TCA were included. Permanent specimens of the appendix tip from Malone procedures were prospectively collected. All specimens were independently reviewed by two experienced pathologists in a standardized manner to assess for the presence of ganglion cells. RESULTS: A total of 112 appendices were evaluated. Nine came from patients with a diagnosis of TCA, and five from patients with HD. Ganglion cells were present in all specimens from patients with diagnoses other than TCA and were absent in all specimens from patients with TCA. CONCLUSION: In the correct clinical setting, the absence of ganglion cells in the appendix can allow for a reliable diagnosis of TCA.
Authors: Taiwo A Lawal; Shawn J Rangel; Andrea Bischoff; Alberto Peña; Marc A Levitt Journal: J Laparoendosc Adv Surg Tech A Date: 2011-03-02 Impact factor: 1.878