Skip to main content
Top
Published in: Techniques in Coloproctology 4/2011

01-12-2011 | Review

Beyond hematoxylin and eosin: the importance of immunohistochemical techniques for evaluating surgically resected constipated patients

Authors: G. Bassotti, V. Villanacci, B. Salerni, C. A. Maurer, G. Cathomas

Published in: Techniques in Coloproctology | Issue 4/2011

Login to get access

Abstract

Chronic constipation requiring surgical ablation for intractability is often a frustrating condition from the pathologist’s point of view. In fact, limiting the histological examination to only hematoxylin–eosin staining usually yields only the information that there are no abnormalities. By employing some simple and widely available immunohistochemical methods, discussed in this review, it is possible to gather data that may help in explaining the pathophysiological basis of constipation in these patients.
Literature
1.
go back to reference Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L (2001) An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 96:3130–3137PubMedCrossRef Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L (2001) An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 96:3130–3137PubMedCrossRef
2.
go back to reference Rao SS (2009) Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastrointest Endosc Clin N Am 19:117–139PubMedCrossRef Rao SS (2009) Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastrointest Endosc Clin N Am 19:117–139PubMedCrossRef
3.
go back to reference Iantorno G, Cinquetti M, Mazzocchi A, Morelli A, Bassotti G (2007) Audit of constipation in a gastroenterology referral center. Dig Dis Sci 52:317–320PubMedCrossRef Iantorno G, Cinquetti M, Mazzocchi A, Morelli A, Bassotti G (2007) Audit of constipation in a gastroenterology referral center. Dig Dis Sci 52:317–320PubMedCrossRef
4.
go back to reference Tack J, Müller-Lissner S (2009) Treatment of chronic constipation: current pharmacologic approaches and future directions. Clin Gastroenterol Hepatol 7:502–508PubMedCrossRef Tack J, Müller-Lissner S (2009) Treatment of chronic constipation: current pharmacologic approaches and future directions. Clin Gastroenterol Hepatol 7:502–508PubMedCrossRef
5.
go back to reference Khaikin M, Wexner SD (2006) Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 12:3168–3173PubMed Khaikin M, Wexner SD (2006) Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 12:3168–3173PubMed
6.
go back to reference Velio P, Bassotti G (1996) Chronic idiopathic constipation: pathophysiology and treatment. J Clin Gastroenterol 22:190–196PubMedCrossRef Velio P, Bassotti G (1996) Chronic idiopathic constipation: pathophysiology and treatment. J Clin Gastroenterol 22:190–196PubMedCrossRef
7.
go back to reference Bassotti G, de Roberto G, Sediari L, Morelli A (2004) Colonic motility studies in severe chronic constipation: an organic approach to a functional problem. Tech Coloproctol 8:147–150PubMedCrossRef Bassotti G, de Roberto G, Sediari L, Morelli A (2004) Colonic motility studies in severe chronic constipation: an organic approach to a functional problem. Tech Coloproctol 8:147–150PubMedCrossRef
8.
go back to reference Dinning PG, Benninga MA, Southwell BR, Scott SM (2010) Paediatric and adult colonic manometry: a tool to help unravel the pathophysiology of constipation. World J Gastroenterol 16:5162–5172PubMedCrossRef Dinning PG, Benninga MA, Southwell BR, Scott SM (2010) Paediatric and adult colonic manometry: a tool to help unravel the pathophysiology of constipation. World J Gastroenterol 16:5162–5172PubMedCrossRef
9.
go back to reference Bassotti G, Chiarioni G, Germani U, Battaglia E, Vantini I, Morelli A (1999) Endoluminal instillation of bisacodyl in patients with severe (slow transit type) constipation is useful to test residual colonic propulsive activity. Digestion 60:69–73PubMedCrossRef Bassotti G, Chiarioni G, Germani U, Battaglia E, Vantini I, Morelli A (1999) Endoluminal instillation of bisacodyl in patients with severe (slow transit type) constipation is useful to test residual colonic propulsive activity. Digestion 60:69–73PubMedCrossRef
