[Excluded rectum during Crohn's diseases: what is the risk of dysplasia?].
OBJECTIVE
An excluded rectum may be at risk of carcinoma in the course of Crohn's disease. Surveillance of patients requires detection of dysplasia. The aim of our study was to determine the frequency of dysplasia from secondary proctectomy specimens in active rectal Crohn's disease.


METHODS
Twenty three patients (13 women and 10 men, median age 38 years) were studied. The median duration of rectal exclusion was four years. Detection of dysplasia relied upon histopathology. Immunohistochemistry with MIB-1 (Ki-67) and anti-p53 (clone DO7) antibodies was performed as well.


RESULTS
Frequency of dysplasia was 30%. This was low grade dysplasia, focally observed in proctectomy specimens. MIB-1 was positive on 46% of dysplastic cells. There was no expression of p53 protein.


CONCLUSIONS
These results must be taken into account for decision of secondary proctectomy, in patients having an excluded rectum for Crohn's disease, when ileorectal anastomosis is not possible. Rectal endoscopic surveillance is advisable with multiple biopsies according to focal distribution of dysplasia.
Service d'Anatomie et Cytologie Pathologiques A, Faculté de Médecine, CHRU, Lille.
E
E
Leteurtre
P
P
Kosydar
L
L
Gambiez
J F
JF
Colombel
P
P
Quandalle
M
M
Lecomte-Houcke
D000293:Adolescent; D000328:Adult; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D012007:Rectum / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53
Rectums exclus au cours de la maladie de Crohn: quel est le risque de dysplasie?