Evidence against flat dysplasia as a regional field defect in small bowel adenocarcinoma associated with celiac sprue

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. fur study, A thin sim 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 fiat 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.