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World J Gastroenterol. Mar 28, 2014; 20(12): 3164-3172
Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3164
Microscopic features of colorectal neoplasia in inflammatory bowel diseases
Aude Bressenot, Virginie Cahn, Silvio Danese, Laurent Peyrin-Biroulet
Aude Bressenot, Virginie Cahn, Department of pathology, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
Silvio Danese, IBD Center, Division of Gastroenterology, Humanitas Clinical and Research Center, 20089 Milan, Italy
Laurent Peyrin-Biroulet, Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
Author contributions: Bressenot A wrote the first draft of the article; Cahn V provided figures and critical revision of the manuscript; Danese S provided critical revision of the manuscript; Peyrin-Biroulet L contributed to editing of the manuscript and supervised the work.
Correspondence to: Laurent Peyrin-Biroulet, Professor, Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France. peyrinbiroulet@gmail.com
Telephone: +33-3-83153661 Fax: +33-3-83153633
Received: July 31, 2013
Revised: December 20, 2013
Accepted: January 19, 2014
Published online: March 28, 2014
Processing time: 240 Days and 19 Hours
Abstract

The risk of developing dysplasia leading to colorectal cancer (CRC) is increased in both ulcerative colitis and Crohn’s disease. The prognosis of CRC may be poorer in patients with inflammatory bowel disease (IBD) than in those without IBD. Most CRCs, in general, develop from a dysplastic precursor lesion. The interpretation by the pathologist of the biopsy will guide decision making in clinical practice: colonoscopic surveillance or surgical management. This review summarizes features of dysplasia (or intraepithelial neoplasia) with macroscopic and microscopic characteristics. From an endoscopic (gross) point of view, dysplasia may be classified as flat or elevated (raised); from a histological point of view, dysplasia is separated into 3 distinct categories: negative for dysplasia, indefinite for dysplasia, and positive for dysplasia with low- or high-grade dysplasia. The morphologic criteria for dysplasia are based on a combination of cytologic (nuclear and cytoplasmic) and architectural aberrations of the crypt epithelium. Immunohistochemical and molecular markers for dysplasia are reviewed and may help with dysplasia diagnosis, although diagnosis is essentially based on morphological criteria. The clinical, epidemiologic, and pathologic characteristics of IBD-related cancers are, in many aspects, different from those that occur sporadically in the general population. Herein, we summarize macroscopic and microscopic features of IBD-related colorectal carcinoma.

Keywords: Inflammatory bowel disease; Dysplasia; Colorectal cancer; Microscopic features

Core tip: The risk of developing dysplasia leading to colorectal cancer is increased in both ulcerative colitis and Crohn’s disease. The biopsy interpretations will guide decision making in clinical practice: colonoscopic surveillance or surgical management. This review summarizes histological features of dysplasia and colorectal cancer in inflammatory bowel disease.