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Gui X, Köbel M, Ferraz JGP, Iacucci M, Ghosh S, Demetrick DJ. Newly recognized non-adenomatous lesions associated with enteric carcinomas in inflammatory bowel disease - Report of six rare and unique cases. Ann Diagn Pathol 2019; 44:151455. [PMID: 31862522 DOI: 10.1016/j.anndiagpath.2019.151455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 01/26/2023]
Abstract
It is the current view that the inflammatory bowel disease (IBD)-associated precancerous lesions may be adenomatous (with classic cytologic dysplasia) and non-adenomatous (without frank cytologic dysplasia), and the latter ones are in various histomorphologies including serrated, mucinous, eosinophilic (goblet cell deficient), and differentiated (dysplasia with terminal epithelial differentiation) types. By retrospectively reviewing the surgically resected IBD-associated colorectal and ileal carcinomas (×53), analyzing the background epithelial changes/lesions in the mucosa surrounding and adjacent to invasive carcinomas, and testing the key molecular profile (KRAS, BRAF, PIK3CA, NRAS, p53, mismatch repair proteins, and SAT-B2) known to be involved in colorectal carcinogenesis, we identified 6 representative, rare and unique cases, in which non-adenomatous lesions were clearly in vicinity and in transition to invasive carcinomas. Furthermore, we identified certain colonic carcinoma-related molecular alterations, and thus further confirmed the neoplastic nature of various non-adenomatous lesions. It was also revealed that non-adenomatous lesions are heterogeneous in both morphology and molecular alterations, and that it is common to have more than one type of lesions be associated with a carcinoma. Moreover, mixed focal adenomatous dysplasia was common, which may be the necessary step in the malignant transformation of the non-adenomatous lesions.
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Affiliation(s)
- Xianyong Gui
- Department of Pathology and Laboratory Medicine, University of Calgary, Canada; Alberta Precision Laboratories, Calgary, Canada; Department of Pathology, University of Washington School of Medicine, USA.
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Canada; Alberta Precision Laboratories, Calgary, Canada
| | - Jose G P Ferraz
- Division of Gastroenterology and Hepatology, University of Calgary, Canada
| | - Marietta Iacucci
- Division of Gastroenterology and Hepatology, University of Calgary, Canada; NIHR Biomedical Research Centre, Institute of Translational Medicine, University of Birmingham, UK
| | - Subrata Ghosh
- Division of Gastroenterology and Hepatology, University of Calgary, Canada; NIHR Biomedical Research Centre, Institute of Translational Medicine, University of Birmingham, UK
| | - Douglas J Demetrick
- Department of Pathology and Laboratory Medicine, University of Calgary, Canada; Alberta Precision Laboratories, Calgary, Canada
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Gui X, Köbel M, Ferraz JG, Iacucci M, Ghosh S, Liu S, Ou Y, Perizzolo M, Winkfein RJ, Rambau P, Demetrick DJ. Histological and molecular diversity and heterogeneity of precancerous lesions associated with inflammatory bowel diseases. J Clin Pathol 2019; 73:391-402. [PMID: 31801800 DOI: 10.1136/jclinpath-2019-206247] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 01/08/2023]
Abstract
AIMS Inflammatory bowel disease (IBD)-associated precancerous lesions may be adenomatous or non-adenomatous with various histomorphologies. We aim to validate the newly proposed classification, to explore the neoplastic nature of the non-adenomatous lesions and to elucidate the molecular mechanisms underlying the different histomorphologies. METHODS 44 background precursor lesions identified in 53 cases of surgically resected IBD-associated colorectal and ileal carcinomas were reviewed for the histomorphological features (classified into adenomatous, mucinous, sessile serrated adenoma (SSA)-like, traditional serrated adenoma-like, differentiated, eosinophilic and serrated not otherwise specified (NOS)) and analysed for a key panel of colonic cancer-related molecular markers. RESULTS Approximately 60% of the lesions were adenomatous, of which some had mixed serrated, mucinous or eosinophilic changes. The remaining non-adenomatous lesions, including all other types except SSA-like type, mostly showed mixed features and focal adenomatous dysplasia. KRAS mutation and p53 mutant-type expression were found in about half cases across all types, while PIK3CA mutation only in some of adenomatous and eosinophilic lesions and MLH1/PMS2 loss in a subset of adenomatous, mucinous and eosinophilic but not in differentiated and serrated lesions. SAT-B2 or PTEN loss and IMP3 overexpression were seen in a small subset of lesions. No BRAF, NRAS or EGFR gene mutation was detected in any type. Certain molecular-morphological correlations were demonstrated; however, no single or combined molecular alteration(s) was specific to any particular morphological type. CONCLUSIONS IBD-associated precancerous lesions are heterogeneous both histologically and molecularly. True colitis-associated adenomatous lesions are unlikely conventional adenomas. Non-adenomatous lesions without frank cytologic dysplasia should also be regarded as neoplastic.
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Affiliation(s)
- Xianyong Gui
- Pathology, University of Washington School of Medicine, Seattle, Washington, USA .,Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martin Köbel
- Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jose Gp Ferraz
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marietta Iacucci
- NIHR Biomedical Research Centre, Institute of Translational Medicine, University of Birmingham, Birmingham, Birmingham, UK
| | - Subrata Ghosh
- NIHR Biomedical Research Centre, Institute of Translational Medicine, University of Birmingham, Birmingham, Birmingham, UK
| | - Shuhong Liu
- Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Young Ou
- Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marco Perizzolo
- Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert J Winkfein
- Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter Rambau
- Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Douglas J Demetrick
- Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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