Analysis of Full-Thickness Gastric Body Sections: Normal Values for Gastric Motility Disorders.
Amol Sharma, Henry Parkman, Rebecca Thomas. Temple University Hospital, Philadelphia
Background: Due to growing interest in gastrointestinal motility and neuromuscular disorders, the Gastro 2009 International Working Group (IWG) created guidelines for assessing histologic sections in these patients. However, recommendations originated from studies of small intestinal and colonic specimens. The aim of this study was to examine full thickness gastric body sections from patients without symptoms of gastroparesis, as controls.
Design: Full-thickness H+E sections from the gastric margin, approximately 8 cm proximal to the pylorus, were evaluated from 17 patients who underwent a Whipple procedure at Temple University Hospital between 2005 and 2010. There were 17 patients (11 male, 7 female); average age of 60.2 (range 40 to 76) years; 7 patients had diabetes mellitus, type II. Masson trichrome stain and immunohistochemical stains for CD45, CD3, CD20, CD68, NSE, S-100, GFAP and c-kit were also performed. Sections were evaluated for fibrosis, ganglia, ganglion cells, interstitial cells of Cajal (ICC), inflammatory cells and glia in the muscularis propria.
Results: All 7 diabetics had mild fibrosis of the muscularis propria. B lymphocytes were confined to the mucosa; 3 patients had >5 periganglionic T lymphocytes (IWG criteria for myenteric ganglionitis); 2 intraganglionic T lymphocytes were noted in one specimen. In the intermyenteric plexus (IMP), there were 1.0±0.4 (SD) ganglia/HPF with 2.3±1.9 (SD) ganglion cells/HPF. S-100 showed strong staining of the Schwann cells; GFAP staining showed very focal weak positivity in close proximity to ganglia in two cases; c-Kit staining revealed 3.7±2.6 (SD) ICC in the inner circular layer, 1.3±1.1 (SD) ICC in the outer longitudinal layer, and 1.0±0.7 (SD) ICC in the IMP. There was no difference between diabetics and non-diabetics in number of ICC in any layer.
Conclusions: These results provide control data for the evaluation of tissue from patients with gastroparesis. Further studies to detect glial cells by immunohistochemical staining are necessary. Myenteric ganglionitis in 3 specimens may be due to inflammation secondary to prolonged surgery, as there was a prominent infiltrate of neutrophils and macrophages in several cases. ICC control data is presented; however, the wide standard deviation indicates patchy distribution of these cells in the gastric body. The lack of difference in ICC distribution in diabetic and non-diabetic patients suggests that some trigger may play a role resulting in decreased ICC in diabetic gastroparetic patients, or, the decreased ICC in diabetic gastroparetic patients may be dependent on the portion of stomach sampled.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 142, Tuesday Morning