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Hypercellular/heterotopic ganglia in omphalomesenteric duct remnants
S S Wu1, M H Collins, S Coventry
1Department of Pathology and Laboratory Medicine, MCP Hahnemann University and St. Christopher's Hospital for Children, Front Street at Erie Avenue, Philadelphia, PA 19134, USA.
Abstract:
Omphalomesenteric duct remnants (ODR) including Meckel diverticula often present with symptoms of bowel obstruction. Their histologic features are varied and include heterotopic gastrointestinal mucosa and/or pancreatic tissue within the wall. Abnormalities of the submucosal plexus of Meissner, however, have not been documented in the literature. Thus, we have examined a number of ODR for evidence of ganglion abnormalities. Fifty-three cases of ODR were retrieved from our archives, along with 25 nonduodenal small bowel control specimens obtained from autopsies of patients without clinical or pathologic evidence of enteropathy. Histologic criteria for the diagnosis of abnormal hypercellular/heterotopic ganglia (HHG) in ODR were defined as a single submucosal ganglion/plexus containing > 10 neurons, or > 5 submucosal ganglions per high-power (x 40) field, or heterotopic ganglion cells within the muscularis mucosa or the lamina propria. HHG, histologically indistinguishable from intestinal neuronal dysplasia type B, were found in more than half of the ODR (ODR: 51.9%, n = 50 vs. control: 4%, n = 25, P = 3.6 x 10(-6), particularly those excised for obstructive complications (ODR with acute abdomen: 65.7%, n = 35, vs. ODR without acute abdomen: 33.3%, n = 15, P = 0.035). HHG were present in equal numbers of inflamed and noninflamed ODR (inflamed: 53.6%, n = 28, vs. noninflamed: 59.1%, n = 22, P = 0.70). A similar incidence was found in ODR with heterotopia and without (with heterotopia: 61.1%, n = 18, vs. without: 53.1%, n = 32, P = 0.59). ODR frequently contained HHG histomorphologically similar to those found in intestinal neuronal dysplasia, type B (IND-B). The overrepresentation of HHG in symptomatic ODR patients suggests an association with bowel obstruction. The data did not demonstrate a relationship with either inflammation or heterotopia.
Insights
Omphalomesenteric duct remnants (ODR) frequently exhibit abnormal hypercellular/heterotopic ganglia (HHG), similar to intestinal neuronal dysplasia type B. This finding suggests a link between ODR, HHG, and bowel obstruction.
Area of Science:
- Gastroenterology
- Pathology
- Developmental Biology
Background:
- Omphalomesenteric duct remnants (ODR), including Meckel diverticula, are congenital anomalies often presenting with bowel obstruction.
- Histologic examination of ODR typically reveals heterotopic gastrointestinal or pancreatic tissue.
- Abnormalities in the submucosal plexus of Meissner within ODR have not been previously documented.
Purpose of the Study:
- To investigate the presence and characteristics of ganglion abnormalities in the submucosal plexus of ODR.
- To determine if these abnormalities are associated with clinical presentation, particularly bowel obstruction.
- To compare the histologic features of ODR ganglia with known conditions like intestinal neuronal dysplasia type B.
Main Methods:
- Retrospective analysis of 53 ODR cases and 25 control small bowel specimens.
- Histologic examination to identify abnormal hypercellular/heterotopic ganglia (HHG) based on defined criteria (e.g., neuron count per field, location).
- Statistical analysis to compare the incidence of HHG in ODR versus controls and in relation to clinical factors (obstruction, inflammation, heterotopia).
Main Results:
- Abnormal hypercellular/heterotopic ganglia (HHG) were found in 51.9% of ODR cases, significantly higher than in controls (4%, P = 3.6 x 10(-6)).
- HHG were more prevalent in ODR excised for obstructive complications (65.7%) compared to those without acute abdomen (33.3%, P = 0.035).
- The incidence of HHG was similar in inflamed versus noninflamed ODR and in ODR with versus without heterotopic tissue.
Conclusions:
- ODR frequently harbor HHG, histomorphologically similar to those seen in intestinal neuronal dysplasia type B.
- The increased prevalence of HHG in symptomatic ODR suggests a potential association with bowel obstruction.
- No significant relationship was found between HHG and inflammation or heterotopic tissue within ODR.