Sporadic adenomas in chronic ulcerative colitis

Presence of polyps with intraepithelial neoplasia in patients with ulcerative colitis (UC) is associated with a very high risk of associated invasive carcinoma. Histologically, these lesions may not easily be differentiated from sporadic adenomas, which may occur in patients with UC. The treatment option for patients with polyps with intraepithelial neoplasia includes, at least in some centres, total colectomy which contrasts to polypectomy for patients with sporadic adenomas. Until recently, adenomatous polyps were not diagnosed in patients with UC because of the inability to differentiate adequately between UC-associated dysplastic polyps and adenomas. Multiple attempts have been made over the years to differentiate between UC-associated polyps with intraepithelial neoplasia and sporadic adenomas in patients with UC to ensure adequate treatment and follow-up for the correct diagnosis. These studies include morphologic, immunohistochemical and genetic analysis of lesions considered to be representative for each entity.