title: Polypectomy is adequate treatment for adenoma-like dysplastic lesions (DALMs) in Crohn's disease.
abstract: BACKGROUND
  The purpose of this study was to reevaluate the clinical and pathologic features and outcomes in patients with Crohn's disease with an adenoma-like dysplasia-associated lesion or mass (DALMs) to determine if polypectomy is adequate treatment.
  
  
  METHODS
  The clinical, endoscopic and pathologic features, and outcomes of 50 patients with Crohn's disease, each with ≥1 adenoma-like DALM were evaluated. The median length of follow-up was 39 months (range: 0.5-156 months).
  
  
  RESULTS
  Of the 50 patients with Crohn's disease (male to female ratio, 30:20; median age: 53 years; median duration of disease: 83 months), 11 had ileal disease, 26 had colonic disease, and 13 had both ileal and colonic disease. Approximately 43% of polyps occurred within areas of previous or concurrent colitis, whereas 57% occurred in areas not previously involved by colitis. Most polyps had tubular architecture and contained low-grade dysplasia. Of the patients who had polypectomy followed by surveillance, 45% developed new adenoma-like DALMs, but none developed flat dysplasia and only 1 had adenocarcinoma at the time of resection, which was within 3 months of polypectomy. There were no differences in the clinical or pathologic features or outcomes in patients who had adenoma-like DALMs within versus outside areas of previous or concurrent colitis, except that the former showed a higher risk of developing new polyps within areas of colitis and near the site of the original polyp compared with the latter.
  
  
  CONCLUSIONS
  Patients with Crohn's disease who develop an adenoma-like DALM, regardless of its location in relationship to previous or concurrent colitis, may be treated safely with polypectomy and continued surveillance.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Quinn
authors.forename: Francis A
authors.initials: FA
authors.lastname: Farraye
authors.forename: Bita V
authors.initials: BV
authors.lastname: Naini
authors.forename: Sandra
authors.initials: S
authors.lastname: Cerda
authors.forename: Jennifer
authors.initials: J
authors.lastname: Coukos
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Tze
authors.initials: T
authors.lastname: Khor
authors.forename: Robert D
authors.initials: RD
authors.lastname: Odze
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007077:Ileal Diseases / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult