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Updated: Jul 14, 2026

Deficient Pms2, ERCC1, Ku86, CcOI in Field Defects During Progression to Colon Cancer
Published on: July 28, 2010
Evidence against flat dysplasia as a regional field defect in small bowel adenocarcinoma associated with celiac sprue
C J Bruno1, K P Batts, D A Ahlquist
1Division of Gastroenterology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Objective:
To determine whether diffuse flat dysplasia, akin to that seen with chronic ulcerative colitis, occurs as a mucosal field defect accompanying small bowel adenocarcinoma in patients with celiac sprue.
Design:
A pathologic investigation of archival tissue was undertaken.
Material And Methods:
From the tissue archives at Mayo Clinic Rochester for the period from January 1978 to January 1993, resected sprue-associated adenocarcinomas with adequate adjacent mucosa for study were identified. On the basis of multiple strip biopsy specimens obtained at the tumor margins and within 4 cm distal and proximal to the tumor, histologic maps were created.
Results:
Among 94 patients with primary adenocarcinoma of the small bowel, 8 had a concurrent diagnosis of celiac sprue. Of these eight cases, six surgically resected specimens (five duodenal and one jejunal adenocarcinoma) were adequate for study. A thin rim of benign dysplasia was demonstrated at the tumor margin in three of the six specimens; however, contiguous fields of flat dysplasia were not present in any of these cases.
Conclusion:
These data support focal dysplasia (for example, adenoma) rather than sheets of flat dysplasia as the premalignant lesion in sprue-associated small bowel adenocarcinoma. Blind endoscopic biopsies of small bowel mucosa are not justified for neoplasia surveillance in patients with celiac sprue.
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