Idiopathic gastric perforation in neonates and abnormal distribution of intestinal pacemaker cells.
OBJECTIVE
The etiology of idiopathic gastric perforation (IGP) in neonates is unclear. Interstitial cells of Cajal (ICC) express tyrosine kinase receptor C-kit, and act as gastrointestinal pacemaker cells. Stem cell factor (SCF) is a C-kit ligand and plays an important role in immune system homeostasis in the gastrointestinal tract. The authors hypothesized that abnormal distribution of ICC or SCF in the gastric wall (ie, abnormal motility or impaired immunity) could predispose the stomach to IGP.


METHODS
Stomachs obtained at postmortem from neonates who died of IGP (n = 7) and other causes (control group; n = 10) were used. Biopsy sections were taken at random from various sites in the stomach, including macroscopically intact areas, and labeled immunohistochemically using antibodies to C-kit(a marker for ICC) and SCF.


RESULTS
In all control specimens, ICC were present between the muscle layers and around the myenteric plexuses of the stomach wall. In contrast, ICC were absent in all biopsy sections from 3 of the 7 IGP stomachs. In the remaining 4 IGP stomachs, there were fewer ICC in the muscle layers compared with controls, and ICC were absent around the myenteric plexuses. The distribution of SCF immunoreactivity in IGP and control specimens was similar.


CONCLUSIONS
The findings suggest that a lack of ICC (ie, gastric hypomotility) may be implicated in the etiology of IGP in neonates.
Ohshiro
K
K
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Yamataka
A
A
Kobayashi
H
H
Hirai
S
S
Miyahara
K
K
Sueyoshi
N
N
Suda
K
K
Miyano
T
T
D000704:Analysis of Variance; D001344:Autopsy; D001707:Biopsy, Needle; D046508:Culture Techniques; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007231:Infant, Newborn; D008297:Male; D008407:Mast Cells / Q000378:metabolism*; D011336:Probability; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis*; D012422:Rupture, Spontaneous; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology; D013272:Stomach Diseases / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*
D019009:Proto-Oncogene Proteins c-kit