Margaret Collins

168 statements · 2 topics

Colorectal / ARM & Hirschsprung · guest expert

Featured statements

We perform autopsies and during the course of those autopsies, we examine sections from the bowel and so we know that there are ganglion cells present in the rectal submucosa at 28 weeks gestation normally.
quote · Colorectal / ARM & Hirschsprung
Large nerves are not present in the submucosa of all cases of Hirschberg disease.
quote · Colorectal / ARM & Hirschsprung
The failure rate for the suction rectal biopsy increases after one year of age.
quote · Hirschsprung disease
When absent ganglion cells are found without hypertrophic nerves, the strength of clinical findings, biopsy adequacy, patient age, gender, contrast enema results, family history, and ancillary stains must all be considered.
clinical · Hirschsprung disease

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Margaret's statements about Colorectal / ARM & Hirschsprung 84 statements

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CinciHirsch - Pathology of Hirschprung Disease

Quotation We perform autopsies and during the course of those autopsies, we examine sections from the bowel and so we know that there are ganglion cells present in the rectal submucosa at 28 weeks gestation normally. Open
Quotation We perform autopsies and during the course of those autopsies, we examine sections from the bowel and so we know that there are ganglion cells present in the rectal submucosa at 28 weeks gestation normally. Open
Statement Ganglion cells are present in the rectal submucosa at 28 weeks gestation normally, though they may appear immature. Open
Statement Ganglion cells are present in the rectal submucosa at 28 weeks gestation normally, though they may appear immature. Open
Statement An experienced pediatric pathologist can recognize immature ganglion cells at 28 weeks gestation. Open
Statement An experienced pediatric pathologist can recognize immature ganglion cells at 28 weeks gestation. Open
Statement Suction rectal biopsies to rule out Hirschsprung disease on 28-week gestation newborns are extremely rare. Open
Statement Suction rectal biopsies to rule out Hirschsprung disease on 28-week gestation newborns are extremely rare. Open
Quotation The failure rate for the suction rectal biopsy increases after one year of age. Open
Quotation The failure rate for the suction rectal biopsy increases after one year of age. Open
Statement The failure rate for suction rectal biopsy increases after one year of age. Open
Statement The failure rate for suction rectal biopsy increases after one year of age. Open
Statement After infancy, there is increased separation of ganglia as a result of growth, making suction biopsy more difficult. Open
Statement After infancy, there is increased separation of ganglia as a result of growth, making suction biopsy more difficult. Open
Statement Beyond infancy, there is increased toughness of the stroma, making it more difficult to obtain a good suction rectal biopsy. Open
Statement Beyond infancy, there is increased toughness of the stroma, making it more difficult to obtain a good suction rectal biopsy. Open
Statement The anal canal becomes longer and thicker with age, contributing to increased suction biopsy failure rates. Open
Statement The anal canal becomes longer and thicker with age, contributing to increased suction biopsy failure rates. Open
Statement If suction biopsy fails in children over one year, a deeper or full-thickness rectal biopsy should be considered as the first option. Open
Statement If suction biopsy fails in children over one year, a deeper or full-thickness rectal biopsy should be considered as the first option. Open
Statement Having hypertrophic nerves is helpful in the setting of no ganglion cells in an otherwise adequate suction rectal biopsy. Open
Statement Having hypertrophic nerves is helpful in the setting of no ganglion cells in an otherwise adequate suction rectal biopsy. Open
Statement Communication between surgeon and pathologist is essential when deciding whether to proceed with surgery based on biopsy findings. Open
Quotation This is an area in which there must be communication between the surgeon and the pathologist. Open
Quotation This is an area in which there must be communication between the surgeon and the pathologist. Open
Statement Communication between surgeon and pathologist is essential when deciding whether to proceed with surgery based on biopsy findings. Open
