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Dysplasia in Ulcerative Colitis

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Terminology for Dysplasia in Ulcerative Colitis (UC): Biopsies performed during surveillance colonoscopy in patients with UC are reported as negative for dysplasia; indefinite for dysplasia; positive for dysplasia, low-grade; and positive for dysplasia, high-grade.

Biopsies obtained from nodular lesions or mass, plaques, or strictures have often shown dysplasia or cancer. Such lesions have been referred to by the acronym DALM (dysplasia-associated lesion or mass). Based on their endoscopic appearance, they have been further subdivided into adenoma-like DALM and nonadenoma-like DALM.

In 2015, SCENIC International Consensus Statement on the surveillance and management of dysplasia in inflammatory bowel disease issued a statement. The term DALM was replaced by visible dysplasia (dysplasia identified on targeted biopsies from a lesion visualized on colonoscopy) and invisible dysplasia (dysplasia identified on random, non-targeted biopsies of colonic mucosa without a visible lesion). Visible dysplasia was further subdivided into polypoid (protruding 2.5 mm above the mucosal surface) and non-polypoid (flat, depressed lesion; or protruding <2.5 mm above the surface).

This biopsy from a raised area found during surveillance colonoscopy in a patient with UC shows tubular adenoma with high-grade dysplasia (visible dysplasia; adenoma-like DALM). Note the crypt abscess at the bottom and crypt distortion. The dysplastic cells lining the crypts have eosinophilic cytoplasm and enlarged hyperchromatic nuclei.

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