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Table 5 Histopathological Findings of AMC

From: Symptoms and diagnostic criteria of acquired Megacolon - a systematic literature review

Author Date No. Pts Findings
Kobak et al. [30] 1962 2 1× nerve ganglia in rectal segment distal to megacolon, some diminution of ganglia in involved area
1× nerve ganglia observed entire colon
Koch et al. [35] 1993 6 1× CM hypertrophy
2× LM hypertrophy
Diminished concentrations AChE in ME p < 0.01
Diminished concentrations VIP in ME p = 0.03
Diminished VIP-staining neurons CM + LM
Diminished immunostaining neuronal bodies SPE
Myenteric plexus, submuocus plexus externus, submucous plexus internus normal
No inflammatory infiltrate
Koch et al. [34] 1996 10 Diminished concentration VIP ME p = 0.01
Increased NADPH diaphorase activity in ME p = 0.01
Gattuso et al. [36] 1996 3 Hypertrophy ME
Lower density NADPH-diaphorase in ME
Decreased neural density shown by PGP 9.5 immunoreactivity
Smaller number nitric oxide motor system nerve fibres in ME
Gattuso et al. [32] 1997 6 No thickening enteric smooth muscle
No change in density of enteric innervation
2× mild melanosis coli
3× mild chronic inflammatory cell infiltrate LP
2× hypertrophied ME
No thickening enteric smooth muscle p < 0.005
2× fibrosis LM
1× fibrosis CM
3× fibrosis MM
Gattuso et al. [27] 1998 1 Hypertrophy LM
Hypertrophy MM
Diminished enteric neural density in ME, most marked in LM
Increased density AChE− + ve nerves in LP
Mild-moderate fibrosis ME
Lee et al. [23] 2005 9 Diminished ICC and PGP 9.5 reactive neuronal structures in all colonic layers p < 0.05
Meier-Ruge et al. [37] 2006 63 Atrophied collagenous tendinous connective tissue membrane of MP
Atrophied tendinous fibre net of MP
Type III collagen absent from MP
ICC/collagen II/collagen IV/smooth muscle actin/desmin/fibronectin no consistent alteration
Wedel et al. [38] 2006 8 SMMHC, HDAC8 and/or SM absent of lacking in 75%
Diminished myofilaments of myocyte clusters
Oligoneuronal hypogangliosis
Iantorno et al. [24] 2007 9 Decreased enteric neurons and enteric glial cells
Decreased ICC but increased ICC-IM
Diminished NSE − +ve and S100 − +ve cells in SP and MP
67% lymphocyte infiltration MP and SP p = 0.13
Ohkubo et al. [39] 2014 31 Non-dilated loops exhibited similar histopathologic findings as dilated loops
61.3% damaged and/or severe reduction ganglion cells
35.5% atrophy and/or vacuolar degeneration of smooth muscle cells of MP
32.2% abnormal ICC network
19.4% atrophy and/or vacuolar degeneration of smooth muscle cells of MP and damaged and/or severe reduction ganglion cells
3.2% atrophy and/or vacuolar degeneration of smooth muscle cells of MP and abnormal ICC network
12.9% damaged and/or severe reduction ganglion cells and abnormal ICC network
  1. Pts Patients, CM Circular muscularis externa, LM Longitudinal muscularis externa, AChE Acetyl cholinesterase, ME Muscularis externa, VIP Vasoactive intestinal peptide, NADPH Nicotinamide adenine dinucleotide phospate diaphorase, LP Lamina propria, MM Muscularis mucosa, ICC Interstitial cells of Cajal, PGP protein gene product neuronal marker, MP Myenteric plexus, SMMHC smooth muscle myosin heavy chain smooth muscle marker, HDAC8 histone deacetylase 8 smooth muscle marker, SM smoothelin smooth muscle marker, SP Submucosal plexus, NSE Neuron specific elonase enteric neuronal marker, S100, Schwann cell marker IM, intramuscular space