Dysplasia-associated lesion or mass
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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:
- Cytologic dysplasia - as in adenomatous polyps - key feature.
- Flat or polypoid.[1]
DDx:
- Sporadic adenomatous polyp -- favouring sporadic:
Image:
See also
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.
- ↑ 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.