Large Dysplastic Lesion: Resection or Total Colectomy?
Large Dysplastic Lesion: Resection or Total Colectomy?
A 50-year-old patient with left-sided ulcerative colitis underwent colonoscopy to assess a bout of disease exacerbation; a 2-cm mass was found in the rectum. Biopsies showed adenomatous change. The surrounding mucosa and the left and right colon were extensively biopsied, and no dysplasia was found. The patient is in remission on steroids. Is endoscopic resection sufficient therapy? Should this patient be referred for total colectomy?
Endoscopic resection in this patient is not likely to be sufficient. The patient should be referred for colectomy. Distinguishing between a sporadic adenoma and a dysplasia-associated lesion or mass (DALM) is difficult, and sometimes impossible. However, this patient is relatively young and has a large dysplastic lesion in an area affected by colitis. This is most likely a DALM, and his risk of developing cancer in the near future is sufficiently high to warrant a colectomy recommendation.
A 50-year-old patient with left-sided ulcerative colitis underwent colonoscopy to assess a bout of disease exacerbation; a 2-cm mass was found in the rectum. Biopsies showed adenomatous change. The surrounding mucosa and the left and right colon were extensively biopsied, and no dysplasia was found. The patient is in remission on steroids. Is endoscopic resection sufficient therapy? Should this patient be referred for total colectomy?
Endoscopic resection in this patient is not likely to be sufficient. The patient should be referred for colectomy. Distinguishing between a sporadic adenoma and a dysplasia-associated lesion or mass (DALM) is difficult, and sometimes impossible. However, this patient is relatively young and has a large dysplastic lesion in an area affected by colitis. This is most likely a DALM, and his risk of developing cancer in the near future is sufficiently high to warrant a colectomy recommendation.
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