Dysplasia-associated lesion or mass

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

DALM is considered an obsolete term.[1]


  • Proving invasive malignancy (on histopathologic grounds alone) in the setting of chronic inflammation is difficult.[2]
  • The diagnosis depended on correlation of endoscopy and histopathology - important.[3]
    • Biopsies are usually taken of the lesion and around the base.
  • This diagnosis (DALM) typically lead to colectomy.
    • The same histology today (2014) may be managed endoscopically.[4]


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




  • Sporadic adenomatous polyp -- favouring sporadic:
    • Sharp transition between lesion and the surrounding tissue.[3]
    • Polyps not at site of active disease.[5]


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  • DALM is considered obsolete; it should not be used.
  • DALM was replaced by visible dysplasia; the endoscopist saw a lesion.

Visible dysplasia is subdivided into:

  1. Polypoid.
  2. Non-polypoid.

See also


  1. Chiu K, Riddell RH, Schaeffer DF (August 2018). "DALM, rest in peace: a pathologist's perspective on dysplasia in inflammatory bowel disease in the post-DALM era". Mod Pathol 31 (8): 1180–1190. doi:10.1038/s41379-018-0068-9. PMID 29789648.
  2. 2.0 2.1 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.
  3. 3.0 3.1 3.2 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.
  4. 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.
  5. 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.