Statement It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Statement It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Quotation It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Quotation It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Statement A better approach is to obtain a full-thickness rectal biopsy without frozen section, allow permanent sections and adjunctive studies, then plan surgical resection at a future date. Open
Statement A better approach is to obtain a full-thickness rectal biopsy without frozen section, allow permanent sections and adjunctive studies, then plan surgical resection at a future date. Open
Quotation Large nerves are not present in the submucosa of all cases of Hirschberg disease. Open
Statement Large nerves are not present in the submucosa of all cases of Hirschsprung disease; total colonic aganglionosis is a classic example. Open
Quotation Large nerves are not present in the submucosa of all cases of Hirschberg disease. Open
Statement Large nerves are not present in the submucosa of all cases of Hirschsprung disease; total colonic aganglionosis is a classic example. Open
Statement It is possible to have a suction rectal biopsy showing absent ganglion cells without demonstrating large nerves in the submucosa. Open
Statement It is possible to have a suction rectal biopsy showing absent ganglion cells without demonstrating large nerves in the submucosa. Open
Statement When absent ganglion cells are found without hypertrophic nerves, the strength of clinical findings, biopsy adequacy, patient age, gender, contrast enema results, family history, and ancillary stains must all be considered. Open
Statement When absent ganglion cells are found without hypertrophic nerves, the strength of clinical findings, biopsy adequacy, patient age, gender, contrast enema results, family history, and ancillary stains must all be considered. Open
Statement Nerve hypertrophy may be less apparent in very young infants as well as in older children. Open
Statement Nerve hypertrophy may be less apparent in very young infants as well as in older children. Open
Statement In most hospitals, rectal biopsies are seen by more than one pathologist before a diagnosis is rendered. Open
Statement In most hospitals, rectal biopsies are seen by more than one pathologist before a diagnosis is rendered. Open
Statement At Cincinnati Children's, pathologists use a multi-headed microscope with a calibrated arrow to quickly measure nerve diameter during frozen sections without taking out calipers. Open
Statement At Cincinnati Children's, pathologists use a multi-headed microscope with a calibrated arrow to quickly measure nerve diameter during frozen sections without taking out calipers. Open
Statement Transition zone characteristics include partial circumferential aganglionosis, which requires examining the whole circumference of bowel. Open
Statement Transition zone characteristics include partial circumferential aganglionosis, which requires examining the whole circumference of bowel. Open
Statement Transition zone contains ganglion cells that are not in their normal distribution completely around the circumference of the bowel. Open
Statement Transition zone contains ganglion cells that are not in their normal distribution completely around the circumference of the bowel. Open
Statement Transition zone has hypoganglionosis by definition. Open
Statement Transition zone has hypertrophic nerves that can be evaluated with calretinin stain, more in the submucosa than in the myenteric plexus, with or without associated ganglion cells. Open
Statement Transition zone has hypertrophic nerves that can be evaluated with calretinin stain, more in the submucosa than in the myenteric plexus, with or without associated ganglion cells. Open
Statement Transition zone has hypoganglionosis by definition. Open
Statement Submucosal hyperganglionosis (many ganglion cells in one ganglion, at least 10) is a more controversial feature of transition zone, where submucosa can look like IND type B. Open
Statement Submucosal hyperganglionosis (many ganglion cells in one ganglion, at least 10) is a more controversial feature of transition zone, where submucosa can look like IND type B. Open
Statement Ectopic ganglion cells can occur in normal biopsies and normally innervated bowel, making them a controversial transition zone feature. Open
