The Role of Bcl-2 in Pediatric Functional Bowel Obstruction Cases with Ganglionated Specimens

Abstract

Abstract Background Functional disturbances of the gastrointestinal tract is caused by a number of neurodysplastic conditions including other diseases, rarer than the Hirschsprung’s disease dysganglionosis, such as ganglion cells immaturity including Intestinal Neuronal Dysplasia (IND). Bcl-2 shows positive immunoreactivity in the degenerative and immature ganglion cells . Aim This work evaluates the role of immunohistochemical expression of Bcl-2 in pediatric functional bowel obstruction cases with ganglionated specimens. Material and Methods Twenty one cases of functional bowel obstruction were enrolled in our study including the Hirschsprung Allied Disorders (HAD) and operated cases of Hirschsprung’s Disease (HD) with adequate ganglionated resection margins and presented by obstructive symptoms following surgery. All cases underwent histologic examination of ganglion cells and nerve bundles as well as evaluation for Bcl-2 immunohistochemical expression. Results 57.1% of the cases were strongly positive for Bcl-2 protein, 19% were weakly positive and 23.8 % were negative. A highly significant correlation was demonstrated between Bcl-2 expression and ganglion cell number ( P < 0.001 ) where all hyperganglionic specimens showed strong positivity in contrast to the hypoganglionic and adequately ganglionic ones. A positive association was also found between Bcl-2 expression and IND in comparison to other disorders of dysganglionsis (P = 0.04) and recurrent HD cases (P = 0.002). A significant correlation was also detected between ganglion cell number and nerve bundle hypertrophy (P = 0.02). Conclusion Bcl-2 immunohistochemistry can be used as a valuable tool in the diagnosis of Hirschsprung’s disease allied disorders through its expression in the immature ganglion cells which are difficult to be identified by conventional H & E staining.