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Polypoide Dysplasie bei chronisch-entzündlicher Darmerkrankung

Differenzialdiagnose und weiteres diagnostisch-therapeutisches Vorgehen

Polypoid dysplasia in inflammatory bowel disease

Differential diagnosis and further diagnostic and therapeutic approaches

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Zusammenfassung

Polypoide Dysplasien bei chronisch-entzündlicher Darmerkrankung (CED) werden klassischerweise in DALM („dysplasia associated lesion or mass“) und ALM („adenoma-like mass“) unterteilt. DALMs entstehen auf dem Boden der chronischen Entzündung, haben ein hohes Karzinomrisiko und bedürfen der Kolektomie. Sporadische Adenome entstehen koinzidentell im Rahmen der Adenom-Karzinom-Sequenz und sind mit einer lokalen Abtragung ausreichend therapiert. In letzter Zeit wurden „adenoma-like-DALMs“ abgegrenzt, die trotz Entstehung auf dem Boden einer CED eine überlappende Morphologie zu den sporadischen Adenomen zeigen. Adenomähnliche DALMs scheinen ein deutlich geringeres Entartungsrisiko als klassische DALMs zu haben und können deswegen ähnlich den sporadischen Adenomen durch eine lokale Abtragung mit nachfolgender Überwachung adäquat therapiert werden. Voraussetzung hierfür ist die Abtragung in toto sowie das Fehlen dysplastischer Veränderungen im Restkolon.

Abstract

Polypoid dysplasia in inflammatory bowel disease (IBD) is categorized as DALM (dysplasia associated lesion or mass) or ALM (adenoma-like mass). DALMs are etiologically related to the underlying inflammatory disease, have a high risk of cancer and remain an indication for colectomy. Sporadic adenomas occur coincidentally according to the adenoma-carcinoma sequence. They are adequately treated by polypectomy. More recently, a special group of lesions has been termed as “adenoma-like DALM” which shows a morphological overlap with sporadic adenomas in spite of arising against the background of chronic IBD. Adenoma-like DALMs may possess a lower risk of malignancy in contrast to non-adenoma-like DALMs. They may be treated adequately by polypectomy and continued monitoring if the lesion has been excised completely and there is no evidence of flat dysplasia elsewhere in the colon.

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  1. Institut für Pathologie, Klinikum Aschaffenburg, Am Hasenkopf, 63739, Aschaffenburg, Deutschland

    S. Warich-Eitel, T. Katzenberger & M. Eck

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  1. S. Warich-Eitel
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  2. T. Katzenberger
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  3. M. Eck
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Correspondence to S. Warich-Eitel.

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Warich-Eitel, S., Katzenberger, T. & Eck, M. Polypoide Dysplasie bei chronisch-entzündlicher Darmerkrankung. Pathologe 32, 282–288 (2011). https://doi.org/10.1007/s00292-011-1433-3

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