Statement Ectopic ganglion cells can occur in normal biopsies and normally innervated bowel, making them a controversial transition zone feature. Open
Statement A positive calretinin stain (showing nerve twigs in lamina propria) proximal to an aganglionic segment indicates ganglion cells are present even if not visible in that particular section. Open
Statement A positive calretinin stain (showing nerve twigs in lamina propria) proximal to an aganglionic segment indicates ganglion cells are present even if not visible in that particular section. Open
Statement The methodology used for IND diagnosis in Europe (15-micron thick sections, specific histochemical stains) has not been adopted in the United States. Open
Statement The methodology used for IND diagnosis in Europe (15-micron thick sections, specific histochemical stains) has not been adopted in the United States. Open
Statement IND has had inconsistent diagnostic criteria, with definitions changing several times over decades. Open
Statement IND has had inconsistent diagnostic criteria, with definitions changing several times over decades. Open
Statement IND lacks adequate control data—studies have not compared constipated children to age-matched non-constipated controls to determine if features are causative. Open
Statement IND lacks adequate control data—studies have not compared constipated children to age-matched non-constipated controls to determine if features are causative. Open
Statement IND should not be diagnosed in infants, is outgrown by age 4, does not require surgical therapy, and is self-correcting, making its clinical significance unclear. Open
Statement IND should not be diagnosed in infants, is outgrown by age 4, does not require surgical therapy, and is self-correcting, making its clinical significance unclear. Open
Statement Multiple authors have challenged whether IND diagnostic criteria represent one end of a normal spectrum. Open
Statement Multiple authors have challenged whether IND diagnostic criteria represent one end of a normal spectrum. Open
Statement The histopathological phenotype of IND may be a consequence or adaptation to downstream dysmotility rather than the cause. Open
Statement The histopathological phenotype of IND may be a consequence or adaptation to downstream dysmotility rather than the cause. Open
Statement In the United States, many features attributed to IND are considered transition zone in Hirschsprung disease. Open
Statement In the United States, many features attributed to IND are considered transition zone in Hirschsprung disease. Open
Statement The best way to diagnose hypoganglionosis is to consider only myenteric ganglion cell density, which requires resected bowel, not just suction biopsy. Open
Statement The best way to diagnose hypoganglionosis is to consider only myenteric ganglion cell density, which requires resected bowel, not just suction biopsy. Open
Statement Pathologists currently only confidently diagnose severe hypoganglionosis, based on long stretches of myenteric plexus containing small ganglia (one or two ganglion cells per ganglion) with minimal neuropil. Open
Statement Pathologists currently only confidently diagnose severe hypoganglionosis, based on long stretches of myenteric plexus containing small ganglia (one or two ganglion cells per ganglion) with minimal neuropil. Open
Statement Less severe forms of hypoganglionosis can only be resolved for research purposes with dedicated ganglion cell counts using specific antibody markers. Open
Statement Less severe forms of hypoganglionosis can only be resolved for research purposes with dedicated ganglion cell counts using specific antibody markers. Open
Statement Normal variation in ganglion cell density is huge, and large areas must be counted for accurate assessment, limiting the clinical value of diagnosing less severe hypoganglionosis. Open
Statement Normal variation in ganglion cell density is huge, and large areas must be counted for accurate assessment, limiting the clinical value of diagnosing less severe hypoganglionosis. Open
Statement Hypoganglionosis usually enters the differential diagnosis for patients who have had multiple surgical procedures and poor outcomes. Open
Statement Hypoganglionosis usually enters the differential diagnosis for patients who have had multiple surgical procedures and poor outcomes. Open
Margaret's statements about Hirschsprung disease 84 statements

