From the Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Ma is now at West Florida Hospital in Pensacola.
Arch Pathol Lab Med. 2022 Jan 2;146(2):172-181. doi: 10.5858/arpa.2020-0745-OA.
CONTEXT.—: Inflammatory polyps (IPs) in inflammatory bowel disease may have been associated in the past with increased neoplasia risk. Additionally, colonic mucosa in filiform polyposis and giant inflammatory polyposis may be difficult to visualize during endoscopic surveillance, perhaps contributing to early colectomy in these patients.
OBJECTIVE.—: To examine the clinicopathologic characteristics and significance of IPs and inflammatory polyposis in inflammatory bowel disease.
DESIGN.—: We identified 336 resections from inflammatory bowel disease patients (212 [63.1%] male; mean age, 40.3 years; 175 [52.1%] with ulcerative colitis), including 78 with rare/few (<10) IPs, 141 with multiple (≥10) IPs, and 117 with inflammatory polyposis (including 30 with filiform polyposis/giant inflammatory polyposis) and compared them with 100 controls without IPs along various parameters, including overall and occult (unexpected) dysplasia.
RESULTS.—: There was no increased neoplasia in resections with IPs compared with controls, given similar age, disease duration, degree of inflammation, anatomical extent of colitis, prevalence of primary sclerosing cholangitis, and tissue sampling. Increasing numbers of IPs and inflammatory polyposis were significantly associated in multivariate analysis with ulcerative and indeterminate colitis (P = .003) and shorter disease duration (P = .01), but also, and independently, with lower rates of dysplasia overall, including all grades (P = .001) and advanced neoplasia (P = .04). There were no instances of occult dysplasia (any grade) among inflammatory polyposis cases.
CONCLUSIONS.—: These findings support the conclusion that the presence of IPs per se, and inflammatory polyposis in particular (including filiform polyposis and giant inflammatory polyposis), should not be considered an independent risk factor for the development of neoplasia in inflammatory bowel disease patients, outside the context of disease duration and inflammatory burden.
在炎症性肠病中，炎性息肉（IPs）过去可能与增加的肿瘤风险相关。此外，在纤维状息肉和巨大炎性息肉中，结肠黏膜可能难以在内镜监测中可视化，这可能导致这些患者的早期结肠切除术。
检查炎症性肠病中 IPs 和炎性息肉的临床病理特征和意义。
我们从炎症性肠病患者中确定了 336 例切除术（212 例[63.1%]为男性；平均年龄为 40.3 岁；175 例[52.1%]为溃疡性结肠炎），包括 78 例罕见/少量（<10）IPs、141 例多发性（≥10）IPs 和 117 例炎性息肉（包括 30 例纤维状息肉/巨大炎性息肉），并将其与 100 例无 IPs 的对照进行了比较，比较了各种参数，包括总体和隐匿（意外）异型增生。
与对照组相比，IPs 切除术中的肿瘤发生率没有增加，考虑到年龄、疾病持续时间、炎症程度、结肠炎的解剖范围、原发性硬化性胆管炎的患病率以及组织取样。在多变量分析中，IPs 和炎性息肉的数量增加与溃疡性和不确定结肠炎（P =.003）和较短的疾病持续时间（P =.01）显著相关，但也与总体异型增生率较低（包括所有等级）和高级别肿瘤（P =.04）独立相关。炎性息肉病例中没有隐匿性异型增生（任何等级）。
这些发现支持这样的结论，即 IPs 本身的存在，特别是炎性息肉（包括纤维状息肉和巨大炎性息肉），不应被视为炎症性肠病患者发生肿瘤的独立危险因素，除非在疾病持续时间和炎症负担的背景下。