10.
go back to reference Shafik A, Shafik AA, El-Sibai O, Mostafa RM (2003) Electric activity of the colon in subjects with constipation due to total colonic inertia. An electrophysiologic study. Arch Surg 138:1007–1011PubMedCrossRef Shafik A, Shafik AA, El-Sibai O, Mostafa RM (2003) Electric activity of the colon in subjects with constipation due to total colonic inertia. An electrophysiologic study. Arch Surg 138:1007–1011PubMedCrossRef
11.
go back to reference Bassotti G, Roberto GD, Sediari L, Morelli A (2004) Toward a definition of colonic inertia. World J Gastroenterol 10:2465–2467PubMed Bassotti G, Roberto GD, Sediari L, Morelli A (2004) Toward a definition of colonic inertia. World J Gastroenterol 10:2465–2467PubMed
12.
go back to reference Frattini JC, Nogueras JJ (2008) Slow transit constipation: a review of a colonic functional disorder. Clin Colon Rectal Surg 21:146–152PubMedCrossRef Frattini JC, Nogueras JJ (2008) Slow transit constipation: a review of a colonic functional disorder. Clin Colon Rectal Surg 21:146–152PubMedCrossRef
13.
go back to reference Levitt MA, Mathis KL, Pemberton JH (2011) Surgical treatment for constipation in children and adults. Best Pract Res Clin Gastroenterol 25:167–179PubMedCrossRef Levitt MA, Mathis KL, Pemberton JH (2011) Surgical treatment for constipation in children and adults. Best Pract Res Clin Gastroenterol 25:167–179PubMedCrossRef
14.
go back to reference Riss S, Herbst F, Birsan T, Stift A (2009) Postoperative course and long term follow up after colectomy for slow transit constipation–is surgery an appropriate approach? Colorectal Dis 11:302–307PubMedCrossRef Riss S, Herbst F, Birsan T, Stift A (2009) Postoperative course and long term follow up after colectomy for slow transit constipation–is surgery an appropriate approach? Colorectal Dis 11:302–307PubMedCrossRef
15.
go back to reference Martin JE, Hester TW, Aslam H, Sinha S, Knowles CH (2009) Discordant practice and limited histopathological assessment in gastrointestinal neuromuscular disease. Gut 58:1703–1705PubMedCrossRef Martin JE, Hester TW, Aslam H, Sinha S, Knowles CH (2009) Discordant practice and limited histopathological assessment in gastrointestinal neuromuscular disease. Gut 58:1703–1705PubMedCrossRef
16.
go back to reference Koch T, Carney JA, Go VL (1988) Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide. Gastroenterology 94:300–310PubMed Koch T, Carney JA, Go VL (1988) Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide. Gastroenterology 94:300–310PubMed
17.
go back to reference Zhao RH, Baig MK, Mack J, Abramson S, Woodhouse S, Wexner SD (2002) Altered serotonin immunoreactivities in the left colon of patients with colonic inertia. Colorectal Dis 4:56–60PubMedCrossRef Zhao RH, Baig MK, Mack J, Abramson S, Woodhouse S, Wexner SD (2002) Altered serotonin immunoreactivities in the left colon of patients with colonic inertia. Colorectal Dis 4:56–60PubMedCrossRef
18.
go back to reference Krishnamurti S, Schuffler MD, Rohrmann CA, Pope CE (1985) Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 88:26–34 Krishnamurti S, Schuffler MD, Rohrmann CA, Pope CE (1985) Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 88:26–34
19.
go back to reference Schouten WR, ten Kate FJ, de Graaf EJ, Gilberts EC, Simons JL, Kluck P (1993) Visceral neuropathy in slow transit constipation: an immunohistochemical investigation with monoclonal antibodies against neurofilament. Dis Colon Rectum 36:1112–1117PubMedCrossRef Schouten WR, ten Kate FJ, de Graaf EJ, Gilberts EC, Simons JL, Kluck P (1993) Visceral neuropathy in slow transit constipation: an immunohistochemical investigation with monoclonal antibodies against neurofilament. Dis Colon Rectum 36:1112–1117PubMedCrossRef
20.