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CinciHirsch - Pathology of Hirschprung Disease

Quotation We perform autopsies and during the course of those autopsies, we examine sections from the bowel and so we know that there are ganglion cells present in the rectal submucosa at 28 weeks gestation normally. Open
Statement Ganglion cells are present in the rectal submucosa at 28 weeks gestation normally, though they may appear immature. Open
Quotation We perform autopsies and during the course of those autopsies, we examine sections from the bowel and so we know that there are ganglion cells present in the rectal submucosa at 28 weeks gestation normally. Open
Statement Ganglion cells are present in the rectal submucosa at 28 weeks gestation normally, though they may appear immature. Open
Statement An experienced pediatric pathologist can recognize immature ganglion cells at 28 weeks gestation. Open
Statement An experienced pediatric pathologist can recognize immature ganglion cells at 28 weeks gestation. Open
Statement Suction rectal biopsies to rule out Hirschsprung disease on 28-week gestation newborns are extremely rare. Open
Statement Suction rectal biopsies to rule out Hirschsprung disease on 28-week gestation newborns are extremely rare. Open
Statement The failure rate for suction rectal biopsy increases after one year of age. Open
Statement The failure rate for suction rectal biopsy increases after one year of age. Open
Quotation The failure rate for the suction rectal biopsy increases after one year of age. Open
Quotation The failure rate for the suction rectal biopsy increases after one year of age. Open
Statement After infancy, there is increased separation of ganglia as a result of growth, making suction biopsy more difficult. Open
Statement After infancy, there is increased separation of ganglia as a result of growth, making suction biopsy more difficult. Open
Statement Beyond infancy, there is increased toughness of the stroma, making it more difficult to obtain a good suction rectal biopsy. Open
Statement Beyond infancy, there is increased toughness of the stroma, making it more difficult to obtain a good suction rectal biopsy. Open
Statement The anal canal becomes longer and thicker with age, contributing to increased suction biopsy failure rates. Open
Statement The anal canal becomes longer and thicker with age, contributing to increased suction biopsy failure rates. Open
Statement If suction biopsy fails in children over one year, a deeper or full-thickness rectal biopsy should be considered as the first option. Open
Statement If suction biopsy fails in children over one year, a deeper or full-thickness rectal biopsy should be considered as the first option. Open
Statement Having hypertrophic nerves is helpful in the setting of no ganglion cells in an otherwise adequate suction rectal biopsy. Open
Statement Having hypertrophic nerves is helpful in the setting of no ganglion cells in an otherwise adequate suction rectal biopsy. Open
Quotation This is an area in which there must be communication between the surgeon and the pathologist. Open
Quotation This is an area in which there must be communication between the surgeon and the pathologist. Open
Statement Communication between surgeon and pathologist is essential when deciding whether to proceed with surgery based on biopsy findings. Open
Statement Communication between surgeon and pathologist is essential when deciding whether to proceed with surgery based on biopsy findings. Open
Statement It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Quotation It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Statement It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Quotation It is not a good idea to base an entire surgical procedure on the frozen section of a biopsy obtained intraoperatively. Open
Statement A better approach is to obtain a full-thickness rectal biopsy without frozen section, allow permanent sections and adjunctive studies, then plan surgical resection at a future date. Open
Statement A better approach is to obtain a full-thickness rectal biopsy without frozen section, allow permanent sections and adjunctive studies, then plan surgical resection at a future date. Open
Quotation Large nerves are not present in the submucosa of all cases of Hirschberg disease. Open
Statement Large nerves are not present in the submucosa of all cases of Hirschsprung disease; total colonic aganglionosis is a classic example. Open
Quotation Large nerves are not present in the submucosa of all cases of Hirschberg disease. Open
Statement Large nerves are not present in the submucosa of all cases of Hirschsprung disease; total colonic aganglionosis is a classic example. Open
Statement It is possible to have a suction rectal biopsy showing absent ganglion cells without demonstrating large nerves in the submucosa. Open
Statement It is possible to have a suction rectal biopsy showing absent ganglion cells without demonstrating large nerves in the submucosa. Open
Statement When absent ganglion cells are found without hypertrophic nerves, the strength of clinical findings, biopsy adequacy, patient age, gender, contrast enema results, family history, and ancillary stains must all be considered. Open
Statement When absent ganglion cells are found without hypertrophic nerves, the strength of clinical findings, biopsy adequacy, patient age, gender, contrast enema results, family history, and ancillary stains must all be considered. Open
Statement Nerve hypertrophy may be less apparent in very young infants as well as in older children. Open
Statement Nerve hypertrophy may be less apparent in very young infants as well as in older children. Open
Statement In most hospitals, rectal biopsies are seen by more than one pathologist before a diagnosis is rendered. Open
Statement In most hospitals, rectal biopsies are seen by more than one pathologist before a diagnosis is rendered. Open
Statement At Cincinnati Children's, pathologists use a multi-headed microscope with a calibrated arrow to quickly measure nerve diameter during frozen sections without taking out calipers. Open
