Difference between revisions of "Dysplasia-associated lesion or mass"

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#redirect [[Inflammatory_bowel_disease#Dysplasia-associated_lesion_or_mass]]
'''Dysplasia-associated lesion or mass''', abbreviated ''DALM'', is a clinico-pathologic diagnosis seen in the context of [[inflammatory bowel disease]].


==General==
*Proving invasive malignancy (on histopathologic grounds alone) in the setting of chronic inflammation is difficult.<ref name=pmid7450425>{{Cite journal  | last1 = Blackstone | first1 = MO. | last2 = Riddell | first2 = RH. | last3 = Rogers | first3 = BH. | last4 = Levin | first4 = B. | title = Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy. | journal = Gastroenterology | volume = 80 | issue = 2 | pages = 366-74 | month = Feb | year = 1981 | doi =  | PMID = 7450425 }}</ref>
*This diagnosis depends on correlation of endoscopy and histopathology - '''important'''.<ref name=pmid21912466>{{Cite journal  | last1 = Neumann | first1 = H. | last2 = Vieth | first2 = M. | last3 = Langner | first3 = C. | last4 = Neurath | first4 = MF. | last5 = Mudter | first5 = J. | title = Cancer risk in IBD: how to diagnose and how to manage DALM and ALM. | journal = World J Gastroenterol | volume = 17 | issue = 27 | pages = 3184-91 | month = Jul | year = 2011 | doi = 10.3748/wjg.v17.i27.3184 | PMID = 21912466 }}</ref>
**Biopsies are usually taken of the lesion and around the base.
*Historically, this diagnosis lead to [[colectomy]].
**It may be managed endoscopically in the context of modern endoscopy.<ref>{{Cite journal  | last1 = East | first1 = JE. | last2 = Toyonaga | first2 = T. | last3 = Suzuki | first3 = N. | title = Endoscopic management of nonpolypoid colorectal lesions in colonic IBD. | journal = Gastrointest Endosc Clin N Am | volume = 24 | issue = 3 | pages = 435-45 | month = Jul | year = 2014 | doi = 10.1016/j.giec.2014.03.003 | PMID = 24975534 }}
</ref>
==Gross==
*Endoscopically "suspicious", i.e. endoscopist thinks this is a DALM - '''essential feature'''.
**Usually have a positive lifting sign.
==Microscopic==
Features:
*Cytologic dysplasia - as in [[adenomatous polyps]] - '''key feature'''.
*Flat or polypoid.<ref name=pmid7450425/>
DDx:
*Sporadic [[adenomatous polyp]] -- favouring sporadic:
**Sharp transition between lesion and the surrounding tissue.<ref name=pmid21912466/>
**Polyps not at site of active disease.<ref name=pmid10746669>{{Cite journal  | last1 = Fogt | first1 = F. | last2 = Urbanski | first2 = SJ. | last3 = Sanders | first3 = ME. | last4 = Furth | first4 = EE. | last5 = Zimmerman | first5 = RL. | last6 = Deren | first6 = JJ. | last7 = Noffsinger | first7 = AE. | last8 = Vortmeyer | first8 = AO. | last9 = Hartmann | first9 = CJ. | title = Distinction between dysplasia-associated lesion or mass (DALM) and adenoma in patients with ulcerative colitis. | journal = Hum Pathol | volume = 31 | issue = 3 | pages = 288-91 | month = Mar | year = 2000 | doi =  | PMID = 10746669 }}</ref>
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158393/figure/F7/ DALM (nlm.nih.gov)].<ref name=pmid21912466/>
==See also==
*[[Inflammatory bowel disease]].
==References==
{{Reflist|1}}
[[Category:Gastrointestinal pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 19:21, 4 September 2014

Dysplasia-associated lesion or mass, abbreviated DALM, is a clinico-pathologic diagnosis seen in the context of inflammatory bowel disease.

General

  • Proving invasive malignancy (on histopathologic grounds alone) in the setting of chronic inflammation is difficult.[1]
  • This diagnosis depends on correlation of endoscopy and histopathology - important.[2]
    • Biopsies are usually taken of the lesion and around the base.
  • Historically, this diagnosis lead to colectomy.
    • It may be managed endoscopically in the context of modern endoscopy.[3]

Gross

  • Endoscopically "suspicious", i.e. endoscopist thinks this is a DALM - essential feature.
    • Usually have a positive lifting sign.

Microscopic

Features:

DDx:

  • Sporadic adenomatous polyp -- favouring sporadic:
    • Sharp transition between lesion and the surrounding tissue.[2]
    • Polyps not at site of active disease.[4]

Image:

See also

References

  1. ↑ 1.0 1.1 Blackstone, MO.; Riddell, RH.; Rogers, BH.; Levin, B. (Feb 1981). "Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy.". Gastroenterology 80 (2): 366-74. PMID 7450425.
  2. ↑ 2.0 2.1 2.2 Neumann, H.; Vieth, M.; Langner, C.; Neurath, MF.; Mudter, J. (Jul 2011). "Cancer risk in IBD: how to diagnose and how to manage DALM and ALM.". World J Gastroenterol 17 (27): 3184-91. doi:10.3748/wjg.v17.i27.3184. PMID 21912466.
  3. ↑ East, JE.; Toyonaga, T.; Suzuki, N. (Jul 2014). "Endoscopic management of nonpolypoid colorectal lesions in colonic IBD.". Gastrointest Endosc Clin N Am 24 (3): 435-45. doi:10.1016/j.giec.2014.03.003. PMID 24975534.
  4. ↑ Fogt, F.; Urbanski, SJ.; Sanders, ME.; Furth, EE.; Zimmerman, RL.; Deren, JJ.; Noffsinger, AE.; Vortmeyer, AO. et al. (Mar 2000). "Distinction between dysplasia-associated lesion or mass (DALM) and adenoma in patients with ulcerative colitis.". Hum Pathol 31 (3): 288-91. PMID 10746669.
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