Dysplasia of the Gastrointestinal Tract: Pitfalls and Solutions

This presentation will cover dysplasia arising in chronic inflammatory disorders of the gastrointestinal tract, including Barrett’s esophagus, idiopathic inflammatory bowel disease IIIBD), pangastric intestinalized Helicobacter pylori gastritis. Covered topics will include the intestinal and gastric types of Barrett’s dysplasia, dysplasia grading, pitfalls for over diagnosing and over grading dysplasia, broadening therapies for Barrett’s neoplasia and the impact of this on pathology practice, the split muscularis mucosae in Barrett’s, the problems with dysplasia diagnosis, in differences between Barrett’s and IBD neoplasia, visible lesions in IIBD dysplasia, natural history data on dysplasia, improved biomarkers of cancer risk, adequate surveillance biopsies, and treatment options. If time permits, the diagnosis and management of colorectal adenocarcinoma in polypectomy specimens will be reviewed.

Lecture Presenter
Mary Bronner, MD
Mary Bronner, MD
Division Chief of Anatomic and Molecular Oncologic Pathology, University of Utah School of Medicine
Carl R. Kjeldsberg Presidential Endowed Chair & Professor of Pathology, University of Utah Health Sciences Center
Medical Director, AP Oncology R&D, ARUP Laboratories

Dr. Bronner is a Carl R. Kjeldsberg presidential endowed professor of pathology at the University of Utah School of Medicine. Dr. Bronner received her MD from the University of Pennsylvania and completed her pathology residency training and chief residency at the Hospital of the University of Pennsylvania in Philadelphia. Dr. Bronner’s honors include her election as president of the GI Pathology Society, election as council member of the United States and Canadian Academy of Pathology, and, in 2005, the award of the Arthur Purdy Stout Prize, recognizing her work as a surgical pathologist under the age of 45 whose research publications have had a major impact on diagnostic pathology. Dr. Bronner is an editorial journal board member for Human Pathology and Modern Pathology. She has served as an investigator on numerous NIH and foundation grants over the course of her career and has published more than 100 peer-reviewed articles and numerous book chapters.

Objectives

After this presentation, participants will be able to:

Describe the criteria for dysplasia arising in Barrett’s esophagus, idiopathic inflammatory bowel disease, and intestinalized Helicobacter pylori gastritis, including the similarities and differences between dysplasia in these disorders.
Recognize the numerous mimics of dysplasia in the gastrointestinal tract and learn how to avoid over diagnosing dysplasia through their recognition.
Discuss how our diagnoses of dysplasia impact patient management.
Assess what constitutes adequate surveillance biopsy protocols to detect dysplasia with high confidence if present, and why this emphasizes the importance of finding better biomarkers of neoplasia of the gastrointestinal tract than the current extensive biopsy sampling remaining the gold standard.