tumor in the light of the revised SIOP-01 classification

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Annals of Diagnostic Paediatric Pathology 2006, 10 (3–4): 109–113 © Copyright by Polish Paediatric Pathology Society Annals of The study on the pathogenesis of intestinal dismotility and malabsorbtion in gastroschisis on experimental model – chicken embryo Hanna Bu³hak-Guz 1 , Regina Cybulska 2 , Ewa Czichos 3 , Tomasz Krawczyk 3 , Andrzej Kulig 3 , Andrzej Chilarski 1 1 Department of Pediatric Surgery and Urology 3 Departament of Clinical Pathomorphology Polish Mothers's Health Institute Lodz, Poland 2 Institute of Histology and Embriology of Agricultural Academy Lublin, Poland Introduction Abstract In gastroschisis (G) bowel loops protrude through a narrow, paraumbilical defect in the abdominal wall of the fetus into the amniotic cavity and float freely in the amniotic fluid exposed to its irritating activity leading to aseptic perivisceritis. Impairment of peristalsis of the bowels and food malab- Address for correspondence Gastroschisis (G) is a congenital defect of the abdominal wall characterized by translocation of intestinal loops outside the abdominal cavity during fetal life through a defect usually located on the right side of the umbilical cord. Translocated fragment of intestines in the extraembryonic cavity is exposed to direct contact with the amniotic fluid (AF) and excrements contained in it (urine and meconium). The abnormalities of intestinal function vary in intensity and the question arises whether dysfunction of the alimentary tract results form morphological changes in the whole intestinal wall or only in the translocated loops. The designed experiments are aimed to answer this question, and also to determine the character and extension of changes in the abdominal wall. The study consisted of an experimental creation of G on chicken embryos model and the subsequent comparison of the histopathological picture of the bowel wall of the intraabdominal loops versus the exteriorized ones. The histopathological examination revealed lesions in the eviscerated loops (exposed to AF activity) including the congestion of the intestinal villi, accumulation of erythrocytes in the villus vessels, concentration of inflammatory small-round cells in the serosa. Our results showed that: 1) the experimental studies on G showed the differences in the histopathological picture of the eviscerated bowel loops as compared to the intraabdominal ones, 2) lesions in the intestinal epithelium (the congestion of the villi) result from the bowel constriction and can be responsible for malabsorption in G patients, 3) inflammatory lesions in the serosa are caused by the irritating influence of the AF and can be responsible for postnatal peristalsis impairment. Key words: chicken embryo, gastroschisis, intestinal damage Hanna Bu³hak-Guz Phone: + 48 42 2712136 Department of Pediatric Surgery and Urology E-mail: hbulhak@wp.pl Polish Mothers's Health Institute Rzgowska St. 281/289 93-338 Lodz, Poland Diagnostic Paediatric Pathology sorption occurring in newborns treated for G are a serious clinical problem and have an influence on the method, length and costs of the treatment [17]. In relation to the occuring bowel malfunction of various severity, the question arises whether the alimentary tract disfunction results from the morphological changes in the bowel wall in the eviscerated loops only or perhaps they
110 exist in the entire intestine and whether the changes of the AF composition will protect the bowels floating in it against the formation of these lesions. The aim of the study The aim of the study was to explain the pathogenesis of the intestine malfunction in the course of G on the experimental model (the chicken embryos) and to answer the question whether the morphological changes in the bowel wall, which may be the underlying cause of the consequent functional disturbances of the alimentary tract, refer to eviscerated loops only or the whole intestine. If this is the case what is the character of these lesions? Material and method The experimental research was conducted in the Department of Laboratory Animals at the Polish Mother's Health Institute (PMHI) with the consent of The Local Ethics Committee for Research on Animals. The eggs with 9-day-old chicken embryos (Gallus domesticus) obtained from the Poultry Hatching Farm in Rzgów were incubated in a hatching chamber at the temperature of 37,7 Celsius, 60% humidity and the tray rotation every two hours. On the 14 th of embryonic life (which corresponds with the second trimester in mammals), G was created experimentally according to the accepted experimental model under the surgical microscope guidance with the use of microsurgical technique (Fig. 1) [18]. Following the closure of the egg shell with the sterile dressing, the embryos were replaced to the hatching chamber and further incubation took place till the 20 th day. For the assessment of the dynamics of morphological changes occurring in the bowels, the creation of G was performed on the Fig. 1 The view of created gastroschisis in operating microscope (11 th day of incubation) subsequent days of embryonic development i.e. from 11 th to 14 th day. The experiment was completed while at least 3 live embryos with G from each experimental day were achieved. The sacrificed embryos were measured and weighed for the general assessment (Fig. 2). Following the macroscopic evaluation of the abdominal wall and eviscerated bowels, the whole removed intestine was divided into 2 parts: intraabdominal loops and eviscerated loops – positioned outside the abdominal cavity and then fixed in 4% buffered formaline solution. The control group was constituted by the bowels deriving from the embryos no manipulation was performed on and the group of sham operations from the corresponding developmental days, divided into 2 portions either. The histological preparations (routine hematoxyline and eosin staining) was performed at the Clinical Pathomorphology Department of PMHI and the microscopic specimens were evaluated in a light microscope independently in 2 centres: the Clinical Pathomorphology Department of PMHI and the Institute of Histology and Embryology of the Agricultural Academy in Lublin. There were specimens deriving from 34 embryos: 17 from the control group and 17 from the G group. Fig. 2 The macroscopic view of gastroschisis in chicken (21 st day of incubation) Results The specimens obtained from 34 embryos were assessed histopathologically: 17 from the G group and 17 from of the control group (5 from 11 th day of incubation, 11 from 12 th , 8 from 13 th and 10 from 14 th respectively) (Table 1). In 2 cases no G was found (self-cure) and in 1 another concomitant bowel obstruction was recognized (Fig. 3). The histopathology of eviscerated bowel (G) exposed to AF in 8 (57 %) cases revealed significant congestion of the intestinal villi and the accumulation of erythrocytes in
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