Colon non tumor
Inflammatory bowel disease (IBD)
Dysplasia

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 21 December 2016, last major update May 2013

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: colon dysplasia [title]
Cite this page: Dysplasia. PathologyOutlines.com website. http://pathologyoutlines.com/topic/colondalm.html. Accessed January 16th, 2017.
Definition / General
  • Condition usually detected by surveillance colonoscopy with biopsy (Ann Ital Chir 2011;82:11, Pathologe 2011;32:282, Arch Pathol Lab Med 2010;134:876)
  • Precedes carcinoma in almost all cases; carcinoma may not be clinically identifiable (J Clin Pathol 1985;38:30, USCAP 2002)
  • Multiple biopsies recommended for diagnosis of flat lesions
  • Incidence of dysplasia is 5% after 10 years of ulcerative colitis (UC), 25% after 20 years of UC
  • Dysplasia is rare (less than 3%) in retained rectal segment after anastomosis
  • Risk may be reduced by 5-aminosalicylate use (Am J Gastroenterol 2005;100:1345)
  • Recommendations for biopsy interpretation: either negative for dysplasia, positive for dysplasia or indefinite for dysplasia
Pathophysiology
  • Chitinase 3-like-1 (CHI3L1/YKL-40), protein secreted from colonic epithelial cells (CECs) and macrophages may contribute to the proliferation, migration, and neoplastic progression of CECs under inflammatory conditions and could be a useful biomarker for neoplastic changes in patients with IBD (Am J Pathol 2011;179:1494)
Treatment
  • Colectomy if flat high grade dysplasia (confirmed by another pathologist or another biopsy) or possibly multifocal low grade dysplasia
  • "Adenoma": presume actually is inflammatory bowel disease associated dysplasia unless meets all these conditions:
    1. Age 40+
    2. Pedunculated polyp
    3. Complete excision
    4. Negative mucosal margin -AND-
    5. No inflammatory polyposis in remainder of colon
  • Followup:
    • Negative for dysplasia: regular surveillance (annual colonoscopy after 7-10 years of disease)
    • Indefinite for dysplasia: more frequent follow up and treatment of active colitis
    • Low grade dysplasia: short term follow up, more frequent if suspicious lesions
    • High grade dysplasia: follow up needed even after colectomy
Diagrams / Tables

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Macroscopic classification of dysplasia

Neoplastic progression

Molecular pathogenesis

Classification and management of dysplasia

Clinical Images

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Endoscopy of raised dysplasia

Gross Description
  • Mucosa may be flat, villous or nodular
Gross Images

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Descending colon lesion



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Dysplasia in ulcerative colitis

Micro Description
  • Low grade dysplasia: basally oriented nuclei; mild nuclear enlargement, nuclear crowding and hyperchromasia; decreased intracellular mucin
  • High grade dysplasia: prominent nuclear stratification (compared to low grade) with many nuclei in luminal half of cell; more significant hyperchromasia and pleomorphism; may have marked architectural distortion with a villous or nodular growth pattern resembling adenoma or with cribriforming
  • Indefinite for dysplasia: epithelial changes in a background of active inflammation with regeneration
Micro Images


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Low grade dysplasia

Low grade dysplasia - pancolitis



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Low grade dysplasia

High grade dysplasia

High grade dysplasia

High grade dysplasia (right) reparative change (left)

Dysplasia (unspecified) and normal glands


Regenerative change: dispersed chromatin, prominent nucleoli and intraepithelial neutrophils

Remote dysplasia

CHI3L1 expression

Low-grade tubuloglandular adenocarcinoma


Colonic mucosa negative for dysplasia

Low-grade dysplasia

High-grade dysplasia

Indefinite for dysplasia

Positive Stains
Cytology Images

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High grade dysplasia

Molecular / Cytogenetics Description
  • Genomic alterations in ulcerative colitis progressors are widespread, even involving single non-dysplastic biopsies that are far distant from neoplasia (Mod Pathol 2010;23:1624)
Molecular / Cytogenetics Images

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Gene targets associated with colorectal neoplasia

Differential Diagnosis
  • Adenoma: occurs in background of normal mucosa, no inflamed mucosa; has typical features of adenoma (Hum Pathol 2000;31:288)
  • Reactive epithelial changes: regular nuclear contours, prominent nucleoli, adjacent cryptitis and crypt abscesses, no hyperchromasia, no pleomorphism, no nuclear stratification, no loss of nuclear polarity, no marked architectural distortions