go back to reference Wedel T, Roblick UJ, Ott V et al (2002) Oligoneural hypoganglionosis in patients with idiopathic slow transit constipation. Dis Colon Rectum 45:54–62PubMedCrossRef Wedel T, Roblick UJ, Ott V et al (2002) Oligoneural hypoganglionosis in patients with idiopathic slow transit constipation. Dis Colon Rectum 45:54–62PubMedCrossRef
21.
go back to reference Wedel T, Spiegler J, Soellner S et al (2002) Enteric nerves and interstitial cells of Cajal are altered in patients with slow transit constipation and megacolon. Gastroenterology 123:1459–1467PubMedCrossRef Wedel T, Spiegler J, Soellner S et al (2002) Enteric nerves and interstitial cells of Cajal are altered in patients with slow transit constipation and megacolon. Gastroenterology 123:1459–1467PubMedCrossRef
22.
go back to reference Tong WD, Liu BH, Zhang LY, Zhang SB, Lei Y (2004) Decreased interstitial cells of Cajal in the sigmoid colon of patients with slow transit constipation. Int J Colorect Dis 19:467–473CrossRef Tong WD, Liu BH, Zhang LY, Zhang SB, Lei Y (2004) Decreased interstitial cells of Cajal in the sigmoid colon of patients with slow transit constipation. Int J Colorect Dis 19:467–473CrossRef
23.
go back to reference Bassotti G, Villanacci V, Maurer CA et al (2006) The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation. Gut 55:41–46PubMedCrossRef Bassotti G, Villanacci V, Maurer CA et al (2006) The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation. Gut 55:41–46PubMedCrossRef
24.
go back to reference Bassotti G, Villanacci V, Nascimbeni R et al (2007) Colonic neuropathological aspects in patients with intractable constipation due to obstructed defecation. Mod Pathol 20:367–374PubMedCrossRef Bassotti G, Villanacci V, Nascimbeni R et al (2007) Colonic neuropathological aspects in patients with intractable constipation due to obstructed defecation. Mod Pathol 20:367–374PubMedCrossRef
25.
go back to reference Knowles CH, De Giorgio R, Kapur RP et al (2009) Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the gastro 2009 international working group. Acta Neuropathol 118:271–301PubMedCrossRef Knowles CH, De Giorgio R, Kapur RP et al (2009) Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the gastro 2009 international working group. Acta Neuropathol 118:271–301PubMedCrossRef
26.
go back to reference Hutson JM, Chow CW, Borg J (1996) Intractable constipation with a decrease in substance P-immunoreactive fibres: is it a variant of intestinal neuronal dysplasia? J Pediatr Surg 31:580–583PubMedCrossRef Hutson JM, Chow CW, Borg J (1996) Intractable constipation with a decrease in substance P-immunoreactive fibres: is it a variant of intestinal neuronal dysplasia? J Pediatr Surg 31:580–583PubMedCrossRef
27.
go back to reference King SK, Sutcliffe JR, Hutson JM (2005) Laparoscopic seromuscular colonic biopsies: a surgeon’s experience. J Pediatr Surg 40:381–384PubMedCrossRef King SK, Sutcliffe JR, Hutson JM (2005) Laparoscopic seromuscular colonic biopsies: a surgeon’s experience. J Pediatr Surg 40:381–384PubMedCrossRef
28.
go back to reference Ohlsson B, Fork FT, Veress B, Toth E (2005) Coexistent chronic idiopathic intestinal pseudo obstruction and inflammatory bowel disease. Gut 54:729–730PubMedCrossRef Ohlsson B, Fork FT, Veress B, Toth E (2005) Coexistent chronic idiopathic intestinal pseudo obstruction and inflammatory bowel disease. Gut 54:729–730PubMedCrossRef
29.
go back to reference Porter AJ, Wattchow DA, Brookes SJ, Costa M (1997) The neurochemical coding and projections of circular muscle motor neurons in the human colon. Gastroenterology 113:1916–1923PubMedCrossRef Porter AJ, Wattchow DA, Brookes SJ, Costa M (1997) The neurochemical coding and projections of circular muscle motor neurons in the human colon. Gastroenterology 113:1916–1923PubMedCrossRef
30.
