Colorectal dysplasia in chronic inflammatory bowel disease: pathology, clinical implications, and pathogenesis.
BACKGROUND
Colorectal cancer, the most lethal long-term complication of chronic inflammatory bowel disease (IBD), is the culmination of a complex sequence of molecular and histologic derangements of the intestinal epithelium that are initiated and at least partially sustained by chronic inflammation. Dysplasia, the earliest histologic manifestation of this process, plays an important role in cancer prevention by providing the first clinical alert that this sequence is underway and serving as an endpoint in colonoscopic surveillance of patients at high risk for colorectal cancer.


OBJECTIVE
To review the histology, nomenclature, clinical implications, and molecular pathogenesis of dysplasia in IBD.


METHODS
Literature review and illustrations from case material.


CONCLUSIONS
The diagnosis and grading of dysplasia in endoscopic surveillance biopsies play a decisive role in the management of patients with IBD. Although interpathologist variation, endoscopic sampling problems, and incomplete information regarding the natural history of dysplastic lesions are important limiting factors, indirect evidence that surveillance may be an effective means of reducing cancer-related mortality in the population with IBD has helped validate the histologic criteria, nomenclature, and clinical recommendations that are the basis of current practice among pathologists and clinicians. Emerging technologic advances in endoscopy may permit more effective surveillance, but ultimately the greatest promise for cancer prevention in IBD lies in expanding our thus far limited understanding of the molecular pathogenetic relationships between neoplasia and chronic inflammation.
Department of Pathology, The Mount Sinai School of Medicine, New York, New York 10092, USA. Noam.harpaz@mountsinai.org
Noam
N
Harpaz
Alexandros D
AD
Polydorides
D001706:Biopsy; D002908:Chronic Disease; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000235:genetics / Q000473:pathology; D011230:Precancerous Conditions / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D012307:Risk Factors