Terminology Is Unclear

The Origins of Colorectal Carcinoma: Specific Nomenclature for Different Pathways and Precursor Lesions by Prof. Dr. med. Andrea Tannapfel, Dr. med. Matthias Neid, PD Dr. med. Daniela Aust, Prof. Dr. med. Gustavo Baretton in volume 43/10

From the perspective of general pathology and its terminology, several terminological unclarities remain. The term dysplasia is not completely replaced by intraepithelial neoplasia (IEN), because there are two dimensions to it. On the one hand it describes attributes of cells and tissues that are not limited to neoplasias; on the other hand it is used to describe entities such as pre-neoplasias, among others. And only in this respect it is less misleading than dysplasia. An IEN always refers to an entity, never an attribute. Using the term IEN indicates certainty that the finding is a neoplasia. If this certainty does not exist, the problem with nomenclature arises. Those hyperplastic polyps that degenerate are undoubtedly pre-neoplasias but not (yet) recognizeable as such. One therefore should not do without terms such as atypical cells or cellular or tissue dysplasia when describing a morphological entity whose prospective potential is not known at the time when the lesion is diagnosed. The umbrella term for the colorectal lesions under discussion is intraepithelial proliferative lesion. From a certain (now well defined) stage of abnormality of tissues or cells (atypia, dysplasia), the assumption should be of an intraepithelial neoplasia, for example, and adenoma, which—the more it deviates from the norm (adenoma with light and moderate dysplasia corresponds to LGIEN, adenoma with severe dysplasia and intramucosal carcinoma corresponds to HGIEN) the higher the probability that it will degenerate into an invasive neoplasia, meaning that the monitoring and treatment options are different.

DOI: 10.3238/arztebl.2010.0116a

Prof. Dr. med. habil. Gunter Haroske

Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum

Friedrichstr. 41, 01067 Dresden, Germany

Conflict of interest statement

The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References

1. Tannapfel A, Neid M, Aust D, Baretton G: The origins of colorectal carcinoma: specific nomenclature for different pathways and precursor lesions. Dtsch Arztebl Int 2010; 107(43): 760–6.