Increased Active Inflammation in the Colon is Not a Reliable Predictor of an Elevated Risk of Dysplasia in Patients With Primary Sclerosing Cholangitis and Ulcerative Colitis.

IF 4.5 1区 医学 Q1 PATHOLOGY
American Journal of Surgical Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-29 DOI:10.1097/PAS.0000000000002255
Ruth Zhang, Dongliang Wang, Gregory Y Lauwers, Won-Tak Choi
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Abstract

Although the increased risk of colorectal neoplasia in patients with both primary sclerosing cholangitis (PSC) and ulcerative colitis (UC; termed PSC-UC) is well documented, the mechanism through which concomitant PSC increases the risk of colorectal neoplasia remains unclear. Given that the risk of colorectal neoplasia in UC is positively correlated with increased histologic inflammation, this study sought to investigate whether increased histologic inflammation could be used to stratify the risk of dysplasia development in patients with PSC-UC. Twenty patients with PSC-UC and dysplasia were compared with 30 control patients with PSC-UC who had no history of neoplasia. For each patient, all surveillance biopsies were scored using a 4-point scoring system: (1) no epithelial neutrophils = 0, (2) cryptitis only = 1, (3) cryptitis plus crypt abscess in <50% of crypts = 2, and (4) crypt abscess in ≥50% of crypts, erosion, neutrophilic exudate, and/or ulceration = 3. A score was designated for each biopsy, and both mean and maximum inflammation scores were calculated from all biopsies taken during each colonoscopy. The inflammation burden score was calculated for each surveillance interval by multiplying the average maximum score between each pair of surveillance episodes by the length of the surveillance interval in years. The average scores derived from all colonoscopies for each patient were used to determine the patient's overall mean, maximum, and inflammation burden scores. In both the dysplasia and control groups, the 3 summative inflammation scores were calculated independently for the entire colon, right colon, and left colon. The dysplasia group consisted of 14 (70%) men and 6 (30%) women, with a mean age of 27 years at UC diagnosis and a long history of pancolitis (mean duration: 17 y). A total of 49 dysplastic lesions were detected in the dysplasia group, and 8 (40%) of the 20 patients had multifocal dysplasia. The majority of dysplastic lesions belonged to nonconventional subtypes (n = 28; 57%) and were located in the right colon (n = 37; 76%). Irrespective of the colon segment, there was no significant difference in the 3 summative inflammation scores between the dysplasia and control groups ( P > 0.05). However, in each group, the 3 summative inflammation scores were significantly higher in the right colon than in the left colon ( P < 0.05). In conclusion, patients with PSC-UC exhibit increased histologic inflammation in the right colon compared with the left colon, regardless of the presence of dysplasia. Although this may provide an explanation for the predominance of right-sided colorectal neoplasia in patients with PSC-UC, increased histologic inflammation does not reliably predict an elevated risk of dysplasia in patients with PSC-UC. These findings reinforce the current recommendation for annual endoscopic surveillance for all patients with PSC-UC, irrespective of the extent and severity of inflammation.

结肠中活性炎症的增加并不是原发性硬化性胆管炎和溃疡性结肠炎患者增生风险升高的可靠预测因素。
尽管原发性硬化性胆管炎(PSC)和溃疡性结肠炎(UC,称为 PSC-UC)患者发生结直肠肿瘤的风险增加已得到充分证实,但同时患有 PSC 的患者发生结直肠肿瘤的风险增加的机制仍不清楚。鉴于UC的结直肠肿瘤风险与组织学炎症的增加呈正相关,本研究试图探讨组织学炎症的增加是否可用于对PSC-UC患者的发育不良风险进行分层。研究人员将20名患有PSC-UC且发育不良的患者与30名无肿瘤病史的PSC-UC对照组患者进行了比较。对每位患者的所有监测活检均采用 4 点评分法进行评分:(1)无上皮中性粒细胞 = 0;(2)仅有隐窝炎 = 1;(3)隐窝炎加隐窝脓肿 = 0.05)。然而,在每组中,右侧结肠的 3 项炎症总评分均明显高于左侧结肠(P< 0.05)。总之,与左侧结肠相比,无论是否存在发育不良,PSC-UC 患者右侧结肠的组织学炎症都会加重。虽然这可以解释 PSC-UC 患者右侧结直肠肿瘤居多的原因,但组织学炎症的增加并不能可靠地预测 PSC-UC 患者发育不良风险的升高。这些发现加强了目前对所有 PSC-UC 患者进行年度内镜监测的建议,无论炎症的范围和严重程度如何。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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