Dysplasia and carcinoma in the rectal stump of total colitics who have undergone colectomy and ileo-rectal anastomosis.
From a group of 374 patients with ulcerative colitis who underwent colectomy and ileo-rectal anastomosis between 1952 and 1976, 104 presented for follow-up rectal biopsies over a 5 year period to 1986. These patients have been followed for an average of 28 years since the onset of the disease (range 11-56) and provide a unique model for the study of the development of carcinoma in colitis. A total of 443 biopsies was examined and epithelial morphology assessed according to the classification of Riddell et al. (1983). Five patients developed carcinoma of whom two showed dysplasia in biopsies taken a year or more before the diagnosis; one showed dysplasia 2 months before the appearance of cancer, another synchronous with it, and in the fifth patient dysplasia was not detected. Of 20 biopsies classified as 'indefinite for dysplasia, probably negative', 80% were associated with subsequent resolution, while of nine 'indefinite for dysplasia, probably positive' biopsies, eight (89%) were subsequently associated with either carcinoma (six) or dysplasia (two). The results emphasize the danger of absolute reliance upon dysplasia in assessing individual cancer risk in colitics, appear to demonstrate the usefulness of Riddell's classification and provide additional information on the natural history of dysplasia.
Thomas
D M
DM
Department of Histopathology, Queen Mary's University Hospital, Roehampton.
Filipe
M I
MI
Smedley
F H
FH
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000150:complications / Q000473:pathology*; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology*; D012007:Rectum / Q000473:pathology / Q000601:surgery*