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Chapter 8 - Gastrointestinal Dysplasia

Published online by Cambridge University Press:  06 June 2020

By
Magali Svrcek  and
Roger M. Feakins
Edited by
Roger M. Feakins
Roger M. Feakins
Affiliation:
Royal Free London NHS Foundation Trust, London, UK
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Summary

There are significant differences between paediatric and adult gastrointestinal (GI) disease, and even the normal GI histology shows some variation.Excess eosinophils in the gut can be present in food allergies (frequent in children) but also in eosinophilic gastroenteritis. Inflammatory bowel disease (IBD) has some distinctive features when it presents in children. Genetic factors may play a greater role in pathogenesis, and the combination of clinical and histological criteria required for diagnosing Crohn’s Disease or ulcerative colitis (UC) is different. Atypical UC patterns are more common and clinical presentation of Crohn’s disease can also be different; the frequency of granulomas in Crohn’s disease is significantly higher in children. Inflammatory Bowel Disease Unclassified (IBDU) has its highest frequency in younger patients, possibly because of atypical characteristics of paediatric UC. Monogenic forms of IBD-like colitis typically develop during infancy or early childhood, an can have features of Crohn’s disease, UC or IBD unclassified. Histology is often indistinguishable from conventional IBD.Necrotising enterocolitis (NEC) primarily affects the small intestine of premature infants, with haemorrhagic necrosis of the bowel wall.Fibrosing colonopathy has been reported in children exposed to high doses of pancreatic enzymes and is characterised by bowel wall thickening, submucosal fibrosis and chronic mucosal inflammation.

Keywords

paediatric gastrointestinal mucosaallergic colitiseosinophilic gastroenteritispaediatric inflammatory bowel diseaseulcerative colitisCrohn’s diseasenecrotising enterocolitis,fibrosing colonopathy
Type
Chapter
Information
Non-Neoplastic Pathology of the Gastrointestinal Tract
A Practical Guide to Biopsy Diagnosis
 , pp. 116 - 130
Publisher: Cambridge University Press
Print publication year: 2020

