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June 27, 1977

Endoscopic Recognition of Early Carcinoma in Ulcerative Colitis

JAMA. 1977;237(26):2811. doi:10.1001/jama.1977.03270530019002

To the Editor.—  In their article on the inefficacy of colonoscopy for early carcinoma detection in patients with ulcerative colitis (236:2651,1976), Crowson et al emphasize the difficulty that even the experienced endoscopist can encounter in detecting early carcinoma in ulcerative colitis. They also quote the inability of Cook et al1 to detect macroscopically five of the 26 carcinomas that they examined in patients with colitis, although these were detected microscopically. However, there is an inconsistency here. Could all of these carcinomas detected by microscopic means only be accidents of random sectioning by the pathologist? As pathologists are trained to take sections of virtually any abnormality, these "accidents" are almost certainly macroscopic abnormalities which, perhaps unwittingly, have been sampled.The problem, therefore, might be that the early carcinoma in ulcerative colitis may be sufficiently atypical that the endoscopist (or pathologist) is unfamiliar with its appearance. For while they may have