go back to reference Ganns D, Schrödl F, Neuhuber W, Brehmer A (2006) Investigation of general and cytoskeletal markers to estimate numbers and proportions of neurons in the human intestine. Histol Histopathol 21:41–51PubMed Ganns D, Schrödl F, Neuhuber W, Brehmer A (2006) Investigation of general and cytoskeletal markers to estimate numbers and proportions of neurons in the human intestine. Histol Histopathol 21:41–51PubMed
31.
go back to reference Murphy EM, Defontgalland D, Costa M, Brookes SJ, Wattchow DA (2007) Quantification of subclasses of human colonic myenteric neurons by immunoreactivity to Hu, choline acetyltransferase and nitric oxide synthase. Neurogastroenterol Motil 19:126–134PubMedCrossRef Murphy EM, Defontgalland D, Costa M, Brookes SJ, Wattchow DA (2007) Quantification of subclasses of human colonic myenteric neurons by immunoreactivity to Hu, choline acetyltransferase and nitric oxide synthase. Neurogastroenterol Motil 19:126–134PubMedCrossRef
32.
go back to reference Krammer HJ, Karahan ST, Sigge W, Kühnel W (1994) Immunohistochemistry of markers of the enteric nervous system in whole-mount preparations of the human colon. Eur J Pediatr Surg 4:274–278PubMedCrossRef Krammer HJ, Karahan ST, Sigge W, Kühnel W (1994) Immunohistochemistry of markers of the enteric nervous system in whole-mount preparations of the human colon. Eur J Pediatr Surg 4:274–278PubMedCrossRef
33.
go back to reference Dzienis-Koronkiewicz E, Debek W, Sulkowska M, Chyczewski L (2002) Suitability of selected markers for identification of elements of the intestinal nervous system (INS). Eur J Pediatr Surg 12:397–401PubMedCrossRef Dzienis-Koronkiewicz E, Debek W, Sulkowska M, Chyczewski L (2002) Suitability of selected markers for identification of elements of the intestinal nervous system (INS). Eur J Pediatr Surg 12:397–401PubMedCrossRef
34.
go back to reference Villanacci V, Bassotti G, Ortensi B et al (2008) Expression of the Rai (Shc C) adaptor protein in the human enteric nervous system. Neurogastroenterol Motil 20:206–212PubMedCrossRef Villanacci V, Bassotti G, Ortensi B et al (2008) Expression of the Rai (Shc C) adaptor protein in the human enteric nervous system. Neurogastroenterol Motil 20:206–212PubMedCrossRef
35.
go back to reference Hoff S, Zeller F, von Weyhern CW et al (2008) Quantitative assessment of glial cells in the human and guinea pig enteric nervous system with an anti-Sox8/9/10 antibody. J Comp Neurol 509:356–371PubMedCrossRef Hoff S, Zeller F, von Weyhern CW et al (2008) Quantitative assessment of glial cells in the human and guinea pig enteric nervous system with an anti-Sox8/9/10 antibody. J Comp Neurol 509:356–371PubMedCrossRef
36.
go back to reference Williams DE, Eisenman J, Baird A et al (1990) Identification of a ligand for the c-kit proto-oncogene. Cell 63:167–174PubMedCrossRef Williams DE, Eisenman J, Baird A et al (1990) Identification of a ligand for the c-kit proto-oncogene. Cell 63:167–174PubMedCrossRef
37.
go back to reference Horisawa M, Watanabe Y, Torihashi S (1998) Distribution of c-Kit immunopositive cells in normal human colon and in Hirschsprung’s disease. J Pediatr Surg 33:1209–1214PubMedCrossRef Horisawa M, Watanabe Y, Torihashi S (1998) Distribution of c-Kit immunopositive cells in normal human colon and in Hirschsprung’s disease. J Pediatr Surg 33:1209–1214PubMedCrossRef
38.
go back to reference Knowles CH, Silk DB, Darzi A et al (2004) Deranged smooth muscle alpha-actin as a biomarker of intestinal pseudo-obstruction: a controlled multinational case series. Gut 53:1583–1589PubMedCrossRef Knowles CH, Silk DB, Darzi A et al (2004) Deranged smooth muscle alpha-actin as a biomarker of intestinal pseudo-obstruction: a controlled multinational case series. Gut 53:1583–1589PubMedCrossRef
39.
go back to reference Smith VV, Gregson N, Foggensteiner L, Neale G, Milla PJ (1997) Acquired intestinal aganglionosis and circulating autoantibodies without neoplasia or other neural involvement. Gastroenterology 112:1366–1371PubMedCrossRef Smith VV, Gregson N, Foggensteiner L, Neale G, Milla PJ (1997) Acquired intestinal aganglionosis and circulating autoantibodies without neoplasia or other neural involvement. Gastroenterology 112:1366–1371PubMedCrossRef
