Dysplastic Lesions in Inflammatory Bowel Disease Molecular Pathogenesis to Morphology
Dysplastic Lesions in Inflammatory Bowel Disease Molecular Pathogenesis to Morphology
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DOI：
10.5858/arpa.2012-0086-ra
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发表时间：
2013-03-01
影响因子：
4.6
通讯作者：
Yang, Guang-Yu
中科院分区：
文献类型：
--
作者：
Matkowskyj, Kristina A.;Chen, Zongming E.;Yang, Guang-Yu
背景。-炎症性肠病（IBD）是一种长期存在的肠道慢性活动性炎症过程，具有发生结直肠癌的风险增加。参与慢性活动性炎症过程的几种分子事件有助于人类癌症发展的多阶段进展，包括活性氧和氮物质、异常花生四烯酸代谢物和细胞因子/生长因子以及免疫功能障碍。IBD中的这些分子事件导致遗传异常并促进异常细胞增殖，这进一步导致上皮变化，包括从炎症诱导的增生到发育不良的广谱。回顾（1）IBD中结直肠癌风险的流行病学和分子发病机制，（2）异型增生病变的形态学特征，生物标志物和分类，以及（3）IBD中出现的异型增生病变的临床管理。不同的IBD相关的异型增生病变的说明，通过使用形态学结合分子途径，并讨论了“现场癌变”的理论及其潜在的意义与文献回顾。IBD患者患结直肠癌的风险增加。发生癌症的风险与患者疾病的程度/持续时间/活动有关。关于IBD相关的癌症风险程度尚未达成共识;然而，所有人都同意IBD患者代表了发生癌症的显著风险组，因此需要进行充分的监测和预防。通过更好的筛查方式和异型增生病变、IBD相关锯齿状病变和“实地癌变”的检测/表征，我们将提高对风险分层的理解和方法。
Context.-Inflammatory bowel disease (IBD) is a long-standing chronic active inflammatory process in the bowel with increased risk for the development of colorectal carcinoma. Several molecular events involved in chronic active inflammatory processes contribute to multistage progression of human cancer development, including reactive oxygen and nitrogen species, aberrant arachidonic acid metabolites and cytokines/growth factors, and immune dysfunction. These molecular events in IBD lead to genetic abnormality and promote aberrant cell proliferation, which further lead to epithelial changes encompassing a broad spectrum from inflammation-induced hyperplasia to dysplasia.Objective.-To review the (1) epidemiologic and molecular pathogenesis of the risk for colorectal cancer in IBD, (2) morphologic characterization, biomarker(s), and classification of dysplastic lesions, and (3) clinical management of dysplastic lesions arising in IBD.Data Sources.-The different IBD-related dysplastic lesions are illustrated by using morphology in conjunction with molecular pathways, and the "field cancerization'' theory and its potential significance are discussed with a review of the literature.Conclusions.-Patients with IBD are at increased risk of developing colorectal cancer. The risk of developing carcinoma is related to the extent/duration/activity of the patient's disease. There is no consensus regarding the extent of carcinoma risk associated with IBD; however, all would agree that patients with IBD represent a group at significant risk for developing carcinoma and as such, warrant adequate surveillance and prevention. With better screening modalities and detection/characterization of dysplastic lesions, IBD-associated serrated lesions, and "field cancerization,'' we will improve our understanding of and approach to risk stratification.