Advertisement

Colitis pp 141-154 | Cite as

Dysplasia in Inflammatory Bowel Disease

  • Ann Driessen
  • Karen Paula Geboes
  • Olivier Dewit
  • Anne Jouret-Mourin
Chapter

Abstract

Due to the continuous inflamed state of the mucosa, ulcerative colitis and Crohn’s disease patients are at risk of developing colorectal cancer at an earlier age and with a poorer prognosis. Hence continuous endoscopic surveillance with sampling of biopsies is necessary to detect the preneoplastic lesions in an early stage. Recently a new endoscopic classification is published, in which the lesions are categorized into invisible and visible dysplasia, of which the latter is subtyped into polypoid and non-polypoid lesions. Histologically these lesions consist of different types, namely, adenomatous, villous, and the more recently discovered serrated dysplasia. The presence of an inflamed mucosa complicates its diagnosis, resulting in a high interobserver variability in the categories indefinite for dysplasia and low-grade dysplasia. Hence the ECCO guidelines recommend to confirm the diagnosis of dysplasia by an expert pathologist in gastrointestinal pathology.

Keywords

Dysplasia IBD Dysplasia grading Dysplasia surveillance Flat dysplasia Polypoid dysplasia Non-polypoid dysplasia Serrated dysplasia Villous dysplasia 

