title: High-grade dysplastic adenoma-like mass lesions are not an indication for colectomy in patients with ulcerative colitis.
abstract: OBJECTIVE
  The management of high-grade dysplasia (HGD) in polypoid lesions in patients with ulcerative colitis (UC) is not well characterized. The purpose of this study was to characterize the clinical course of patients with HGD in adenoma-like dysplasia-associated lesion or masses (DALMs) in the absence of any synchronous flat dysplasia. We hypothesize that colectomy is not warranted in patients who undergo complete excision of adenoma-like DALMs with HGD in UC.
  
  
  METHODS
  Pathology and clinical databases were systematically searched for the presence of dysplastic lesions in inflammatory bowel disease from 1997 to 2004. Patients with UC who had adenoma-like DALMs were identified, and a subset with HGD lesions was defined as our study cohort.
  
  
  RESULTS
  A total of 102 patients with UC were identified. Thirty of them (29%) had adenoma-like DALMs without synchronous flat dysplasia; 9 of these patients (30%) had HGD in these lesions. Thirty-two surveillance colonoscopies were performed in this cohort (mean 3.6 colonoscopies/patient). The patients were followed for a mean of 76.5 months (52-99 months). Three out of 9 patients (33%) had colectomy. None of the patients in this cohort was detected to have carcinoma in surveillance biopsies and/or in the resection specimens.
  
  
  CONCLUSIONS
  Our data suggest that the presence of HGD in DALMs does not warrant colectomy. Continued close observation is suggested in this patient cohort after complete excision of polyps. Further prospective evaluation of this patient population is merited.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, USA.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Blonski
authors.forename: Rabi
authors.initials: R
authors.lastname: Kundu
authors.forename: Emma F
authors.initials: EF
authors.lastname: Furth
authors.forename: James
authors.initials: J
authors.lastname: Lewis
authors.forename: Faten
authors.initials: F
authors.lastname: Aberra
authors.forename: Gary R
authors.initials: GR
authors.lastname: Lichtenstein
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology; D003110:Colonic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged