Characteristics of an Inflammatory Bowel Disease Population with Dysplasia and Adenocarcinoma

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Purpose: Inflammatory bowel disease (IBD) is associated with an increased risk of intestinal dysplasia and neoplasia. The purpose of our study was to identify characteristics of IBD patients diagnosed with such findings. Methods: Patients found to have both IBD and dysplasia or neoplasia on histology between 1994 and 2004 were identified from a pathology database of the largest healthcare system in Rhode Island and from community recruitment. A retrospective chart review was then performed to identify the demographic, historical, clinical, and histologic characteristics of qualifying patients. Results: 32 IBD patients were identified as having dysplasia and/or neoplasia on histology. 25 (78%) were men, and 7 (22%) were women. Of the patients for whom information was available, 24 (83%) had ulcerative colitis (UC) and 5 (17%) had Crohn's disease (CD). 21 of 32 patients (66%) had low or moderate grade dysplasia, 5 of 32 (16%) had high grade dysplasia, and 13 of 32 (41%) had adenocarcinoma, with 8 of 32 patients (25%) having more than one of the above findings concurrently. 5 of 20 IBD patients (25%) had their dysplasia or neoplasia found during IBD surveillance while the other 15 (75%) were diagnosed either incidentally or due disease symptoms. The average age of the 13 patients with neoplasia was 60 ± 17 years while it was 56 ± 17 years for the 13 patients without neoplasia. Of 13 patients with UC, 11 (85%) had pancolitis and 2 (15%) had solitary left-sided disease. Only 2 of 17 patients (12%) had a family history of colon cancer and no patients had a history of primary sclerosing cholangitis. Conclusion: A population of IBD patients from a large healthcare system in Rhode Island found to have dysplasia or neoplasia was predominantly male and without family history of colorectal cancer. Most had ulcerative colitis with pancolitic involvement and none had primary sclerosing cholangitis. The majority had their diagnoses made incidentally or because of disease symptoms, not during IBD surveillance. The most common diagnoses were low or moderate grade dysplasia or neoplasia. The average age of the subgroup of patients with neoplasia was similar to those patients with dysplasia without neoplasia.