High-Grade Dysplastic Adenoma-like Mass Lesions are Not an Indication for Colectomy in Patients with Ulcerative Colitis

Abstract

Purpose: The management of polypoid dysplasia in ulcerative colitis (UC) is evolving. Currently, the presence of dysplasia in flat mucosa is regarded to be an indication for colectomy in pts with UC. The management of high grade dysplasia in polypoid lesions is not well characterized. Our previous study observed that the presence of high grade dysplasia (HGD) in (adenoma-like mass lesions) ALMs in the absence of any synchronous flat dysplasia does not mandate colectomy (Scand J Gastroenterol 2008, in press). The aim of this study was to update with 4-years of additional follow-up on this previously reported cohort of 9 pts. Methods: Pathology and clinical databases were systematically searched for the presence of dysplastic lesions in inflammatory bowel disease (IBD) from 1997–2004. Nine previously reported pts were identified with UC who had HGD in DALMs in the absence of any synchronous flat dysplasia. Their pathology, endoscopy and clinical records were reviewed and updated from 2004–2008. Results: Seven of 9 (77%) pts had pancolitis. There were a total of 9 ALMs with HGD (polyps in the area of active colitis) in 8 pts and 1 sporadic adenoma (outside the region of active colits) with high-grade dysplasia in 1 pt. The polyps were found in varied locations in the colon: 1 (10%) in cecum, 3 (30%) in ascending colon, 1 (10%) in descending colon, 3 (30%) in sigmoid colon, and 2 (20%) in rectum. All polyps were adenomatous. The mean duration of disease was 23.3 yrs (10–46 yrs). There were 52 surveillance colonoscopies performed in this cohort (mean 5.8 colonoscopies/patient) between 1997–2008. The pts were followed for a mean of 124.5 months (100–147 months). Three of 9 pts (33%) had colectomy. No pts in this cohort were detected to have carcinoma in surveillance biopsies and/or in their resection specimens. Conclusion: Our follow-up data confirms and strengthens our previous findings that the presence of high grade dysplasia in ALMs does not mandate colectomy. Continued close observation is suggested in this pt cohort after complete excision of polyps is performed. Future prospective studies on large cohort of pts are required to fully validate our findings.