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Polypectomy is Adequate Treatment for Adenoma-like Dysplastic Lesions (DALMs) in Crohn's Disease

Quinn, Andrew M. MD*; Farraye, Francis A. MD, MSc; Naini, Bita V. MD; Cerda, Sandra MD§; Coukos, Jennifer BS; Li, Yuan; Khor, Tze; Odze, Robert D. MD*

doi: 10.1097/MIB.0b013e318280e749
Original Clinical Article

Background: The purpose of this study was to reevaluate the clinical and pathologic features and outcomes in patients with Crohn's disease with an adenoma-like dysplasia-associated lesion or mass (DALMs) to determine if polypectomy is adequate treatment.

Methods: The clinical, endoscopic and pathologic features, and outcomes of 50 patients with Crohn's disease, each with ≥1 adenoma-like DALM were evaluated. The median length of follow-up was 39 months (range: 0.5–156 months).

Results: Of the 50 patients with Crohn's disease (male to female ratio, 30:20; median age: 53 years; median duration of disease: 83 months), 11 had ileal disease, 26 had colonic disease, and 13 had both ileal and colonic disease. Approximately 43% of polyps occurred within areas of previous or concurrent colitis, whereas 57% occurred in areas not previously involved by colitis. Most polyps had tubular architecture and contained low-grade dysplasia. Of the patients who had polypectomy followed by surveillance, 45% developed new adenoma-like DALMs, but none developed flat dysplasia and only 1 had adenocarcinoma at the time of resection, which was within 3 months of polypectomy. There were no differences in the clinical or pathologic features or outcomes in patients who had adenoma-like DALMs within versus outside areas of previous or concurrent colitis, except that the former showed a higher risk of developing new polyps within areas of colitis and near the site of the original polyp compared with the latter.

Conclusions: Patients with Crohn's disease who develop an adenoma-like DALM, regardless of its location in relationship to previous or concurrent colitis, may be treated safely with polypectomy and continued surveillance.

Article first published online 4 April 2013

*Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts;

Gastroenterology, Boston Medical Center, Boston, Massachusetts;

Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California;

§Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts;

Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.

Reprints: Robert D. Odze, MD, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (e-mail:

Presented at the American Gastroenterological Association annual meeting in Chicago, May 2011.

The authors have no conflicts of interest to disclose.

All of the authors participated in designing the study, analyzing the data, and writing the manuscript.

Received August 14, 2012

Accepted August 27, 2012

© Crohn's & Colitis Foundation of America, Inc.
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