Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy

Sep 21, 2026

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Study evaluates how often ulcerative colitis-associated neoplasms (UCANs) contain poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma components (por/sig/muc) and how this relates to invasiveness and clinical detection. A retrospective cohort of UC patients diagnosed with high-grade dysplasia or adenocarcinoma from 1997–2022 compared cases with versus without por/sig/muc. Survival was worse with the component, and biopsy detected it in only 40%.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Background/Aims

Methods

Patient selection

Results

Conclusions

| ORIGINAL ARTICLE | | | --- | --- | | pISSN 1598-9100 • eISSN 2288-1956 [https://doi.org/10.5217/ir.2024.00006](https://doi.org/10.5217/ir.2024.00006)[ ](https://doi.org/10.5217/ir.2024.00006)[Intest Res 2024](Intest Res 2024) ;[22](22)([4](4)) [:428-438](:428-438) | | | Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy
Ryoya Sakakibara1, Shinya Sugimoto1, Kaoru Takabayashi2, Hiroki Kiyohara1, Yusuke Wakisaka1, Yuta Kaieda1, Miho Kawaida3, Yusuke Yoshimatsu1, Tomohisa Sujino2, Naoki Hosoe4, Motohiko Kato2, Masayuki Shimoda3, Yohei Mikami1, Yasushi Iwao4, Takanori Kanai1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo; 2Centerfor Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo; 3Department of Pathology, Keio University School of Medicine, Tokyo; 4Centerfor Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
Background/Aims: Poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma (por/ sig/muc), which are considered to be histologic subtypes with a poor prognosis, occur more frequently with colitis-associated cancer than with sporadic tumors. However, their invasiveness and manifestations are unclear. This study aimed to determine the prevalence of the por/sig/muc component in ulcerative colitis-associated neoplasms (UCANs) and its association with invasiveness and to clarify its clinicohistologic and endoscopic features. Methods: This retrospective observational study included patients diagnosed with ulcerative colitis-associated high-grade dysplasia or adenocarcinoma from 1997 to 2022 who were divided according to the presence or absence of a por/sig/muc component. Results: Thirty-five patients had UCAN with a por/ sig/muc component and 66 had UCAN without this component. The 5-year survival rate was significantly lower in the por/sig/ muc group than in the tub group (67% vs. 96%, P = 0.001), which was attributed to disease above stage III and depth to below the subserosa. Biopsy-based diagnosis before resection detected a por/sig/muc component in only 40% of lesions (14/35). Lesions with a por/sig/muc component were prevalent even in the early stages: stage 0 (4/36, 11%), I (8/20, 40%), II (7/12, 58%), III (10/14, 71%), and IV (6/8, 75%). Conclusions: This is the first investigation that shows UCANs with a por/sig/muc component tended to be deeply invasive and were often not recognized preoperatively. Endoscopists should be aware that UCAN often has a por/sig/muc component that is not always recognized on biopsy, and the optimal treatment strategy needs to be carefully considered. (Intest Res 2024;22:428-438)
KeyWords: Colitis-associated neoplasms; Dysplasia; Colorectal neoplasms | | INTRODUCTION Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory disease of the colorectum. Currently, there is no radical medication for UC, and the therapeutic goal is to main- Received January 5, 2024. Revised February 27, 2024. Accepted March 5, 2024. Correspondence to Shinya Sugimoto, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Tel: +81- 3-3353-1211, Fax: +81-3-3353-6247, [E-mail:](E-mail: sugimoto-kei@umin.ac.jp)[ sugimoto-kei@umin.ac.jp](E-mail: sugimoto-kei@umin.ac.jp) tain endoscopic remission.1 Long-term inflammation is associated with an increased incidence of neoplasia,2 and there is growing interest in colitis-associated cancer (CAC), which has a significant prognostic impact,3 considering that advances in immunosuppressive therapies have reduced the overall likelihood of colectomy in patients with UC.4 The characteristics of CAC are different from those of usual sporadic tumors because UC-associated neoplasms (UCANs) occur primarily via

FAQs

What was the study’s main objective regarding UCAN and por/sig/muc?

To determine how prevalent the por/sig/muc component is in UCANs and to assess its association with invasiveness and clinicohistologic/endoscopic characteristics, including biopsy detectability before resection.

How did survival differ between UCAN patients with and without the por/sig/muc component?

The 5-year survival rate was significantly lower in the por/sig/muc group than in the tub group (67% vs. 96%, P = 0.001), linked to disease above stage III and depth to below the subserosa.

How reliably did biopsy detect the por/sig/muc component before resection?

Biopsy-based diagnosis detected the por/sig/muc component in only 40% of lesions (14/35), indicating frequent under-recognition preoperatively.

Sep 21, 2026

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