Enea Diana, Lauwers Grégory, Svrcek Magali
Sorbonne université, Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, service d'anatomie et cytologie pathologiques, SIRIC CURAMUS, Paris, France.
Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute and Departments of Pathology and Oncologic Sciences, University of South Florida, Tampa, FL, États-Unis.
Ann Pathol. 2023 Jun;43(3):180-191. doi: 10.1016/j.annpat.2023.02.006. Epub 2023 Mar 9.
Compared to the general population, patients with inflammatory bowel disease (IBD), both ulcerative colitis (UC) or Crohn's disease (CD), are at increased risk of developing some cancers, particularly colorectal cancers (CRC). CRCs, the vast majority of which are adenocarcinomas, develop from a precancerous lesion called dysplasia (or intraepithelial neoplasia) via an inflammation-dysplasia-adenocarcinoma sequence. The advancements of new endoscopic techniques, including visualisation and resection techniques, has led to a reclassification of dysplasia lesions into visible and invisible lesions and their therapeutic management, with a more conservative approach to the colorectal setting. In addition, besides conventional dysplasia, of intestinal phenotype, classically described in IBD, non-conventional dysplasias (as opposed to conventional dysplasia of intestinal phenotype) are now described, including at least seven subtypes. Recognition of these unconventional subtypes, which are still poorly known from pathologists, is becoming crucial, as some of these subtypes appear to be at high risk of developing advanced neoplasia (i.e. high-grade dysplasia or CRC). This review briefly describes the macroscopic features of dysplastic lesions in IBD, as well as their therapeutic management, followed by the clinicopathological features of these dysplastic lesions, with particular emphasis on the new subtypes of unconventional dysplasia, both from a morphological and molecular point of view.
与普通人群相比，炎症性肠病（IBD）患者，包括溃疡性结肠炎（UC）或克罗恩病（CD）患者，患某些癌症的风险增加，尤其是结直肠癌（CRC）。绝大多数结直肠癌为腺癌，它是由一种称为发育异常（或上皮内瘤变）的癌前病变通过炎症-发育异常-腺癌序列发展而来。包括可视化和切除技术在内的新内镜技术的进步，导致发育异常病变重新分类为可见和不可见病变及其治疗管理，在结直肠方面采取了更保守的方法。此外，除了IBD中经典描述的肠道表型的传统发育异常外，现在还描述了非传统发育异常（与肠道表型的传统发育异常相对），包括至少七种亚型。认识这些病理学家仍知之甚少的非传统亚型变得至关重要，因为其中一些亚型似乎有发展为高级别瘤变（即高级别发育异常或结直肠癌）的高风险。本文综述简要描述了IBD中发育异常病变的宏观特征及其治疗管理，随后介绍了这些发育异常病变的临床病理特征，特别强调了非传统发育异常的新亚型，包括形态学和分子学方面。
