Dysplasia-like epithelial atypia in ischemic bowel disease

Susan C. Abraham, Melissa W. Taggart, Edward Vincent Loftus, Jr, Tsung Teh Wu

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Inflammatory and reactive conditions are known to mimic dysplasia or malignancy in the gastrointestinal tract. Epithelial atypia that closely mimics low-grade dysplasia (LGD) or high-grade dysplasia (HGD) can sometimes be seen in ischemic bowel. To study this phenomenon, we evaluated surgical resections for ischemic enteritis (n = 65) and ischemic colitis (n = 99) that included sections of viable epithelium adjacent to necrosis. Viable epithelium was classified as normal, obviously reactive, LGD-like atypia or high-grade dysplasia (HGD)-like atypia. Cases with available paraffin blocks were characterized immunohistochemically with antibodies to p16, p53, and MIB-1. Fourteen dysplastic lesions in chronic ulcerative colitis served as controls. Dysplasia-like atypia was found in 13 small bowel resections (20%) and 15 colectomies (15%), most common near re-epithelializing erosions. Two colectomies had extensive dysplasia-like atypia, whereas the other 26 demonstrated focal or several foci of atypia. Nine cases contained HGD-like atypia, 15 contained LGD-like atypia, and 4 showed both HGD- and LGD-like atypia. Features indicating subacute-to-chronic ischemia were more frequent in LGD-like atypia (13/15, 87%) than HGD-like atypia (2/9, 22%; P =.003). Dysplasia-like atypia showed overexpression of p16 (73%), p53 (50%), and MIB-1 (92%), but these markers did not reliably distinguish dysplasia-like atypia from true dysplasia in chronic ulcerative colitis (P =.45 for p16, P =.51 for p53, P =.08 for MIB-1). These results underscore the frequency of dysplasia-like atypia in ischemic bowel, which can occasionally be an extensive and worrisome finding. Distinction from true dysplasia requires recognizing the context of the epithelial atypia because cell cycle markers were not helpful in classifying individual cases.

Original languageEnglish (US)
Pages (from-to)1348-1357
Number of pages10
JournalHuman Pathology
Volume45
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Colectomy
Ulcerative Colitis
Epithelium
Ischemic Colitis
Enteritis
Paraffin
Gastrointestinal Tract
Cell Cycle
Necrosis
Ischemia
Antibodies
Neoplasms

Keywords

  • Atypia
  • Dysplasia
  • Inflammatory bowel disease
  • Ischemia
  • Ischemic colitis
  • Ulcerative colitis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Dysplasia-like epithelial atypia in ischemic bowel disease. / Abraham, Susan C.; Taggart, Melissa W.; Loftus, Jr, Edward Vincent; Wu, Tsung Teh.

In: Human Pathology, Vol. 45, No. 7, 2014, p. 1348-1357.

Research output: Contribution to journalArticle

Abraham, Susan C. ; Taggart, Melissa W. ; Loftus, Jr, Edward Vincent ; Wu, Tsung Teh. / Dysplasia-like epithelial atypia in ischemic bowel disease. In: Human Pathology. 2014 ; Vol. 45, No. 7. pp. 1348-1357.
@article{60e88e8fd77444ffaa8c11acb77c12c2,
title = "Dysplasia-like epithelial atypia in ischemic bowel disease",
abstract = "Inflammatory and reactive conditions are known to mimic dysplasia or malignancy in the gastrointestinal tract. Epithelial atypia that closely mimics low-grade dysplasia (LGD) or high-grade dysplasia (HGD) can sometimes be seen in ischemic bowel. To study this phenomenon, we evaluated surgical resections for ischemic enteritis (n = 65) and ischemic colitis (n = 99) that included sections of viable epithelium adjacent to necrosis. Viable epithelium was classified as normal, obviously reactive, LGD-like atypia or high-grade dysplasia (HGD)-like atypia. Cases with available paraffin blocks were characterized immunohistochemically with antibodies to p16, p53, and MIB-1. Fourteen dysplastic lesions in chronic ulcerative colitis served as controls. Dysplasia-like atypia was found in 13 small bowel resections (20{\%}) and 15 colectomies (15{\%}), most common near re-epithelializing erosions. Two colectomies had extensive dysplasia-like atypia, whereas the other 26 demonstrated focal or several foci of atypia. Nine cases contained HGD-like atypia, 15 contained LGD-like atypia, and 4 showed both HGD- and LGD-like atypia. Features indicating subacute-to-chronic ischemia were more frequent in LGD-like atypia (13/15, 87{\%}) than HGD-like atypia (2/9, 22{\%}; P =.003). Dysplasia-like atypia showed overexpression of p16 (73{\%}), p53 (50{\%}), and MIB-1 (92{\%}), but these markers did not reliably distinguish dysplasia-like atypia from true dysplasia in chronic ulcerative colitis (P =.45 for p16, P =.51 for p53, P =.08 for MIB-1). These results underscore the frequency of dysplasia-like atypia in ischemic bowel, which can occasionally be an extensive and worrisome finding. Distinction from true dysplasia requires recognizing the context of the epithelial atypia because cell cycle markers were not helpful in classifying individual cases.",
keywords = "Atypia, Dysplasia, Inflammatory bowel disease, Ischemia, Ischemic colitis, Ulcerative colitis",
author = "Abraham, {Susan C.} and Taggart, {Melissa W.} and {Loftus, Jr}, {Edward Vincent} and Wu, {Tsung Teh}",
year = "2014",
doi = "10.1016/j.humpath.2014.03.009",
language = "English (US)",
volume = "45",
pages = "1348--1357",
journal = "Human Pathology",
issn = "0046-8177",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Dysplasia-like epithelial atypia in ischemic bowel disease

AU - Abraham, Susan C.