References

  1. 1.
    Pulusu SSR, Lawrance IC. Dysplasia and colorectal cancer surveillance in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol. 2017;11(8):711–22.CrossRefPubMedGoogle Scholar
  2. 2.
    Ou B, Zhao J, Guan S, Lu A. Survival of colorectal cancer in patients with or without inflammatory bowel disease: a meta-analysis. Dig Dis Sci. 2016;61(3):881–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Bye WA, Nguyen TM, Parker CE, Jairath V, East JE. Strategies for detecting colon cancer in patients with inflammatory bowel disease. Cochrane Database Syst Rev. 2017;9:CD000279.PubMedGoogle Scholar
  4. 4.
    Geboes K, Rutgeerts P. Dysplasia in inflammatory bowel diseases: definition and clinical impact. Can J Gastroenterol. 1999;13(8):671–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Riddell RH, Goldman H, Ransohoff DF, Appelman HD, Fenoglio CM, Haggitt RC, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983;14(11):931–68.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee HJ, Park JM, Han YM, Gil HK, Kim J, Chang JY, et al. The role of chronic inflammation in the development of gastrointestinal cancers: reviewing cancer prevention with natural anti-inflammatory intervention. Expert Rev Gastroenterol Hepatol. 2016;10(1):129–39.CrossRefPubMedGoogle Scholar
  7. 7.
    Rogler G. Chronic ulcerative colitis and colorectal cancer. Cancer Lett. 2014;345(2):235–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Robles AI, Traverso G, Zhang M, Roberts NJ, Khan MA, Joseph C, et al. Whole-exome sequencing analyses of inflammatory bowel disease-associated colorectal cancers. Gastroenterology. 2016;150(4):931–43.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Driessen A, Macken E, Moreels T, Jouret-Mourin A. Dysplasia in inflammatory bowel disease. Acta Gastroenterol Belg. 2017;80(1):299–308.PubMedGoogle Scholar
  10. 10.
    Lai KK, Horvath B, Xie H, Wu X, Lewis BL, Pai RK, et al. Risk for colorectal neoplasia in patients with inflammatory bowel disease and mucosa indefinite for dysplasia. Inflamm Bowel Dis. 2015;21(2):378–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Connell WR, Lennard-Jones JE, Williams CB, Talbot IC, Price AB, Wilkinson KH. Factors affecting the outcome of endoscopic surveillance for cancer in ulcerative colitis. Gastroenterology. 1994;107(4):934–44.CrossRefPubMedGoogle Scholar
  12. 12.
    Navaneethan U, Jegadeesan R, Gutierrez NG, Venkatesh PG, Hammel JP, Shen B, et al. Progression of low-grade dysplasia to advanced neoplasia based on the location and morphology of dysplasia in ulcerative colitis patients with extensive colitis under colonoscopic surveillance. J Crohns Colitis. 2013;7(12):e684–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138(2):746–74. 74 e1–4; quiz e12–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Choi CH, Ignjatovic-Wilson A, Askari A, Lee GH, Warusavitarne J, Moorghen M, et al. Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer. Am J Gastroenterol. 2015;110(10):1461–71. quiz 72.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ullman T, Croog V, Harpaz N, Sachar D, Itzkowitz S. Progression of flat low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis. Gastroenterology. 2003;125(5):1311–9.CrossRefPubMedGoogle Scholar
  16. 16.
    van Schaik FD, Offerhaus GJ, Schipper ME, Siersema PD, Vleggaar FP, Oldenburg B. Endoscopic and pathological aspects of colitis-associated dysplasia. Nat Rev Gastroenterol Hepatol. 2009;6(11):671–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology. 2015;148(3):639–51 e28.CrossRefPubMedGoogle Scholar
  18. 18.
    Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc. 2015;81(3):489–501 e26.CrossRefPubMedGoogle Scholar
  19. 19.
    Vieth M, Neumann H. Current issues in inflammatory bowel disease neoplasia. Histopathology. 2015;66(1):37–48.CrossRefPubMedGoogle Scholar
  20. 20.
    Torres C, Antonioli D, Odze RD. Polypoid dysplasia and adenomas in inflammatory bowel disease: a clinical, pathologic, and follow-up study of 89 polyps from 59 patients. Am J Surg Pathol. 1998;22(3):275–84.CrossRefPubMedGoogle Scholar
  21. 21.
    Odze RD. Adenomas and adenoma-like DALMs in chronic ulcerative colitis: a clinical, pathological, and molecular review. Am J Gastroenterol. 1999;94(7):1746–50.CrossRefPubMedGoogle Scholar
  22. 22.
    Vieth M, Behrens H, Stolte M. Sporadic adenoma in ulcerative colitis: endoscopic resection is an adequate treatment. Gut. 2006;55(8):1151–5.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47(2):251–5.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Harpaz N. Neoplastic precursor lesions related to the development of cancer in inflammatory bowel disease. Gastroenterol Clin N Am. 2007;36(4):901–26. vii-viiiCrossRefGoogle Scholar
  25. 25.
    Eaden J, Abrams K, McKay H, Denley H, Mayberry J. Inter-observer variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitis. J Pathol. 2001;194(2):152–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Odze RD, Goldblum J, Noffsinger A, Alsaigh N, Rybicki LA, Fogt F. Interobserver variability in the diagnosis of ulcerative colitis-associated dysplasia by telepathology. Mod Pathol. 2002;15(4):379–86.CrossRefPubMedGoogle Scholar
  27. 27.
    Xie H, Xiao SY, Pai R, Jiang W, Shadrach B, Carver P, et al. Diagnostic utility of TP53 and cytokeratin 7 immunohistochemistry in idiopathic inflammatory bowel disease-associated neoplasia. Mod Pathol. 2014;27(2):303–13.CrossRefPubMedGoogle Scholar
