Microtubule associated protein-2 (MAP-2) in the diagnosis of hirschsprung disease – a rewarding ancillary technique

Abstract

Introduction Hirschsprung disease (HD) also known as congenital aganglionosis, is characterized by the absence of myenteric and submucosal ganglion cells (GC) in the distal gastrointestinal tract. Diagnosis of HD is a negative diagnosis, made on the absence of GC and missing out on even a single ganglion cell can totally change the diagnosis. Microtubule associated protein 2 (MAP2) immunohistochemistry is very helpful in catching the elusive ganglion cells in the small, improperly oriented rectal biopsies. Material and methods To assess this, 72 samples from 42 suspected cases of HD were subjected to routine haematoxylin and eosin stain and MAP 2 immunohistochemistry. Results On paraffin section analysis the number of samples considered positive for HD were 24 which were brought down to 19 after MAP-2 analysis. The sensitivity of paraffin sections in the diagnosis of HD is 79.16% and specificity is 91.37%. The p-value is Conclusions MAP-2 immunohistochemistry is a very good ancillary technique in the diagnosis of Hirschsprung disease and can catch even a single ganglion cell in the small rectal biopsies.