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dysplasia in inflammatory bowel disease

Saturday 1 December 2012

Inflammatory bowel disease (IBD); dysplasia in inflammatory bowel diseases; colorectal mucoasal dysplasia in inflammatory bowel disease

Definition: Inflammatory bowel disease (IBD) is a well-known risk factor for the development of dysplasia and carcinoma.

Dysplastic lesions in the setting of IBD can be flat (endoscopically invisible) or raised, which are both graded as indefinite for dysplasia, low grade dysplasia or high grade dysplasia.

Raised lesions were commonly termed "dysplasia-associated lesions or masses" (DALMs) and can be difficult or impossible to distinguish from sporadic adenomas.

However, several studies have shown that adenoma-like lesions in IBD patients, regardless of whether it represents an IBD-associated DALM lesion or a sporadic adenoma, can be adequately managed by polypectomy and continued endoscopic surveillance if there is no coexisting "flat dysplasia".

Given the treatment implications, it is recommended that the diagnosis of dysplasia in the setting of IBD be confirmed by an experienced pathologist.

The diagnosis of "indefinite for dysplasia" should not become a waste basket, and should be reserved for cases showing worrisome cytologic and architectural changes but also showing surface maturation or abundant inflammation.

The diagnosis is also appropriate if the mucosal surface cannot be evaluated due to tangential sectioning of the tissue, the presence of marked cautery effect, or the presence of other processing artifacts.

Types

- dysplasia in ulcerative colitis
- dysplasia in Crohn disease

Dysplastic lesions in the setting of IBD can be flat (endoscopically invisible) or raised, which are both graded as :
- indefinite for dysplasia,
- low grade dysplasia
- high grade dysplasia.

Raised lesions are commonly termed dysplasia-associated lesions or masses (DALMs) and can be difficult or impossible to distinguish from sporadic adenomas.

However, several studies have shown that adenoma-like lesions in IBD patients, regardless of whether it represents an IBD-associated DALM lesion or a sporadic adenoma, can be adequately managed by polypectomy and continued endoscopic surveillance if there is no coexisting flat dysplasia.

Given the treatment implications, it is recommended that the diagnosis of dysplasia in the setting of IBD be confirmed by an experienced pathologist.

Indefinite for dysplasia

The diagnosis of "indefinite for dysplasia" should not become a waste basket, and should be reserved for cases showing worrisome cytologic and architectural changes but also showing surface maturation or abundant inflammation.

The diagnosis is also appropriate if the mucosal surface cannot be evaluated due to tangential sectioning of the tissue, the presence of marked cautery effect, or the presence of other processing artifacts.

Open references

- http://www.thejgo.org/article/view/410/821

References

- Pascal R R,“Dysplasia and early carcinoma in inflammatory bowel disease and colorectal adenoma”, Human Pathol. 25: (1994), pp. 1,160–1,171.