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. 1985 Jan;38(1):30–43. doi: 10.1136/jcp.38.1.30

Large bowel mucosal dysplasia and carcinoma in ulcerative colitis.

D C Allen, J D Biggart, P C Pyper
PMCID: PMC499068  PMID: 3968207

Abstract

The clinicopathological details of eight cases of ulcerative colitis complicated by carcinoma of the colon are described. There was a total of 14 primary colonic cancers, six of which were not detected before pathological examination of the resection specimens. The reason for this may be related to atypical tumour growth patterns. Three occurred in flat mucosa, one in a mucosal plaque lesion, and another in polypoidal mucosa. The occurrence, distribution, and morphology of mucosal dysplasia were noted in both resection specimens and biopsies taken at varying stages before resection. Tumour was associated with normal and adjacent dysplastic mucosa of varying grades. The extent and grade of dysplasia were not reliable indicators of tumour differentiation or subsequent clinical outcome. Only two cancers were poorly differentiated. In five cases a total of 23 mucosal biopsies were taken, all less than 12 months before resection. Three rectal biopsies were graded positive for dysplasia and three colonic biopsies indefinite for dysplasia. The subsequent resection specimens showed both dysplastic and carcinomatous changes. Three rectal and 14 colonic biopsies were graded negative for dysplasia despite positive findings in the subsequent resection specimens. This anomaly is partly attributed to the patchy nature of dysplasia in colitic mucosa. Two cases illustrate the possibility of dysplasia pursuing a rapidly progressive course. The mucosal changes of ulcerative colitis were assessed using a recently introduced and standardised international classification.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Butt J. H., Konishi F., Morson B. C., Lennard-Jones J. E., Ritchie J. K. Macroscopic lesions in dysplasia and carcinoma complicating ulcerative colitis. Dig Dis Sci. 1983 Jan;28(1):18–26. doi: 10.1007/BF01393356. [DOI] [PubMed] [Google Scholar]
  2. Butt J. H., Lennard-Jones J. E. A practical approach to the risk of cancer in inflammatory bowel disease. Med Clin North Am. 1980 Nov;64(6):1203–1220. doi: 10.1016/s0025-7125(16)31564-4. [DOI] [PubMed] [Google Scholar]
  3. Cook M. G., Goligher J. C. Carcinoma and epithelial dysplasia complicating ulcerative colitis. Gastroenterology. 1975 May;68(5 Pt 1):1127–1136. [PubMed] [Google Scholar]
  4. Crowson T. D., Ferrante W. F., Gathright J. B., Jr Colonoscopy. Inefficacy for early carcinoma detection in patients with ulcerative colitis. JAMA. 1976 Dec 6;236(23):2651–2652. doi: 10.1001/jama.236.23.2651. [DOI] [PubMed] [Google Scholar]
  5. DAWSON I. M., PRYSE-DAVIES J. The development of carcinoma of the large intestine in ulcerative colitis. Br J Surg. 1959 Sep;47:113–128. doi: 10.1002/bjs.18004720202. [DOI] [PubMed] [Google Scholar]
  6. DUKES C. E., BUSSEY H. J. The spread of rectal cancer and its effect on prognosis. Br J Cancer. 1958 Sep;12(3):309–320. doi: 10.1038/bjc.1958.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Devroede G., Taylor W. F. On calculating cancer risk and survival of ulcerative colitis patients with the life table method. Gastroenterology. 1976 Sep;71(3):505–509. [PubMed] [Google Scholar]
  8. Dickinson R. J., Dixon M. F., Axon A. T. Colonoscopy and the detection of dysplasia in patients with longstanding ulcerative colitis. Lancet. 1980 Sep 20;2(8195 Pt 1):620–622. doi: 10.1016/s0140-6736(80)90286-x. [DOI] [PubMed] [Google Scholar]
  9. EDWARDS F. C., TRUELOVE S. C. THE COURSE AND PROGNOSIS OF ULCERATIVE COLITIS. III. COMPLICATIONS. Gut. 1964 Feb;5:1–22. doi: 10.1136/gut.5.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Evans D. J., Pollock D. J. In-situ and invasive carcinoma of the colon in patients with ulcerative colitis. Gut. 1972 Jul;13(7):566–570. doi: 10.1136/gut.13.7.566. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fennessy J. J., Sparberg M. B., Kirsner J. B. Radiological findings in carcinoma of the colon complicating chronic ulcerative colitis. Gut. 1968 Aug;9(4):388–397. doi: 10.1136/gut.9.4.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Fuson J. A., Farmer R. G., Hawk A., Sullivan B. H. Endoscopic surveillance for cancer in chronic ulcerative colitis. Am J Gastroenterol. 1980 Feb;73(2):120–126. [PubMed] [Google Scholar]
  13. Granqvist S., Gabrielsson N., Sundelin P., Thorgeirsson T. Precancerous lesions in the mucosa in ulcerative colitis. A radiographic, endoscopic, and histopathologic study. Scand J Gastroenterol. 1980;15(3):289–296. doi: 10.3109/00365528009181472. [DOI] [PubMed] [Google Scholar]
  14. Kewenter J., Hultén L., Ahrén C. The occurrence of severe epithelial dysplasia and its bearing on treatment of longstanding ulcerative colitis. Ann Surg. 1982 Feb;195(2):209–213. doi: 10.1097/00000658-198202000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lennard-Jones J. E., Morson B. C., Ritchie J. K., Shove D. C., Williams C. B. Cancer in colitis: assessment of the individual risk by clinical and histological criteria. Gastroenterology. 1977 Dec;73(6):1280–1289. [PubMed] [Google Scholar]
  16. Lennard-Jones J. E., Morson B. C., Ritchie J. K., Williams C. B. Cancer surveillance in ulcerative colitis. Experience over 15 years. Lancet. 1983 Jul 16;2(8342):149–152. doi: 10.1016/s0140-6736(83)90129-0. [DOI] [PubMed] [Google Scholar]
  17. Morson B. C., Pang L. S. Rectal biopsy as an aid to cancer control in ulcerative colitis. Gut. 1967 Oct;8(5):423–434. doi: 10.1136/gut.8.5.423. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Richart R. M., Barron B. A. A follow-up study of patients with cervical dysplasia. Am J Obstet Gynecol. 1969 Oct 1;105(3):386–393. doi: 10.1016/0002-9378(69)90268-3. [DOI] [PubMed] [Google Scholar]
  19. Riddell R. H. Dysplasia in inflammatory bowel disease. Clin Gastroenterol. 1980 May;9(2):439–458. [PubMed] [Google Scholar]
  20. Riddell R. H., Goldman H., Ransohoff D. F., Appelman H. D., Fenoglio C. M., Haggitt R. C., Ahren C., Correa P., Hamilton S. R., Morson B. C. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983 Nov;14(11):931–968. doi: 10.1016/s0046-8177(83)80175-0. [DOI] [PubMed] [Google Scholar]
  21. Riddell R. H., Morson B. C. Value of sigmoidoscopy and biopsy in detection of carcinoma and premalignant change in ulcerative colitis. Gut. 1979 Jul;20(7):575–580. doi: 10.1136/gut.20.7.575. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Simpson S., Traube J., Riddell R. H. The histologic appearance of dysplasia (precarcinomatous change) in Crohn's disease of the small and large intestine. Gastroenterology. 1981 Sep;81(3):492–501. [PubMed] [Google Scholar]
  23. WARREN S., SOMMERS S. C. Pathogenesis of ulcerative colitis. Am J Pathol. 1949 Jul;25(4):657–679. [PMC free article] [PubMed] [Google Scholar]

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