And the story goes on: non-conventional dysplasia of the colorectum

Lavisha S. Punjabi; Yi Neng Lai; Anjula Thomas

doi:10.4132/jptm.2021.12.29

Articles

Page Path: HOME > J Pathol Transl Med > Volume 56(2); 2022 > Article

Letter to the Editor And the story goes on: non-conventional dysplasia of the colorectum: Lavisha S. Punjabi^,, Yi Neng Lai, Anjula Thomas; Journal of Pathology and Translational Medicine 2022;56(2):109-110.
DOI: https://doi.org/10.4132/jptm.2021.12.29
Published online: February 3, 2022

Department of Anatomical Pathology, Sengkang General Hospital, Singapore

Corresponding Author: Lavisha S. Punjabi, MBBS Department of Anatomical Pathology, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886 Tel: +65-6930-5000, E-mail: lavisha.s.punjabi@gmail.com

• Received: October 13, 2021 • Revised: December 27, 2021 • Accepted: December 28, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next

3,312 Views
83 Download
1 Crossref

Full Article

Download PDF

NOTES
REFERENCES

The adenoma-carcinoma sequence of carcinogenesis in the colorectum, featuring the progressive accumulation of alterations of APC, KRAS, p53, and other genes, was elucidated in the 1990s and has since become a textbook example of the stepwise model of carcinogenesis. In recent decades, our understanding of colorectal dysplasia has expanded through the study of the clinical, morphologic, molecular aspects of serrated dysplasia and non-conventional dysplasia in inflammatory bowel disease (IBD). Hence, we read with interest Choi’s timely review of the seven morphologic subtypes of non-conventional dysplasia in IBD [1].

The assessment of dysplasia in the context of IBD is a widely accepted and long-held area of diagnostic difficulty, associated with fair to moderate interobserver agreement even among subspeciality pathologists [2]. The question that naturally arises from the discovery of these unusual morphologic subtypes of dysplasia, that was to some extent based on retrospective study and generous resection specimens, is its applicability and impact on routine reporting of limited endoscopic biopsies. It is plausible that awareness of these morphologic subtypes could facilitate more accurate histologic recognition of dysplasia.

Alternatively, the devil’s advocate may posit that the subtlety of some of these morphologic subtypes may make the diagnosis of dysplasia in superficial biopsies inconclusive and ambiguous. Of note, hypermucinous dysplasia shows progressively less cytologic atypia towards the surface and is thus a more subtle form of dysplasia than we are accustomed to recognizing. Contrary to its low-grade appearance however, this subtype harbors a higher rate of KRAS alterations and aneuploidy [3,4], rendering it a high-risk lesion that should not be missed. From the clinical point of view, it would therefore be important to recognize nonconventional dysplasia, particularly the high-risk subtypes, and recommend short-term follow-up for these lesions, despite the concern about the ambiguous diagnosis for dysplasia. Conversely, from the healthcare systems point of view, a higher overall “indefinite for dysplasia” call rate may result in increased healthcare costs, particularly if the number needed to treat is high. Evidently, prospective evaluation of the impact on and of reporting, including inter-observer and intra-observer reproducibility among both subspecialty and general pathologists, is required, albeit conceivably limited by relatively small case numbers.

As with many areas in pathology, new knowledge often undergoes a process of “splitting,” investigation and then meaningful “lumping.” A prime example of this process, although out of the field of gastrointestinal pathology, is the study of subtypes of non-mucinous adenocarcinoma of the lung, that began with meticulous morphologic descriptions, such as lepidic, acinar, complex glandular, papillary, micropapillary and solid. Subsequent data on the prognostic implications of each of these subtypes facilitated meaningful grouping within a three-tier grading system formulated by the International Association for the Study of Lung Cancer, incorporated in the latest iteration of the World Health Organization classification of thoracic tumors. Similarly, further study of the behavior of the morphologic subtypes of non-conventional dysplasia in the colorectum may eventually allow formulation of broader categories in the future. In addition, one may contend that serrated lesions in IBD and sporadic serrated lesions could be united, given the similarity in clinical, pathologic, and molecular features.

As a matter of topical interest and therapeutic relevance, findings of a recent study by Kim et al. [5] concluded that NTRK-rearranged colorectal carcinomas progress exclusively via the serrated pathway of neoplasia, thus expanding the molecular landscape of serrated colorectal lesions. To the best of our knowledge, oncogenic gene fusions including NTRK fusions have yet to be studied in serrated lesions in IBD, and would indeed form an interesting research question.

In conclusion, while we have made strides in expanding the concepts of colorectal dysplasia, the present-day story of colorectal carcinogenesis in IBD is an unfinished one, with many curious questions, practical and scientific, yet to be solved.

Ethics Statement

Not applicable.

Availability of Data and Material

Data sharing not applicable to this article as no datasets were generated or analyzed during the study.

Code Availability

Not applicable.

Author contributions

Conceptualization: LSP. Writing—original draft: LSP. Writing—review & editing: YNL, AT. Approval of final manuscript: all authors.

Conflicts of Interest

The authors declare that they have no potential conflicts of interest.

Funding Statement

No funding to declare.

REFERENCES

1. Choi WT. Non-conventional dysplastic subtypes in inflammatory bowel disease: a review of their diagnostic characteristics and potential clinical implications. J Pathol Transl Med 2021; 55: 83-93. Article PubMed PMC
2. Laine L, Kaltenbach T, Barkun A, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc 2015; 81: 489-501. Article PubMed
3. Lee H, Rabinovitch PS, Mattis AN, Lauwers GY, Choi WT. Nonconventional dysplasia in inflammatory bowel disease is more frequently associated with advanced neoplasia and aneuploidy than conventional dysplasia. Histopathology 2021; 78: 814-30. Article PubMed
4. Andersen SN, Lovig T, Clausen OP, Bakka A, Fausa O, Rognum TO. Villous, hypermucinous mucosa in long standing ulcerative colitis shows high frequency of K-ras mutations. Gut 1999; 45: 686-92. Article PubMed PMC
5. Kim JH, Hong JH, Choi YL, et al. NTRK oncogenic fusions are exclusively associated with the serrated neoplasia pathway in the colorectum and begin to occur in sessile serrated lesions. J Pathol 2021; 255: 399-411. Article PubMed

Figure & Data

References

Citations

Citations to this article as recorded by

Seeing the random forest through the decision trees. Supporting learning health systems from histopathology with machine learning models: Challenges and opportunities
Ricardo Gonzalez, Ashirbani Saha, Clinton J.V. Campbell, Peyman Nejat, Cynthia Lokker, Andrew P. Norgan
Journal of Pathology Informatics.2024; 15: 100347. CrossRef

PubReader
ePub Link

Cite this Article

Cite this Article: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

And the story goes on: non-conventional dysplasia of the colorectum

J Pathol Transl Med. 2022;56(2):109-110. Published online February 3, 2022

DOI: https://doi.org/10.4132/jptm.2021.12.29

XML Download

Related articles

Evolving pathologic concepts of serrated lesions of the colorectum

And the story goes on: non-conventional dysplasia of the colorectum