New Classification of Histochemical Staining Patterns of
Acetylcholinesterase Activity in Rectal Suction Biopsy in
Hirschsprung's Disease
VILAI CHENTANEZ, M.D., Ph.D*,
SOOTTIPORN CHITTMITTRAPAP, M.D.**,
POONLARP CHEEPSOONTHORN, B.Sc., M.S.*, SITHIPORN AGTHONG, M.D.*
Affiliation : * Department of Anatomy,
** Department of Surgery, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.
AbstractSeveral previous studies have introduced classifications of Acetylcholinesterase (AChE)
histochemical staining patterns in rectal suction biopsy performed in patients with Hirschsprung's
disease. However, we introduce a new classification that is less complicated but shows the same
age dependence as seen in previous studies. 135 rectal suction biopsies were submitted to histo-
chemical staining for AChE activity and 88 specimens showed increased AChE activity. There-
fore, we retrospectively analysed these 88 cases and could establish three patterns. Pattern I,
presence of thick nerve trunks or coarse nerve fibers only in the muscularis mucosae and submucosa.
This pattern was mainly seen in children aged 6 months or below. Pattern II, presence of abundant
nerve fibers in all three layers of mucosa. This pattern was predominantly seen in children over 6
months of age. Pattern III, not predominant in any age group, showed positive nerve fibers in all
three layers but, in one or more layers, the nerve fibers were sparse.
Upon comparison with previous studies, we could observe the same age-pattern rela-
tionship. Thus, we propose this method of classification as a new tool to classify AChE histo-
chemical staining patterns.
Keywords : Patterns of Acetylcholinesterase Activity, Rectal Suction Biopsy, Hirschsprung's
Disease
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