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References

Riddell, RH, Goldman, H, Ransohoff, DF. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical implications. Hum Pathol. 1983;14:931–68.CrossRefGoogle Scholar
Rubio, CA, Liu, FS, Zhao, HZ. Histological classification of intraepithelial neoplasias and microinvasive squamous carcinoma of the esophagus. Am J Surg Pathol. 1989;13:685–90.Google Scholar
Schlemper, RJ, Riddell, RH, Kato, Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–5.Google Scholar
Sharma, P, Montgomery, E. Gastrointestinal dysplasia. Pathology. 2013;45:273–85.CrossRefGoogle ScholarPubMed
Odze, RH, Riddell, RH, Bosman, FT, et al. Premalignant lesions of the digestive system. In Bosman, FT, Carneiro, F, Hruban, RH, Theise, ND (eds), WHO Classification of Tumours of the Digestive System. Lyon, France: International Agency for Research on Cancer; 2010, 10–12.Google Scholar
Montgomery, E, Bronner, MP, Goldblum, JR, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol. 2001;32:368–78.Google Scholar
Shimizu, M, Ban, S, Odze, RD. Squamous dysplasia and other precursor lesions related to esophageal squamous cell carcinoma. Gastroenterol Clin North Am. 2007;36:797–811.CrossRefGoogle ScholarPubMed
Patil, DT, Greenson, JK, Odze, RD. Inflammatory disorders of the small intestine. In Odze, RD, Goldblum, JR (eds), Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas, 3rd ed. Philadelphia: Elsevier; 2015, 436–511.Google Scholar
Fiocca, R, Mastracci, L, Riddell, R, et al. Development of consensus guidelines for the histologic recognition of microscopic esophagitis in patients with gastroesophageal reflux disease: the Esohisto project. Hum Pathol. 2010;41:223–31.CrossRefGoogle ScholarPubMed
Goldblum, JR, Lauwers, GY. Dysplasia arising in Barrett’s esophagus: diagnostic pitfalls and natural history. Semin Diagn Pathol. 2002;19:12–19.Google Scholar
Lomo, LC, Blount, PL, Sanchez, CA, et al. Crypt dysplasia with surface maturation: a clinical, pathologic, and molecular study of a Barrett’s esophagus cohort. Am J Surg Pathol. 2006;30:423–35.Google Scholar
Levi, GS, Harpaz, N. Intestinal low grade tubuloglandular adenocarcinoma in inflammatory bowel disease. Am J Surg Pathol. 2006;30:1022–9.Google Scholar
Odze, RD, Maley, CC. Neoplasia without dysplasia: lessons from Barrett esophagus and other tubal gut neoplasms. Arch Pathol Lab Med. 2010;134:896–906.Google Scholar
Agoston, AT, Odze, RD. Evidence that gastric pit dysplasia-like atypia is a neoplastic precursor lesion. Hum Pathol. 2014;45:446–55.CrossRefGoogle ScholarPubMed
Coco, DP, Goldblum, JR, Hornick, JL, et al. Interobserver variability in the diagnosis of crypt dysplasia in Barrett esophagus. Am J Surg Pathol. 2011;35:45–54.CrossRefGoogle ScholarPubMed
Kaye, PV, Haider, SA, Ilyas, M, et al. Barrett’s dysplasia and the Vienna classification: reproducibility, prediction of progression and impact of consensus reporting and p53 immunohistochemistry Histopathology. 2009;54:699–712.CrossRefGoogle ScholarPubMed
Dixon, MF, Brown, LJ, Gilmour, HM, et al. Observer variation in the assessment of dysplasia in ulcerative colitis. Histopathology. 1988;13:385–97.CrossRefGoogle ScholarPubMed
Eaden, J, Abrams, K, McKay, H, Denley, H, Mayberry, J. Interobserver variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitis. J Pathol. 2001;194:152–7.CrossRefGoogle ScholarPubMed
Downs-Kelly, E, Mendelin, JE, Bennett, AE, et al. Poor interobserver agreement in the distinction of high grade dysplasia and adenocarcinoma in pretreatment Barrett’s esophagus biopsies. Am J Gastroenterol. 2008;103:2333–40.Google Scholar
Eaden, JA, Mayberry, JF. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut. 2002;51 (Suppl V):10–12.Google Scholar
Magro, F, Langner, C, Driessen, A, et al. on behalf of the European Society of Pathology (ESP) and the European Crohn’s and Colitis Organisation (ECCO). European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7:827–51.Google Scholar