AU - Taggart, Melissa W.

AU - Loftus, Jr, Edward Vincent

AU - Wu, Tsung Teh

PY - 2014

Y1 - 2014

N2 - Inflammatory and reactive conditions are known to mimic dysplasia or malignancy in the gastrointestinal tract. Epithelial atypia that closely mimics low-grade dysplasia (LGD) or high-grade dysplasia (HGD) can sometimes be seen in ischemic bowel. To study this phenomenon, we evaluated surgical resections for ischemic enteritis (n = 65) and ischemic colitis (n = 99) that included sections of viable epithelium adjacent to necrosis. Viable epithelium was classified as normal, obviously reactive, LGD-like atypia or high-grade dysplasia (HGD)-like atypia. Cases with available paraffin blocks were characterized immunohistochemically with antibodies to p16, p53, and MIB-1. Fourteen dysplastic lesions in chronic ulcerative colitis served as controls. Dysplasia-like atypia was found in 13 small bowel resections (20%) and 15 colectomies (15%), most common near re-epithelializing erosions. Two colectomies had extensive dysplasia-like atypia, whereas the other 26 demonstrated focal or several foci of atypia. Nine cases contained HGD-like atypia, 15 contained LGD-like atypia, and 4 showed both HGD- and LGD-like atypia. Features indicating subacute-to-chronic ischemia were more frequent in LGD-like atypia (13/15, 87%) than HGD-like atypia (2/9, 22%; P =.003). Dysplasia-like atypia showed overexpression of p16 (73%), p53 (50%), and MIB-1 (92%), but these markers did not reliably distinguish dysplasia-like atypia from true dysplasia in chronic ulcerative colitis (P =.45 for p16, P =.51 for p53, P =.08 for MIB-1). These results underscore the frequency of dysplasia-like atypia in ischemic bowel, which can occasionally be an extensive and worrisome finding. Distinction from true dysplasia requires recognizing the context of the epithelial atypia because cell cycle markers were not helpful in classifying individual cases.

AB - Inflammatory and reactive conditions are known to mimic dysplasia or malignancy in the gastrointestinal tract. Epithelial atypia that closely mimics low-grade dysplasia (LGD) or high-grade dysplasia (HGD) can sometimes be seen in ischemic bowel. To study this phenomenon, we evaluated surgical resections for ischemic enteritis (n = 65) and ischemic colitis (n = 99) that included sections of viable epithelium adjacent to necrosis. Viable epithelium was classified as normal, obviously reactive, LGD-like atypia or high-grade dysplasia (HGD)-like atypia. Cases with available paraffin blocks were characterized immunohistochemically with antibodies to p16, p53, and MIB-1. Fourteen dysplastic lesions in chronic ulcerative colitis served as controls. Dysplasia-like atypia was found in 13 small bowel resections (20%) and 15 colectomies (15%), most common near re-epithelializing erosions. Two colectomies had extensive dysplasia-like atypia, whereas the other 26 demonstrated focal or several foci of atypia. Nine cases contained HGD-like atypia, 15 contained LGD-like atypia, and 4 showed both HGD- and LGD-like atypia. Features indicating subacute-to-chronic ischemia were more frequent in LGD-like atypia (13/15, 87%) than HGD-like atypia (2/9, 22%; P =.003). Dysplasia-like atypia showed overexpression of p16 (73%), p53 (50%), and MIB-1 (92%), but these markers did not reliably distinguish dysplasia-like atypia from true dysplasia in chronic ulcerative colitis (P =.45 for p16, P =.51 for p53, P =.08 for MIB-1). These results underscore the frequency of dysplasia-like atypia in ischemic bowel, which can occasionally be an extensive and worrisome finding. Distinction from true dysplasia requires recognizing the context of the epithelial atypia because cell cycle markers were not helpful in classifying individual cases.

KW - Atypia

KW - Dysplasia

KW - Inflammatory bowel disease

KW - Ischemia

KW - Ischemic colitis

KW - Ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=84902977349&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902977349&partnerID=8YFLogxK

U2 - 10.1016/j.humpath.2014.03.009

DO - 10.1016/j.humpath.2014.03.009

M3 - Article

C2 - 24946975

AN - SCOPUS:84902977349

VL - 45

SP - 1348

EP - 1357

JO - Human Pathology

JF - Human Pathology

SN - 0046-8177

IS - 7

ER -