Tufting Enteropathy Revisited The Utility of MOC31 (EpCAM) Immunohistochemistry in Diagnosis

Tufting enteropathy (TE) is an uncommon disease causing intractable diarrheas starting in early childhood and resulting in failure to thrive, dependence on total parenteral nutrition, and eventually requiring transplantation for treatment. The diagnosis has been based on histology showing the presence of epithelial tufts in the small bowel and colonic mucosa and variable villus alterations with mild to no inflammatory changes and preserved brush border. The gene for TE has been identified to be the EpCAM gene on chromosome 2p21. With Institutional Review Board approval, all cases of intractable diarrhea in children in whom TE was suspected or diagnosed were retrieved from the pathology files (17 patients). Other cases of infantile, neonatal, and childhood diarrhea were also retrieved to serve as controls for the staining studies (total 37 patients). EpCAM/MOC31 antibody staining was performed on all cases. The study cohort comprised 17 patients (13 boys, 4 girls) with a diagnosis of TE ranging in age at diagnosis from 3 months to 9 years, all presenting with protracted diarrhea and/or failure to thrive, usually since birth. Staining with MOC31 was carried out in all but 2 patients (both consults) and was completely negative in the epithelium irrespective of the site of biopsy or resection. In contrast, MOC31 was positive in all other cases tested, giving a sensitivity and specificity of 100% for loss of staining. MOC31 is a diagnostic stain for TE and should be included in the panel in any case of prolonged diarrhea in children to exclude this possibility.