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Dysplasia in Ulcerative Colitis

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Management of Dysplasia in Ulcerative Colitis: Patients with diagnosis of indefinite for dysplasia are given intensive medical therapy to control inflammation and brought back for an early repeat biopsy.

The management of dysplasia depends upon the endoscopic appearance of the lesion. Foci of low-grade or high-grade dysplasia, if polypoid, can be treated adequately by endoscopic polypectomy in most cases. Flat high-grade dysplasia and multifocal flat low-grade dysplasias are treated with colectomy. Invasive carcinoma, if present, is also treated with colectomy with ileal pouch-anastomosis.

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). The focus shows complex distorted glands. The dysplastic epithelium has enlarged overlapping vesicular nuclei with prominent nucleoli and eosinophilic cytoplasm. Mitotic activity is brisk.

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