A 45-year-old man with ulcerative colitis for 18 years undergoes surveillance colonoscopy. A raised, non-polypoid lesion with irregular surface is found in the transverse colon, and biopsy shows high-grade dysplasia within a dysplasia-associated lesion or mass (DALM). What is the recommended treatment?
- A Endoscopic resection with close surveillance
- B Total proctocolectomy with ileal pouch-anal anastomosis ✓
- C Colectomy with ileorectal anastomosis
- D Segmental colectomy of the transverse colon
Correct answer: B. Total proctocolectomy with ileal pouch-anal anastomosis
Explanation
DALM with high-grade dysplasia in longstanding ulcerative colitis carries a high risk of synchronous or metachronous carcinoma. Total proctocolectomy with IPAA is the standard recommendation because the entire colonic mucosa is at risk and the lesion may harbour invasive cancer. Endoscopic resection is appropriate only for sporadic-type adenoma-like masses that can be completely excised. Segmental colectomy is insufficient given the field defect in colitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.