van Schaik, FD, Oldenburg, B, Offerhaus, GJ, et al. Role of immunohistochemical markers in predicting progression of dysplasia to advanced neoplasia in patients with ulcerative colitis. Inflamm Bowel Dis. 2012;18:480–8.CrossRefGoogle ScholarPubMed
Vennalaganti, P, Kanakadandi, V, Goldblum, JR, et al. Discordance among pathologists in the United States and Europe in diagnosis of low grade dysplasia for patients with Barrett’s esophagus. Gastroenterology. 2017;152:564–70.Google Scholar
Kastelein, F, Biermann, K, Steyerberg, EW, et al. Aberrant p53 protein expression is associated with an increased risk of neoplastic progression in patients with Barrett’s oesophagus. Gut. 2013;62:1676–83.Google Scholar
Fogt, F, Zhuang, Z, Poremba, C, Dockhorn-Dworniczak, B, Vortmeyer, A. Comparison of p53 immunoexpression with allelic loss of p53 in ulcerative colitis-associated dysplasia and carcinoma. Oncol Rep. 1998;5:477–80.Google ScholarPubMed
Gerritts, MM, Chen, M, Theeuves, M, et al. Biomarker-based prediction of inflammatory bowel disease-related colorectal cancer: a case–control. Cell Oncol (Dordr). 2011;34:107–17.Google Scholar
Xie, H, Xiao, SY, Pai, R, et al. Diagnostic utility of TP53 and cytokeratin 7 immunohistochemistry in idiopathic inflammatory bowel disease-associated neoplasia. Mod Pathol. 2014;27:303–13.CrossRefGoogle ScholarPubMed
Fitzgerald, RC, di Pietro, M, Ragunath, K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014; 63:7–42.Google Scholar
Sikkema, M, Kerkhof, M, Steyerberg, EW, et al. Aneuploidy and overexpression of Ki67 and p53 as markers for neoplastic progression in Barrett’s esophagus: a case-control study. Am J Gastroenterol. 2009;104(11):2673–80.Google Scholar
Wong, NA, Mayer, NJ, MacKell, S, Gilmour, HM, Harrison, DJ. Immunohistochemical assessment of Ki67 and p53 expression assists the diagnosis and grading of ulcerative colitis-related dysplasia. Histopathology. 2000;37:108–14.CrossRefGoogle ScholarPubMed
Bernard, JE, Butler, MO, Sandweiss, L, Weidner, N. Anal intraepithelial neoplasia: correlation of grade with p16INK4a immunohistochemistry and HPV in situ hybridization. Appl Immunohistochem Mol Morphol. 2008;16:215–20.CrossRefGoogle ScholarPubMed
Darragh, TM, Colgan, TJ, Cox, JT, et al. Members of LAST Project Work Groups. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Arch Pathol Lab Med. 2012;136:1266–97.CrossRefGoogle ScholarPubMed
Lauwers, GY, Srivastava, A. Gastric preneoplastic lesions and epithelial dysplasia. Gastroenterol Clin North Am. 2007;36:813–29.Google Scholar
Chen, ZM, Scudiere, JR, Abraham, SC, Montgomery, E. Pyloric gland adenoma: an entity distinct from gastric foveolar type adenoma. Am J Surg Pathol. 2009;33:186–93.CrossRefGoogle ScholarPubMed
Carneiro, F, Charlton, A, Huntsman, DG. Hereditary diffuse gastric cancer. In Bosman, FT, Carneiro, F, Hruban, RH, Theise, ND (eds), WHO Classification of Tumours of the Digestive System. Lyon, France: International Agency for Research on Cancer; 2010, 59–63.Google Scholar
Abraham, SC, Montgomery, EA, Singh, VK, Yardley, JH, Wu, TT. Gastric adenomas: intestinal-type and gastric-type adenomas differ in the risk of adenocarcinoma and presence of background mucosal pathology. Am J Surg Pathol. 2002;26:1276–85.Google Scholar
Wu, TT, Kornacki, S, Rashid, A, Yardley, JH, Hamilton, SR. Dysplasia and dysregulation of proliferation in foveolar and surface epithelia of fundic gland polyps from patients with familial adenomatous polyposis. Am J Surg Pathol. 1998;22(3):293–8.Google Scholar
Worthley, DL, Phillips, KD, Wayte, N, et al. Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS): a new autosomal dominant syndrome. Gut. 2012;61:774–9.CrossRefGoogle ScholarPubMed
Li, J, Woods, SL, Healey, S, et al. Point mutations in exon 1B of APC reveal gastric adenocarcinoma and proximal polyposis of the stomach as a familial adenomatous polyposis variant. Am J Hum Genet. 2016;98:830–42.CrossRefGoogle ScholarPubMed
