Dysplasia Associated with Ulcerative Colitis Detected by Surveillance Colonoscopy, Report of a Case Senichiro Agawa 1 , Tetsuichiro Muto 1 , Fumio Konishi 1 , Toshio Sawada 1 , Yoshiro Kubota 1 1The First Department of Surgery, Faculty of Medicine, University of Tokyo 2Department of Surgery, Self Defense Force Central Hospital pp.987-990
Published Date 1986/9/25
DOI https://doi.org/10.11477/mf.1403110217
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 We present a case of a 41 year-old woman, a longs-tanding ulcerative colitis patient, with dysplasia which had detected by surveillance colonoscopy in the residual rectum. This is the first report in Japan, to the best of our knowledge.

 She began with proctitis in 1973. In spite of conservative treatment she suffered from total colitis in 1976. In 1977, she had ileo-proctostomy for severe total colitis. Because of her high risk for cancer, she has been followed up by surveillance colonoscopy since 1981. A slight flat elevation was found in the rectum in 1985, demonstrated clearly by the dyecontrast method, but the biopsies of the lesion showed dysplasia to be unlikely. In 1986, not only a plaquelike lesion but also granular mucosa surrounding that lesion were distinctly demonstrated by U-turned method in the rectum. Biopsies from the plaque-like lesion showed high grade dysplasia. Moreover, biopsies from the flat mucosa adjacent to the plaquelike lesion showed low grade dysplasia. On histological examination of the resected specimen, submucosal invasive carcinomas were found in two areas of the flat mucosa, as has been previously reported in western countries.

 It has been well recognized that colonoscopy with multiple biopsy specimens is a valuable surveillance technique. However, dye-contrast with indigocarmine and U-turned methods are also useful for detecting dysplasia, especially in cases where the lesions are only slightly elevated or granular. However, multiple biopsies are indispensable especially in the cancer high-risk cases. On endoscopic examination of longstanding ulcerative colitis, close attention should be paid in order to detect slight changes in the appearance of the mucosa.

Copyright © 1986, Igaku-Shoin Ltd. All rights reserved.


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