40.
go back to reference De Giorgio R, Barbara G, Stanghellini V et al (2002) Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 97:2454–2459PubMedCrossRef De Giorgio R, Barbara G, Stanghellini V et al (2002) Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 97:2454–2459PubMedCrossRef
41.
go back to reference Haas S, Bindl L, Fischer HP (2005) Autoimmune enteric leiomyositis: a rare cause of chronic intestinal pseudo-obstruction with specific morphological features. Hum Pathol 36:576–580PubMedCrossRef Haas S, Bindl L, Fischer HP (2005) Autoimmune enteric leiomyositis: a rare cause of chronic intestinal pseudo-obstruction with specific morphological features. Hum Pathol 36:576–580PubMedCrossRef
42.
go back to reference Bassotti G, Villanacci V (2006) Slow transit constipation: a functional disorder becomes an enteric neuropathy. World J Gastroenterol 12:4609–4613PubMed Bassotti G, Villanacci V (2006) Slow transit constipation: a functional disorder becomes an enteric neuropathy. World J Gastroenterol 12:4609–4613PubMed
43.
go back to reference Bassotti G, Villanacci V, Antonelli E, Morelli A, Salerni B (2007) Enteric glial cells: new players in gastrointestinal motility? Lab Invest 87:628–632PubMedCrossRef Bassotti G, Villanacci V, Antonelli E, Morelli A, Salerni B (2007) Enteric glial cells: new players in gastrointestinal motility? Lab Invest 87:628–632PubMedCrossRef
44.
go back to reference Bassotti G, Villanacci V (2011) Can “functional” constipation be considered as a form of enteric neuro-gliopathy? Glia 59:345–350PubMedCrossRef Bassotti G, Villanacci V (2011) Can “functional” constipation be considered as a form of enteric neuro-gliopathy? Glia 59:345–350PubMedCrossRef
45.
go back to reference Rossi E, Villanacci V, Fisogni S et al (2007) Chromosomal study of enteric glial cells and neurons by fluorescence in situ hybridization in slow transit constipation. Neurogastroenterol Motil 19:578–584PubMedCrossRef Rossi E, Villanacci V, Fisogni S et al (2007) Chromosomal study of enteric glial cells and neurons by fluorescence in situ hybridization in slow transit constipation. Neurogastroenterol Motil 19:578–584PubMedCrossRef
46.
go back to reference Bassotti G, Villanacci V, Fisogni S et al (2007) Comparison of three methods to assess enteric neuronal apoptosis in patients with slow transit constipation. Apoptosis 12:329–332PubMedCrossRef Bassotti G, Villanacci V, Fisogni S et al (2007) Comparison of three methods to assess enteric neuronal apoptosis in patients with slow transit constipation. Apoptosis 12:329–332PubMedCrossRef
47.
go back to reference Bassotti G, Villanacci V, Fisogni S, Cadei M, Di Fabio F, Salerni B (2007) Apoptotic phenomena are not a major cause of enteric neuronal loss in constipated patients with dementia. Neuropathology 27:67–72PubMedCrossRef Bassotti G, Villanacci V, Fisogni S, Cadei M, Di Fabio F, Salerni B (2007) Apoptotic phenomena are not a major cause of enteric neuronal loss in constipated patients with dementia. Neuropathology 27:67–72PubMedCrossRef
48.
go back to reference Gibbons SJ, De Giorgio R, Pellegrini MS et al (2009) Apoptotic cell death of human interstitial cells of Cajal. Neurogastroenterol Motil 21:85–93PubMedCrossRef Gibbons SJ, De Giorgio R, Pellegrini MS et al (2009) Apoptotic cell death of human interstitial cells of Cajal. Neurogastroenterol Motil 21:85–93PubMedCrossRef
Metadata
Title
Beyond hematoxylin and eosin: the importance of immunohistochemical techniques for evaluating surgically resected constipated patients
Authors
G. Bassotti
V. Villanacci
B. Salerni
C. A. Maurer
G. Cathomas
Publication date
01-12-2011
Publisher
Springer Milan
Published in
Techniques in Coloproctology / Issue 4/2011
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-011-0721-5

Other articles of this Issue 4/2011

Techniques in Coloproctology 4/2011 Go to the issue