Noffsinger, AE. Serrated polyps and colorectal cancer: new pathway to malignancy. Annu Rev Pathol. 2009;4:343–64.CrossRefGoogle ScholarPubMed
Snover, DC, Jass, JR, Fenoglio-Preiser, C, Batts, KP. Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. Am J Clin Pathol. 2005;124:380–91.CrossRefGoogle ScholarPubMed
Snover, DC, Ahnen, DJ, Burt, RW, et al. Serrated polyps of the colon and rectum and serrated polyposis. In Bosman, FT, Carneiro, F, Hruban, RH, et al. (eds), WHO Classification of Tumours of the Digestive System. Lyon, France: International Agency for Research on Cancer; 2010, 160–5.Google Scholar
Rex, DK, Ahnen, DJ, Baron, JA, et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012;107(9):1315–29; quiz 1314, 1330.Google Scholar
Torlakovic, EE, Gomez, JD, Driman, DK, Parfitt, JR, Wang, C, Benerjee, T, Snover, DC. Sessile serrated adenoma (SSA) vs. traditional serrated adenoma (TSA). Am J Surg Pathol. 2008;32:21–9. Erratum in: Am J Surg Pathol. 2008;32: 491.CrossRefGoogle ScholarPubMed
Longacre, TA, Fenoglio-Preiser, CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol. 1990;14(6):524–37.Google Scholar
Beaugerie, L, Itzkowitz, S. Cancers complicating inflammatory bowel disease. N Engl J Med. 2015;372:1441–52.CrossRefGoogle ScholarPubMed
Rubin, DT, Rothe, JA, Hetzel, JT, Cohen, RD, Hanauer, SB. Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis? Gastrointest Endosc. 2007;65:998–1004.CrossRefGoogle ScholarPubMed
Laine, L, Kaltenbach, T, Barkun, A, McQuaid, KR, Subramanian, V, Soetikno, R; SCENIC Guideline Development Panel. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology. 2015;148:639–51.Google Scholar
Kaltenbach, T, Sandborn, WJ. Endoscopy in inflammatory bowel disease: advances in dysplasia detection and management. Gastrointest Endosc.2017;86:962–71.Google Scholar
Srivastava, A, Redston, M, Farraye, FA, Yantiss, RK, Odze, RD. Hyperplastic/serrated polyposis in inflammatory bowel disease: a case series of a previously undescribed entity. Am J Surg Pathol. 2008;32:296–303.Google Scholar
Ko, HM, Harpaz, N, McBride, RB, et al. Serrated colorectal polyps in inflammatory bowel disease. Mod Pathol. 2015;28:1584–93.Google Scholar
Shen, J, Gibson, JA, Schulte, S, et al. Clinical, pathologic, and outcome study of hyperplastic and sessile serrated polyps in inflammatory bowel disease. Hum Pathol. 2015;46:1548–56.Google Scholar
Parian, AM, Lazarev, MG. Serrated colorectal lesions in patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2018;14:19–25.Google ScholarPubMed
Lee, LH, Iacucci, M, Fort Gasia, M, Ghosh, S, Panaccione, R, Urbanski, S. Prevalence and anatomic distribution of serrated and adenomatous lesions in patients with inflammatory bowel disease. Can J Gastroenterol Hepatol. 2017;2017:5490803. DOI:10.1155/2017/5490803. Epub 2017 Jan 15.CrossRefGoogle ScholarPubMed
Parian, A, Koh, J, Limketkai, BN, et al. Association between serrated epithelial changes and colorectal dysplasia in inflammatory bowel disease. Gastrointest Endosc. 2016;84:87–95.Google Scholar
Johnson, DH, Khanna, S, Smyrk, TC, et al. Detection rate and outcome of colonic serrated epithelial changes in patients with ulcerative colitis or Crohn’s colitis. Aliment Pharmacol Ther. 2014;39:1408–17.Google Scholar
Svrcek, M, Piton, G, Cosnes, J, et al. Small bowel adenocarcinomas complicating Crohn’s disease are associated with dysplasia: a pathological and molecular study. Inflamm Bowel Dis. 2014;20:1584–92.Google Scholar
Fenger, C. Anal canal. In Mills, SE (ed), Histology for Pathologists, 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007, 663–83.Google Scholar
Parkin, DM, Bray, F. Chapter 2: the burden of HPV-related cancers. Vaccine. 2006;24(Suppl 3):S11–25.Google Scholar
Fléjou, JF. An update on anal neoplasia. Histopathology. 2015;66(1):147–60.Google Scholar

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