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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