Dysplasia in pediatric patients with IBD: distinct clinicopathologic features
Information about the clinicopathologic features of dysplasia in pediatric patients with inflammatory bowel disease is limited because such dysplasia is rare in this patient population. Surveillance guidelines for these patients do not include dysplasia as a potential risk factor for colorectal cancer, and no clear guidance on the optimal strategy for detecting dysplasia is available. The authors conducted a study to characterize the clinicopathologic features of dysplasia in pediatric patients with inflammatory bowel disease (IBD) and compare them with those of adults with IBD. To this end, they analyzed the clinicopathologic features of 20 patients with IBD who developed at least one instance of dysplasia (n = 56) before the age of 21 years. The results were then compared with data from a previously published adult cohort that included 315 dysplastic lesions from 167 consecutive adult patients with IBD, which served as a control group. The authors’ study group consisted of 11 men and nine women, who were a mean age of 11 years (range, 2–19 years) at the time of IBD diagnosis. The mean age at the time of first dysplasia diagnosis was 18 years for the study group and 54 years for the adult group. The study group had a lower incidence of ulcerative colitis (65 versus 92 percent in the adult group, P < .001), but the proportion of patients with concurrent primary sclerosing cholangitis was nearly double that of the adult group (25 versus 13 percent in the adult group, P = .129). Dysplasia in the study group was more likely to be nonconventional (38 percent, P = .047) and invisible or flat (50 percent, P < .001) than in the adult group (25 and 24 percent, respectively). High-risk nonconventional dysplastic subtypes, including crypt dysplasia, goblet cell-deficient dysplasia, and hypermucinous dysplasia, were more common in the study group (13, 11, and nine percent, respectively) than in the adult group (four, three, and two percent, respectively). The mean time from IBD diagnosis to first dysplasia diagnosis was significantly shorter in the study group (eight years) than in the adult group (16 years) (P = .005). Although dysplastic lesions in the adult group were more likely to present as high-grade dysplasia at initial diagnosis (17 versus four percent in the study group, P = .008), the rate of advanced neoplasia (high-grade dysplasia or colorectal cancer) on follow-up was similar between the two groups (26 percent in the adult group versus 22 percent in the study group, P = 1.000). In summary, dysplasia in pediatric patients with IBD is often associated with nonconventional subtypes (especially high-risk subtypes), an invisible/flat appearance, concurrent primary sclerosing cholangitis, and early development (within eight years of IBD diagnosis), all of which may contribute to faster progression to colorectal cancer in this population. The authors concluded that pediatric patients with IBD who are at high risk of developing colorectal cancer may benefit from surveillance colonoscopy starting at the recommended eight years after the onset of IBD, focusing on the detection of nonconventional or invisible/flat dysplasia, or both.
Bahceci D, Hu S, Liao X, et al. Dysplasia in pediatric patients with inflammatory bowel disease shows distinct clinicopathologic features compared with that in adult patients. Mod Pathol. 2025;38(6). doi.org/10.1016/j.modpat.2025.100735
Correspondence: Dr. Won-Tak Choi at won-tak.choi@ucsf.edu
Significance of Crohn’s disease-like pathology in surgically diverted recta of patients with ulcerative colitis
Diversion colitis, which is commonly seen in surgically diverted bowel, can exhibit features resembling Crohn’s disease, even in patients who have established ulcerative colitis. The superposition of diversion colitis on inflammatory bowel disease (IBD) complicates pathological assessment and potentially alters the diagnosis from ulcerative colitis to Crohn’s disease. The authors investigated the diagnostic and prognostic significance of Crohn’s disease-like histological features in diversion colitis. They examined diverted recta from 202 patients (84 females and 118 males; median age, 37 years; range, 7–79 years) who underwent postdiversion proctectomy from 2018 to 2023. Preoperative diagnoses included ulcerative colitis (n = 162), Crohn’s disease (n = 20), indeterminate IBD (IIBD, n = 11), and non-IBD (n = 9). The authors evaluated granulomas and deep mucosal ulcers and scored transmural chronic inflammation (TCI) on a four-tier scale. Patients were followed for eight to 73 months for development of CD-like complications, such as small bowel enteritis, strictures, or fistulas. The authors concluded that TCI was present in all groups but was less frequent in the non-IBD group (P = .015), with median scores similar for ulcerative colitis and Crohn’s disease (median, 1), higher for IIBD (median, 2), and lower for non-IBD (median, 0) (P = .084). TCI scores did not correlate with development of Crohn’s disease-like complications and, therefore, did not have prognostic significance. Conversely, granulomas and fissuring ulcers were significantly more common in Crohn’s disease than in ulcerative colitis and IIBD and were absent in non-IBD (P < .0001 and P = .0009, respectively). These features correlated with higher TCI scores (P = .023 and P = .009, respectively). In summary, granulomas and fissuring mucosal ulcers in diverted recta favor a diagnosis of Crohn’s disease, while TCI alone does not justify altering a diagnosis of ulcerative colitis.
Ni P, Harpaz N, Altahrawi A, et al. Diagnostic and prognostic significance of Crohn’s disease-like pathology in surgically diverted recta of patients with ulcerative colitis. Histopathology. 2025. doi.org/10.1111/his.15429
Correspondence: Dr. Qingqing Liu at qingqing.liu@mountsinai.org