Evidence against flat dysplasia as a regional field defect in small bowel adenocarcinoma associated with celiac sprue.
OBJECTIVE
To determine whether diffuse flat dysplasia, akin to that seen with chronic ulcerative colitis, occurs as a mucosal field defect accompanying small bowel adenocarcinoma in patients with celiac sprue.


METHODS
A pathologic investigation of archival tissue was undertaken.


METHODS
From the tissue archives at Mayo Clinic Rochester for the period from January 1978 to January 1993, resected sprue-associated adenocarcinomas with adequate adjacent mucosa for study were identified. On the basis of multiple strip biopsy specimens obtained at the tumor margins and within 4 cm distal and proximal to the tumor, histologic maps were created.


RESULTS
Among 94 patients with primary adenocarcinoma of the small bowel, 8 had a concurrent diagnosis of celiac sprue. Of these eight cases, six surgically resected specimens (five duodenal and one jejunal adenocarcinoma) were adequate for study. A thin rim of benign dysplasia was demonstrated at the tumor margin in three of the six specimens; however, contiguous fields of flat dysplasia were not present in any of these cases.


CONCLUSIONS
These data support focal dysplasia (for example, adenoma) rather than sheets of flat dysplasia as the premalignant lesion in sprue-associated small bowel adenocarcinoma. Blind endoscopic biopsies of small bowel mucosa are not justified for neoplasia surveillance in patients with celiac sprue.
Bruno
C J
CJ
Division of Gastroenterology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Batts
K P
KP
Ahlquist
D A
DA
D000230:Adenocarcinoma / Q000209:etiology / Q000473:pathology*; D000368:Aged; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000209:etiology / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged