Ulcerative colitis-related epithelial dysplasia represents a premalignant lesion, which may lead to the development of ulcerative colitis-related adenocarcinoma. The proper management of this condition requires proctocolectomy before the acquisition of the invasive phenotype. Patients with chronic ulcerative colitis, however, like the general population, may develop sporadic colorectal adenomas not related to the presence of the inflammatory bowel disease. These adenomas are also characterized by epithelial dysplasia, but their detection carries very different clinical implications. It is therefore essential to distinguish between chronic ulcerative colitis-related dysplasia and sporadic colorectal adenomas. The gross and histologic features do not provide a definite distinction between these two different types of dysplasia of the colonic epithelium. Recent developments in the molecular genetics may provide the necessary means.
1. Shelton AA, Lehman RE, Schrock TR, Welton ML. Retrospective review of colorectal cancer in ulcerative colitis at a tertiary center. Arch Surg131:806-810, 1996
2.
2. Lennard-Jones JE, Melville DM, Morson BC, Ritohic JK, Williams CB. Precancer and cancer in extensive ulcerative colitis: Findings among 401 patients over 22 years. GUT31:800-806, 1990
3.
3. Tytgat GNJ, Dhir V, Gopinath N. Edoscopic appearance of dysplasia and cancer in inflammatory bowel disease. Eur J Cancer31A: 1174-1177, 1995
4.
4. Schneider A, Stolte M. Differential diagnosis of adenomas and dysplastic lesions in patients with ulcerative colitis. Z Gastroenterol31:653-656, 1993
5.
5. Medlicott SA, Jewell LD, Price L, Fedorak RN, Sherbaniuk RW, Urbanski SJ. Conservative management of small adenomata in ulcerative colitis. Am J Gastroenterol92:2094-2098, 1997
6.
6. Torres C, Antonioli D, Odze RD. Polypoid dysplasias and adenomas in inflammatory bowel disease. A clinical, pathologic and follow-up study of 89 polyps from 59 patients. Am J Surg Pathol22:275-284, 1998
7.
7. Urbanski SJ, Kossakowska AE, Marcon N, Bruce WR. Mixed hyperplastic-adenomatous polyps-an underdiagnosed entity. Report of a case of an adenocarcinoma arising within a mixed hyperplastic adenomatous polyp. Am J Surg Pathol8:551-556, 1984
8.
8. Fogt F, Nikulasson ST, Holden JA, Alder SA, Hallgrimsson J, Jessup MJ, O'Brien MJ, Lavin PT, Goldman H. Topoisomerase espression in normal, inflammatory, and neoplastic conditions of the gastric and colonic mucosa. Mod Pathol10:296-302, 1997
9.
9. Noffsinger AE, Miller MA, Cusi MV, Fenoglio-Preiser CM. The pattern of cell proliferation in neoplastic and nonneoplastic lesions of ulcerative colitis. Cancer78:2307-2312, 1996
10.
10. Vogelstein B, Fearon ER, Hamilton SR, Kern S, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AMM, Bos JL. Genetic alterations during colorectal tumor development. N Engl J Med319:525-532, 1988
11.
11. Willenbucher RF, Aust DE, Chang CG, Zelman SJ, Frrell LD, Moore DN, Waldman FM. Genomic instability is an early event during the progression pathway of ulcerative colitis-related neoplasia. Am J Pathol154:1825-1830, 1999
12.
12. Redston MS, Papadopoulos N, Caldas C, Kinzler KW, Kern SE. Common occurrence of APC and K-ras gene mutations in the spectrum of colitis-associated neoplasias. Gastroenterology108:383-392, 1995
13.
13. Greenwald BD, Harpaz N, Yin J, Huang Y, Tong Y, Brown VL, McDaniel T, Newkirk C, Resau JH, Meltzer SJ. Loss of heterozygosity affecting the p53, Rb, and mcc/apc tumor suppressor gene loci in dysplastic and cancerous ulcerative colitis. Cancer Res52:741-745, 1992
14.
14. Fogt F, Zhuang Z, Poremba C, Dockhorn-Dworniczak D, Vortmeyer A. Comparison of p53 immunoexpression with allelic loss of p53 in ulcerative colitisassociated dysplasia and carcinoma. Oncology Rep5:477-480, 1998
15.
15. Park WS, Pham T, Wang C, Pack S, Mueller E, Mueller J, Vortmeyer AO, Zhuang Z, Fogt F. Loss of heterozygosity and microsatellite instability in nonneoplastic mucosa from patients with chronic ulcerative colitis. Int J Mol Med2:221-224, 1998
16.
16. Yin J, Harpaz N, Tong Y, Huang Y, Laurin J, Greenwald BD, Hontanosas M, Newkirk C, Meltzer SJ. p5 3 point mutations in dysplastic and cancerous ulceative colitis lesions. Gastroenterology104:1633-1639, 1993
17.
17. Fogt F, Vortmeyer AO, Stolte M, Mueller E, Mueller J, Noffsinger A, Poremba C, Zhuang Z. Loss of heterozygosity of the von Hippel Lindau gene locus in polypoid dysplasia but not flat dysplasia in ulcerative colitis or sporadic adenomas. Hum Pathol29:961-964, 1998
18.
18. Fogt F, Vortmeyer AO, Goldman H, Giordano TJ, Morino MJ, Zhuang Z. Comparison of genetic alterations in colonic adenoma and ulcerative colitisassociated dysplasia and carcinoma. Hum Pathol29:131-136, 1998
19.
19. Walsh S, Murphy M, Silverman M, Odze R, Antonioli D, Goldman H, Loda M. p27 Expression in Inflammatory Bowel Disease-Associated Neoplasia. Further Evidence of a Unique Molecular Pathogenesis. Am J Pathol155:1511-1518, 1999
20.
20. Tarmin L, Yin J, Harpaz N, Kozam M, Noordizji J, Antonio LB, Jiang HY, Chan O, Cymes K, Meltzer SJ. Adenomatous polyposis coli gene mutations in ulcerative colitis associated dysplasias and cancers versus sporadic colon neoplasms. Cancer Res55:2035-2038, 1995
21.
21. Sanders ME, Fogt F, Urbanski SJ, Furth EE, Zimmerman RL, Deren JJ, Noffsinger AE, Vortmeyer AO, Brown C. Involvement of the chromosome 3p may differentiate between polypoid dysplasia, adenoma and adenoma-type lesions in ulcerative colitis. Mod Pathol112:84A-84A, 1999
22.
22. Yasui W, Yokozaki H, Shiamamoto F, Tahara H, Tahara E. Molecular-pathological diagnosis of gastrointestinal tissues and its contribution to cancer histopathology. Pathol Int49:763-774, 1999