  28. 28.
    van Schaik FD, Oldenburg B, Offerhaus GJ, Schipper ME, Vleggaar FP, Siersema PD, et al. Role of immunohistochemical markers in predicting progression of dysplasia to advanced neoplasia in patients with ulcerative colitis. Inflamm Bowel Dis. 2012;18(3):480–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Dorer R, Odze RD. AMACR immunostaining is useful in detecting dysplastic epithelium in Barrett's esophagus, ulcerative colitis, and Crohn’s disease. Am J Surg Pathol. 2006;30(7):871–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7(10):827–51.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    van Schaik FD, ten Kate FJ, Offerhaus GJ, Schipper ME, Vleggaar FP, van der Woude CJ, et al. Misclassification of dysplasia in patients with inflammatory bowel disease: consequences for progression rates to advanced neoplasia. Inflamm Bowel Dis. 2011;17(5):1108–16.CrossRefPubMedGoogle Scholar
  32. 32.
    Rubio CA, Befrits R, Jaramillo E, Nesi G, Amorosi A. Villous and serrated adenomatous growth bordering carcinomas in inflammatory bowel disease. Anticancer Res. 2000;20(6C):4761–4.PubMedGoogle Scholar
  33. 33.
    Andersen SN, Lovig T, Clausen OP, Bakka A, Fausa O, Rogeenum TO. Villous, hypermucinous mucosa in long standing ulcerative colitis shows high frequency of K-ras mutations. Gut. 1999;45(5):686–92.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Rubio CA, Johansson C, Slezak P, Ohman U, Hammarberg C. Villous dysplasia. An ominous histologic sign in colitic patients. Dis Colon Rectum. 1984;27(5):283–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Lee LH, Iacucci M, Fort Gasia M, Ghosh S, Panaccione R, Urbanski S. Prevalence and anatomic distribution of serrated and adenomatous lesions in patients with inflammatory bowel disease. Can J Gastroenterol Hepatol. 2017;2017:5490803.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ko HM, Harpaz N, McBride RB, Cui M, Ye F, Zhang D, et al. Serrated colorectal polyps in inflammatory bowel disease. Mod Pathol. 2015;28(12):1584–93.CrossRefPubMedGoogle Scholar
  37. 37.
    Shen J, Gibson JA, Schulte S, Khurana H, Farraye FA, Levine J, et al. Clinical, pathologic, and outcome study of hyperplastic and sessile serrated polyps in inflammatory bowel disease. Hum Pathol. 2015;46(10):1548–56.CrossRefPubMedGoogle Scholar
  38. 38.
    Jackson WE, Achkar JP, Macaron C, Lee L, Liu X, Pai RK, et al. The significance of sessile serrated polyps in inflammatory bowel disease. Inflamm Bowel Dis. 2016;22(9):2213–20.CrossRefPubMedGoogle Scholar
  39. 39.
    Johnson DH, Khanna S, Smyrk TC, Loftus EV Jr, Anderson KS, Mahoney DW, et al. Detection rate and outcome of colonic serrated epithelial changes in patients with ulcerative colitis or Crohn’s colitis. Aliment Pharmacol Ther. 2014;39(12):1408–17.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Parian A, Koh J, Limketkai BN, Eluri S, Rubin DT, Brant SR, et al. Association between serrated epithelial changes and colorectal dysplasia in inflammatory bowel disease. Gastrointest Endosc. 2016;84(1):87–95 e1.CrossRefPubMedGoogle Scholar
  41. 41.
    Harpaz N, Goldblum JR, Shepherd N, Riddell RH, Rubio CA, Vieth M, et al. Novel classification of dysplasia in IBD. Mod Pathol. 2017;30(S2):1.Google Scholar
  42. 42.
    van den Broek FJ, Stokkers PC, Reitsma JB, Boltjes RP, Ponsioen CY, Fockens P, et al. Random biopsies taken during colonoscopic surveillance of patients with longstanding ulcerative colitis: low yield and absence of clinical consequences. Am J Gastroenterol. 2014;109(5):715–22.CrossRefPubMedGoogle Scholar
  43. 43.
    Watanabe T, Ajioka Y, Mitsuyama K, Watanabe K, Hanai H, Nakase H, et al. Comparison of targeted vs random biopsies for surveillance of ulcerative colitis-associated colorectal Cancer. Gastroenterology. 2016;151(6):1122–30.CrossRefPubMedGoogle Scholar
  44. 44.
    Van Assche G, Dignass A, Bokemeyer B, Danese S, Gionchetti P, Moser G, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohns Colitis. 2013;7(1):1–33.CrossRefPubMedGoogle Scholar
  45. 45.
    Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105(3):501–23. quiz 24.CrossRefPubMedGoogle Scholar
  46. 46.
    Friedman S, Odze RD, Farraye FA. Management of neoplastic polyps in inflammatory bowel disease. Inflamm Bowel Dis. 2003;9(4):260–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Facciorusso A, Antonino M, Di Maso M, Barone M, Muscatiello N. Non-polypoid colorectal neoplasms: classification, therapy and follow-up. World J Gastroenterol. 2015;21(17):5149–57.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Rutter MD, Riddell RH. Colorectal dysplasia in inflammatory bowel disease: a clinicopathologic perspective. Clin Gastroenterol Hepatol. 2014;12(3):359–67.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ann Driessen
    • 1
  • Karen Paula Geboes
    • 2
  • Olivier Dewit
    • 3
  • Anne Jouret-Mourin
    • 4
  1. 1.Department of PathologyUniversity Hospital Antwerp, University of AntwerpAntwerpBelgium
  2. 2.Department of Gastroenterology, Division of Digestive OncologyGhent University HospitalGhentBelgium
  3. 3.Department of GastroenterologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  4. 4.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium

Personalised recommendations