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Dr Riddell suggests that Cook et al actually did see the five carcinomas that they detected only microscopically. I cannot reply for them, but in their article they stated that they did not recognize these five carcinomas. I agree with Dr Riddell, however, that they may have noted some slightly abnormality that prompted them to take specimens from these areas.
He also mentions that early carcinoma in patients with ulcerative colitis may be sufficiently atypical that the endoscopist is unfamiliar with its appearance. I feel that this is true. In a patient with ulcerative colitis, particularly when there is continuing chronic activity, the entire colon is usually very abnormal. One could take specimens from literally thousands of suspicious areas and still miss an early carcinoma. If a carcinoma is overlooked by the endoscopist, it is certainly possible that the patient may have metastatic disease within a short period
Crowson TD. Endoscopic Recognition of Early Carcinoma in Ulcerative Colitis-Reply. JAMA. 1977;237(26):2811. doi:10.1001/jama.1977.03270530019003
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