Statement At Cincinnati Children's, pathologists use a multi-headed microscope with a calibrated arrow to quickly measure nerve diameter during frozen sections without taking out calipers. Open
Statement Transition zone characteristics include partial circumferential aganglionosis, which requires examining the whole circumference of bowel. Open
Statement Transition zone characteristics include partial circumferential aganglionosis, which requires examining the whole circumference of bowel. Open
Statement Transition zone contains ganglion cells that are not in their normal distribution completely around the circumference of the bowel. Open
Statement Transition zone contains ganglion cells that are not in their normal distribution completely around the circumference of the bowel. Open
Statement Transition zone has hypertrophic nerves that can be evaluated with calretinin stain, more in the submucosa than in the myenteric plexus, with or without associated ganglion cells. Open
Statement Transition zone has hypertrophic nerves that can be evaluated with calretinin stain, more in the submucosa than in the myenteric plexus, with or without associated ganglion cells. Open
Statement Transition zone has hypoganglionosis by definition. Open
Statement Transition zone has hypoganglionosis by definition. Open
Statement Submucosal hyperganglionosis (many ganglion cells in one ganglion, at least 10) is a more controversial feature of transition zone, where submucosa can look like IND type B. Open
Statement Submucosal hyperganglionosis (many ganglion cells in one ganglion, at least 10) is a more controversial feature of transition zone, where submucosa can look like IND type B. Open
Statement Ectopic ganglion cells can occur in normal biopsies and normally innervated bowel, making them a controversial transition zone feature. Open
Statement Ectopic ganglion cells can occur in normal biopsies and normally innervated bowel, making them a controversial transition zone feature. Open
Statement A positive calretinin stain (showing nerve twigs in lamina propria) proximal to an aganglionic segment indicates ganglion cells are present even if not visible in that particular section. Open
Statement A positive calretinin stain (showing nerve twigs in lamina propria) proximal to an aganglionic segment indicates ganglion cells are present even if not visible in that particular section. Open
Statement The methodology used for IND diagnosis in Europe (15-micron thick sections, specific histochemical stains) has not been adopted in the United States. Open
Statement The methodology used for IND diagnosis in Europe (15-micron thick sections, specific histochemical stains) has not been adopted in the United States. Open
Statement IND has had inconsistent diagnostic criteria, with definitions changing several times over decades. Open
Statement IND has had inconsistent diagnostic criteria, with definitions changing several times over decades. Open
Statement IND lacks adequate control data—studies have not compared constipated children to age-matched non-constipated controls to determine if features are causative. Open
Statement IND lacks adequate control data—studies have not compared constipated children to age-matched non-constipated controls to determine if features are causative. Open
Statement IND should not be diagnosed in infants, is outgrown by age 4, does not require surgical therapy, and is self-correcting, making its clinical significance unclear. Open
Statement IND should not be diagnosed in infants, is outgrown by age 4, does not require surgical therapy, and is self-correcting, making its clinical significance unclear. Open
Statement Multiple authors have challenged whether IND diagnostic criteria represent one end of a normal spectrum. Open
Statement Multiple authors have challenged whether IND diagnostic criteria represent one end of a normal spectrum. Open
Statement The histopathological phenotype of IND may be a consequence or adaptation to downstream dysmotility rather than the cause. Open
Statement The histopathological phenotype of IND may be a consequence or adaptation to downstream dysmotility rather than the cause. Open
Statement In the United States, many features attributed to IND are considered transition zone in Hirschsprung disease. Open
Statement In the United States, many features attributed to IND are considered transition zone in Hirschsprung disease. Open
Statement The best way to diagnose hypoganglionosis is to consider only myenteric ganglion cell density, which requires resected bowel, not just suction biopsy. Open
Statement The best way to diagnose hypoganglionosis is to consider only myenteric ganglion cell density, which requires resected bowel, not just suction biopsy. Open
Statement Pathologists currently only confidently diagnose severe hypoganglionosis, based on long stretches of myenteric plexus containing small ganglia (one or two ganglion cells per ganglion) with minimal neuropil. Open
Statement Pathologists currently only confidently diagnose severe hypoganglionosis, based on long stretches of myenteric plexus containing small ganglia (one or two ganglion cells per ganglion) with minimal neuropil. Open
Statement Less severe forms of hypoganglionosis can only be resolved for research purposes with dedicated ganglion cell counts using specific antibody markers. Open
Statement Less severe forms of hypoganglionosis can only be resolved for research purposes with dedicated ganglion cell counts using specific antibody markers. Open
Statement Normal variation in ganglion cell density is huge, and large areas must be counted for accurate assessment, limiting the clinical value of diagnosing less severe hypoganglionosis. Open
Statement Normal variation in ganglion cell density is huge, and large areas must be counted for accurate assessment, limiting the clinical value of diagnosing less severe hypoganglionosis. Open
Statement Hypoganglionosis usually enters the differential diagnosis for patients who have had multiple surgical procedures and poor outcomes. Open
Statement Hypoganglionosis usually enters the differential diagnosis for patients who have had multiple surgical procedures and poor outcomes. Open