Résumé
La survenue d’un cancer sur une maladie inflammatoire intestinale chronique (MICI), une colite ulcéreuse et une maladie de Crohn, est une complication bien connue. Quoique dans l’absolu, le nombre de cancers intestinaux sur MICI reste faible, moins d’1% de la totalité des cancers colorectaux, ils posent au pathologiste le problème du diagnostic de la lésion précancéreuse dans le contexte de programmes de surveillance car un grand nombre de ces patients sont plus jeunes que la moyenne d’âge de la population atteinte de cancer colorectal. La mise en évidence d’une dysplasie sur biopsies colorectales reste encore le meilleur marqueur diagnostique de cancer ou de ses stades prénéoplasiques. Néanmoins, en dépit d’une proposition de classification compréhensive de la dysplasie dans les MICI, cette pathologie reste très rare et même pour des pathologistes gastro-intestinaux expérimentés, le diagnostic de dysplasie n’est pas toujours commode.
Dans la présente revue, les patients à risque, les modifications macroscopiques et histologiques de la dysplasie ainsi que les conséquences cliniques du diagnostic de celle-ci sont discutés dans le but d’aider le pathologiste à déterminer, sur base de biopsies, les caractéristiques des MICI et des lésions prénéoplasiques.
Summary
The occurrence of cancer in long-standing inflammatory bowel diseases (IBD), ulcerative colitis and Crohn’s disease, is well known. Although the absolute number of intestinal cancers in IBD is low, less than 1% of all colorectal cancers, it is the pathologist’s task to diagnose precancer in the context of surveillance programmes as many of these patients are younger than the average colorectal cancer population. The finding of dysplasia in colorectal biopsies is still the best marker of cancer or its precursor stages. However, though a comprehensive classification of dysplasia in IBD has been proposed, the condition remains very rare and even for experienced gastrointestinal pathologists the diagnosis of dysplasia is not always easy.
In this paper the patients at risk, the macroscopic and histological changes in dysplasia as well as the clinical consequences of diagnosing dysplasia are discussed in order to help the pathologist when dealing with biopsies featuring IBD and preneoplastic lesions.
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Cuvelier, C. Dysplasie dans les maladies inflammatoires intestinales. Acta Endosc 30, 153–161 (2000). https://doi.org/10.1007/BF03022282
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DOI: https://doi.org/10.1007/BF03022282