Pathology of Dysplasia and Cancer in Inflammatory Bowel Disease
Section snippets
Classification of Dysplasia in Inflammatory Bowel Disease
From an endoscopic (gross) point of view, dysplasia may be classified as flat or elevated [12], [13], [14], [15]. Elevated lesions are referred to by the acronym DALM (dysplasia-associated lesion or mass) [16]. In some aspects, the term “DALM” is not ideal because some types of DALMs do not show aggressive behavior as often is inferred by use of the terms “lesion” or “mass” [14]. Nevertheless, this classification system is important because the treatment of flat versus elevated dysplasia may be
General Comments
IBD-related neoplasia almost always develops in areas of previous or current, chronic or chronic active inflammation [2], [27], [28]. In some instances, neoplastic lesions may develop in areas of mucosa that appear histologically unremarkable; however, a reasonable explanation for this phenomenon is that the histologic features of inflammation, both chronic and active, may reverse completely as a result of oral or enema medical therapy [19], [29], [30], [31]. Of course, sporadic non-IBD–related
Pathologic Features of Elevated Dysplasia in Inflammatory Bowel Disease
The term “DALM” was coined by Blackstone and colleagues [16] in 1981. In that study, 12 of 112 patients who had long-standing UC had a DALM, and, of these, 58% had carcinoma. Given their finding of a strong association between DALM and cancer, the investigators concluded that the presence of a DALM constituted a strong indication for colectomy, which, until recently, had become the standard of therapy for this type of IBD-related lesion. Furthermore, since Blackstone and colleagues'
Pathologic Features of Carcinoma in Inflammatory Bowel Disease
The clinical, epidemiologic, and pathologic characteristics of IBD-related cancers are, in many aspects, different from those that occur sporadically in the general population. For instance, cancers that occur in IBD, and particularly UC, tend to be distributed more evenly throughout the length of colon, are more likely to be multiple in number and tend to be of higher histologic grade compared with sporadic carcinomas [29], [81]. In some studies, up to 27% of IBD-related cancers are multiple
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2022, Pharmacological ResearchCitation Excerpt :In particular, a surgical approach is often considered for patients with medically resistant disease or with intolerable medication adverse effects, as it can ameliorate the patient’s quality of life [7]. Moreover, histological evidence of dysplasia [8–10] and intervening complications (e.g. toxic megacolon, stenoses and fistulas) are further instances that render the surgical approach necessary [11]. Endoscopy is a critical part of IBD clinical management; it is used for detecting the endoscopic features consistent with active disease and for assessing both grade and extension.
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