Dysplasia-associated mass or lesion (DALM) and sporadic adenomas in patients with chronic idiopathic inflammatory bowel disease

Dysplasia-associated mass or lesion (DALM) can occur in longstanding idiopathic inflammatory bowel disease, particularly in patients with ulcerative colitis who have had episodes of severe pancolitis over many years. Such patients also develop sporadic adenomas at the same rate as the general population. These cases illustrate features that may be used to distinguish these diseases. In DALM, there is an irregular glandular architecture, positive nuclear p53 staining, negative nuclear beta catenin staining and negative Bcl2 staining. In sporadic adenomas, the glandular architecture is regular, p53 nuclear staining is negative, there is usually strong nuclear staining for beta catenin and positive Bcl2 staining. In the past, a diagnosis of DALM was an indication for panproctocolectomy, but local endoscopic resection and surveillance is sufficient if there is no flat dysplasia in the background colon.