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Difference between revisions of "Dysplasia-associated lesion or mass"
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Dysplasia-associated lesion or mass (view source)
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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.<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]] | ||