INCREASED SUBMUCOSAL NERVE TRUNK CALIBER IN AGANGLIONOSIS - A POSITIVE AND OBJECTIVE FINDING IN SUCTION BIOPSIES AND SEGMENTAL RESECTIONS IN HIRSCHSPRUNGS-DISEASE

Objective.-To establish the diagnostic usefulness of submucosal hypert rophic nerve trunk morphology in Hirschsprung's disease as a quantifia ble parameter supportive of aganglionosis on hematoxylin-eosin-stained sections. Design.-We retrospectively evaluated size and density of su bmucosal nerves on hematoxylin-eosin-stained sections and S100 protein -stained sections of resected segments from 13 patients with Hirschspr ung's disease, and in sections of 20 aganglionic and 50 ganglionic rec tal suction biopsies. Setting.-All patients were seen at Childrens Hos pital Los Angeles (Calif), a tertiary-care pediatric center; the age o f patients at diagnosis or resection ranged between 2 days and 3 years . Results.-Aganglionic segments contain many distinct nerve trunks gre ater than 40 mu m in diameter. Ganglionic segments/biopsies showed no nerve trunk larger than this threshold value (P similar to .0000). Ner ve trunks of such caliber are rarely encountered in pathologic transit ion zones and sites of colostomy. Conclusions.-Submucosal nerve trunks that are 40 mu m or greater in diameter strongly correlate with abnor mal innervation/aganglionosis. Use of this objective parameter in eval uating suction biopsies should be helpful in the morphologic diagnosis of Hirschsprung's disease in infancy and early childhood.