Abstract
An increased number and density of the so-called “giant ganglia” (seven or greater ganglion cells per ganglion) serve as histopathological criteria for a bowel motility disorder called intestinal neuronal dysplasia of the submucous plexus (IND B). However, because these morphological criteria have been defined based upon observations in constipated patients, the diagnostic value of previous studies is open to controversy. Moreover, no age-related reference data from unaffected controls are available. This study reports on data from unaffected controls on the variability of size and distribution of ganglia in the submucous plexus during development. Therefore, for the first time, the normal status has been defined. Four age groups have been defined: (a) premature births, gestational age less than 35 weeks; (b) 1–365 days; (c) 1–14 years and (d) 15 years to greater than 70 years). All of these groups revealed giant ganglia in the submucous plexus. With advancing age, there was a decrease in the number of giant ganglia (from 32.7% in group a to 11.2% in group d) accompanied by an inverse increase in the mean distance between all ganglia (from 0.52 mm in group a to 1.17 mm in group d). The data presented permit the conclusion that the criteria mentioned above are not apt to define IND B as an entity, since they do not allow a sufficient demarcation from the age-correlated normal values presented here.
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References
Ammann K, Stoss F, Meier-Ruge W (1999) Intestinale neuronale Dysplasie des Erwachsenen als Ursache der chronischen Obstipation. Chirurg 70:771–776
Berry CL (1993) Intestinal neuronal dysplasia: does it exist or has it been invented? Virchows Arch A Pathol Histopathol 422:183–184
Borchard F, Meier-Ruge WA, Wiebecke B, Briner J, Müntefering H, Födisch HJ, Holschneider AM, Schmidt A, Enck P, Stolte M (1991) Innervationsstörungen des Dickdarms: Klassifikation und Diagnostik. Pathologe 12:171–174
Hess R, Scarpelli DG, Pearse AGE (1958) The cytochemical localization of oxidative enzymes. II. Pyridine nucleotide-linked dehydrogenase. J Biophys Biochem Cytol 4:753
Hirschsprung H (1888) Stuhlträgheit Neugeborener infolge Dilatation und Hypertrophie des Colons. Jahresbericht Kinderheilkunde
Karnovsky MJ, Roots L (1964) A direct-coloring thiocholine method for cholinesterase. J Histochem Cytochem 12:219
Koletzko S, Jesch I, Faus-Kebetaler T, Briner J, Meier-Ruge W, Müntefering H, Coerdt W, Wessel L, Keller KM, Nützenadel W, Schmittenbecher P, Holschneider A, Sacher P (1999) Rectal biopsies for diagnosis of intestinal neuronal dysplasia in children: a prospective multi-centre study on interobserver variation and clinical outcome. Gut 44:853–861
Lumb PD, Moore L (1998) Back to the drawing board. Intestinal neuronal dysplasia type B: not a histological entity yet. Virchows Arch 432:99–102
Lumb PD, Moore L (1998) Are giant ganglia a reliable marker of intestinal neuronal dysplasia type B (IND B)? Virchows Arch 432:103–106
Meier-Ruge W (1971) Über ein Erscheinungsbild des Kolons mit Hirschsprung-Symptomatik. Verh Dtsch Ges Pathol 55:506–510
Meier-Ruge W (1985) Angeborene Dysganglionosen des Colon. Kinderarzt 16:151–164
Meier-Ruge W (1990) Das morphologische Erscheinungsbild der neuronalen Dysplasie des Plexus submucosus. Kinderarzt 21:837–844
Meier-Ruge W, Brönnimann PB, Gambazzi F, Schmidt PC, Schmidt CP, Stoss F (1995) Histopathological criteria for intestinal neuronal dysplasia of the submucosal plexus (type B). Virchows Arch 426:549–556
Meier-Ruge WA, Schmidt CP, Stoss F (1995) Intestinal neuronal dysplasia and its morphometric evidences. Pediatr Surg Int 10:447–453
Nachlas M.M, Tsou K-Ch, Souza E, Cheng Ch-S, Seligman AM (1957) Cytochemical demonstration of succinic dehydrogenase by the use of a new p-nitrophenyl substituted ditetrazole. J Histochem Cytochem 5:420
Scherer-Singler U, Vincent SR, Kimura H, McGeer EC (1983) Demonstration of a unique population of neurons with NADPH-diaphorase histochemistry. J Neurosi Methods 9:229–234
Wester T, O’Briain S, Puri P (1998) Morphometric aspects of the submucous plexus in whole-mount preparations of normal human distal colon. J Pediatr Surg 4:619–622
Wester T, O’Briain DS, Puri P (1999) Notable postnatal alterations in the myenteric plexus of normal human bowel. Gut 44:666–674
Acknowledgements
The authors would like to thank Dr. M. Rossol (Wels, Austria), Prof. Dr. M. Ratschek (Graz, Austria) and Prof. Dr. G. Otto (Mainz) for the very helpful contribution of tissue samples, Mrs. Schilling, Mrs. Heymann and Mrs. Cetin for technical assistance and Mrs. Griesheimer and Mrs. Brucki for their support in the morphometric analysis.
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Coerdt, W., Michel, JS., Rippin, G. et al. Quantitative morphometric analysis of the submucous plexus in age-related control groups. Virchows Arch 444, 239–246 (2004). https://doi.org/10.1007/s00428-003-0951-7
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DOI: https://doi.org/10.1007/s00428-003-0951-7