Suction Rectal and Full Thickness Biopsies
RECTUM, *** CM, BIOPSY:
– Ganglionated colonic mucosa/submucosa with no significant abnormality
– Aganglionic colonic mucosa/submucosa with **** neural hypertrophy
COMMENT: The rectal biopsy from *** cm shows aganglionic colonic mucosa and submucosa. There is associated neural hypertrophy. A calretinin immunohistochemical stain does not demonstrate any neural elements within the mucosa. Overall, these findings are consistent with Hirschsprung’s disease. Clinical correlation is recommended.
Although it is transitioning from aganglionic to ganglionated tissue, the surgical anastomosis should be performed proximal to this region.
– Ganglionated colonic mucosa/submucosa with neural hypertrophy, consistent with transition zone
COMMENT: The rectal biopsy from *** cm shows ganglionated colonic mucosa and submucosa. However, there is associated neural hypertrophy consistent with sampling of the transition zone. A calretinin immunohistochemical stain demonstrates neural twigs within the mucosa. Clinical correlation is recommended.
Physiologic Aganglionic/Hypoganglionic Zone (Distal 2 cm of rectum):
– Aganglionic anorectal squamocolumnar junctional mucosa, consistent with physiologic hypoganglionic zone (see comment)
COMMENT: The presence of squamocolumnar junctional mucosa indicates biopsy of the physiologic hypoganglionic zone located within 2 cm of the dentate line. This specimen is inadequate for the evaluation of Hirschsprung disease.
– Specimen insufficient for evaluation (see comment)
COMMENT: Insufficient submucosal tissue is present to evaluate for the presence of ganglion cells. Suggest consideration for repeat biopsy if cinical concern persists.
– Aganglionic colonic mucosa with acute inflammation and mucosal necrosis (see comment)
COMMENT: In addition to the absence of ganglion cells, acute colitis with cryptitis and mucosal necrosis are seen. These features raise concern for Hirschsprung-associated enterocolitis.
– Ganglionated colonic mucosa with increased eosinophils (see comment)
COMMENT: Scattered crypts are disrupted by numerous intraepithelial eosinophils (with up to *** eosinophils per single high-power field). This feature raises concern for an allergic proctocolitis. Clinical correlation is recommended.
“Pull-through” Resection for Hirschsprung Disease:
Here is a good video on how to gross these specimens
COLON, RECTO-SIGMOID (PULL-THROUGH RESECTION):
– Aganglionosis of distal *** cm of specimen, consistent with Hirschsprung disease
– Hypoganglionated colonic segment with neural hypertrophy, consistent with Transition Zone, in middle *** cm the specimen
– Well-formed submucosal (Meisner) and myenteric (Auerbach) plexi with ganglion cells in proximal *** cm of specimen (see comment)
COMMENT: Histologic sections of the entirely submitted rectosigmoid segment demonstrate distal aganglionosis consistent with Hirschsprung disease in the distal approximately *** cm of the specimen. Proximal to that, there is an approximately *** cm segment with hypoganglionosis and neural hypertrophy, consistent with the transition zone. The most proximal *** cm of the specimen contains well-formed ganglion cells within both neural plexi. The frozen section diagnoses have been confirmed.
Last updated: June 30, 2020