Original ArticleImmunohistochemistry in the diagnosis of dysplasia in chronic inflammatory bowel disease colorectal polyps
Introduction
Extensive and long standing inflammatory bowel disease (IBD) is well known to predispose patients to the development of colorectal carcinoma. This cancer is preceded by dysplasia, sometimes with polypoid appearance. On the basis of morphologic criteria, dysplasia is classified into 1 of 5 categories according to the Vienna classification: Negative for dysplasia (ND), indefinite for dysplasia (IFD), low-grade dysplasia (LGD), high-grade dysplasia (HGD) and adenocarcinoma (ACA) [1].
Differentiating between regenerative changes and true dysplasia in the IFD category is often difficult even in absence of active inflammation and even for experienced pathologists [2]. A search for more objective methods to identify early neoplastic changes in the epithelium therefore seems warranted.
Immunohistochemistry would solve this problem by revealing an expression of potential marker of neoplastic cells, alpha-methylacyl coenzyme A racemase (AMACR) [3], the proliferation index (Ki-67) [4] and of the tumour suppressor protein, p53 [3].
The aim of our study was to evaluate the diagnostic value of the expression of AMACR, Ki67 and p53 in the diagnosis of dysplasia in IBD.
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Patients and methods
Our study included all colorectal polyps from patients with IBD selected by a retrospective search through the files of Department of Pathology of Habib Thameur Hospital in Tunis, throughout a period of 11 years between 2001 and 2011.
It included both biopsy and polyps removed from colectomy specimens. Fragmented and / or crushed polyps, and those which are difficult to analyse histologically were excluded. Clinicopathological parameters including the age and gender of the patients, the type of
Results
Forty polyps were removed in 21 patients with IBD of mean age of 47.5 ± 14.9 years (range: 23–75 years). The male:female ratio was 1.62. Amongst the polyps, 34 were from 16 patients with ulcerative colitis and 6 were obtained from 5 patients with Crohn’s disease. The duration of disease progression varied from several days to 31 years. It was less than 10 years in 55% of cases and between 10 and 25 years in 32% of cases. The median size of colorectal polyps was 7 mm (range 3–20 mm). It was less than 10
Discussion
In our study, we have investigated whether AMACR, Ki67 and p53 immunostaining might help in the diagnosis of dysplasia in IBD developed polyps.
We have obtained substantial expression changes in the majority of dysplastic polyps. These findings raise the possibility that some of these changes may also be useful in a diagnostic setting. Most dysplastic and cancerous polyps showed high AMACR expression (p = 0.007). Extension of p53 and Ki67 staining into the upper third of the crypts was found in
Conflict of interest
The authors declared that there was no conflict of interest.
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