Department of Pathology, The Mount Sinai School of Medicine, New York, New York 10092, USA.
Arch Pathol Lab Med. 2010 Jun;134(6):876-95. doi: 10.5858/134.6.876.
Colorectal cancer, the most lethal long-term complication of chronic inflammatory bowel disease (IBD), is the culmination of a complex sequence of molecular and histologic derangements of the intestinal epithelium that are initiated and at least partially sustained by chronic inflammation. Dysplasia, the earliest histologic manifestation of this process, plays an important role in cancer prevention by providing the first clinical alert that this sequence is underway and serving as an endpoint in colonoscopic surveillance of patients at high risk for colorectal cancer.
To review the histology, nomenclature, clinical implications, and molecular pathogenesis of dysplasia in IBD.
Literature review and illustrations from case material.
The diagnosis and grading of dysplasia in endoscopic surveillance biopsies play a decisive role in the management of patients with IBD. Although interpathologist variation, endoscopic sampling problems, and incomplete information regarding the natural history of dysplastic lesions are important limiting factors, indirect evidence that surveillance may be an effective means of reducing cancer-related mortality in the population with IBD has helped validate the histologic criteria, nomenclature, and clinical recommendations that are the basis of current practice among pathologists and clinicians. Emerging technologic advances in endoscopy may permit more effective surveillance, but ultimately the greatest promise for cancer prevention in IBD lies in expanding our thus far limited understanding of the molecular pathogenetic relationships between neoplasia and chronic inflammation.
结直肠癌是慢性炎症性肠病（IBD）最致命的长期并发症，是肠道上皮发生一系列复杂的分子和组织学紊乱的最终结果，这些紊乱是由慢性炎症引发的，至少部分由其维持。异型增生是该过程的最早组织学表现，通过提供第一个临床警报，表明该序列正在进行，并作为结肠镜监测高危结直肠癌患者的终点，在癌症预防中发挥着重要作用。
回顾 IBD 中异型增生的组织学、命名法、临床意义和分子发病机制。
文献复习和病例材料的插图。
在进行内镜监测活检时，对异型增生的诊断和分级在 IBD 患者的管理中起着决定性作用。尽管病理学家之间的变异、内镜取样问题以及对异型增生病变自然史的不完全了解是重要的限制因素，但监测可能是降低 IBD 人群癌症相关死亡率的有效手段的间接证据，有助于验证目前病理学家和临床医生实践的组织学标准、命名法和临床建议。内镜技术的新兴技术进步可能会使监测更加有效，但最终，IBD 中癌症预防的最大希望在于扩大我们迄今为止对肿瘤和慢性炎症之间的分子发病机制的有限理解。
