Lang-Schwarz Corinna, Büttner-Herold Maike, Burian Stephan, Erber Ramona, Hartmann Arndt, Jesinghaus Moritz, Kamarádová Kateřina, Rubio Carlos A, Seitz Gerhard, Sterlacci William, Vieth Michael, Bertz Simone
Institute of Pathology, Klinikum Bayreuth, Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Germany
Department of Nephropathology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany.
J Clin Pathol. 2025 Jan 17;78(2):103-110. doi: 10.1136/jcp-2023-209206.
Special histomorphological subtypes of colorectal low-grade intraepithelial neoplasia (LGIN) with variable prognostic impact were recently described in patients with inflammatory bowel disease (IBD) referred to as non-conventional dysplasia. However, they can also be found in patients without IBD. We aimed to analyse the reproducibility, frequency and prognostic impact of non-conventional colorectal LGIN in patients with and without IBD.
Six pathologists evaluated 500 specimens of five different LGIN-cohorts from patients with and without IBD. Non-conventional LGIN included hypermucinous, goblet cell-deficient, Paneth cell-rich and crypt cell dysplasia. A goblet cell-rich type and non-conventional LGIN, not otherwise specified were added. Results were compared with the original expert-consented diagnosis from archived pathology records.
Four or more pathologists agreed in 86.0% of all cases. Non-conventional LGIN was seen in 44.4%, more frequently in patients with IBD (52%; non-IBD: 39.3%, p=0.005). In patients with IBD non-conventional LGIN associated with more frequent and earlier LGIN relapse (p=0.006, p=0.025), high-grade intraepithelial neoplasia (p=0.003), larger lesion size (p=0.001), non-polypoid lesions (p=0.019) and additional risk factors (p=0.034). Results were highly comparable with expert-consented diagnoses. In patients without IBD, non-conventional LGIN may indicate a higher risk for concurrent or subsequent colorectal carcinoma (CRC, p=0.056 and p=0.061, respectively). Frequencies and association with high-grade intraepithelial neoplasia or CRC varied between the different LGIN subtypes.
Non-conventional histomorphology in colorectal LGIN is frequent and highly reproducible. Our results indicate an increased risk for CRC in patients with non-conventional LGIN, probably independent of IBD. We recommend reporting non-conventional LGIN in routine pathology reports.
近期在炎症性肠病（IBD）患者中描述了具有不同预后影响的结直肠低级别上皮内瘤变（LGIN）的特殊组织形态学亚型，称为非传统发育异常。然而，在无IBD的患者中也可发现这些亚型。我们旨在分析非传统结直肠LGIN在有IBD和无IBD患者中的可重复性、频率及预后影响。
6名病理学家评估了来自有IBD和无IBD患者的5个不同LGIN队列的500份标本。非传统LGIN包括高黏液性、杯状细胞缺乏型、潘氏细胞丰富型和隐窝细胞发育异常。增加了杯状细胞丰富型和未另行指定的非传统LGIN。将结果与存档病理记录中最初经专家认可的诊断进行比较。
在所有病例中，4名或更多病理学家意见一致的情况占86.0%。非传统LGIN见于44.4%的病例，在IBD患者中更常见（52%；无IBD患者：39.3%，p=0.005）。在IBD患者中，非传统LGIN与更频繁和更早的LGIN复发相关（p=0.006，p=0.025）、高级别上皮内瘤变（p=0.003）、更大的病变大小（p=0.001）、非息肉样病变（p=0.019）及其他危险因素（p=0.034）。结果与专家认可的诊断高度可比。在无IBD的患者中，非传统LGIN可能提示同时发生或随后发生结直肠癌（CRC）的风险更高（分别为p=0.056和p=0.061）。不同LGIN亚型之间，其频率以及与高级别上皮内瘤变或CRC的关联有所不同。
结直肠LGIN中的非传统组织形态学很常见且具有高度可重复性。我们的结果表明，非传统LGIN患者患CRC的风险增加，可能与IBD无关。我们建议在常规病理报告中报告非传统LGIN。
