Figure 5

Panel A shows the endoscopic appearance of early FAP and the difficulty in identifying adenomas; Panel B shows the endoscopic appearance after spraying with dilute Indian ink contrast chromoendoscopy; note the easier identification of small polyps (Figures reproduced from reference [85]: P Rozen, F Macrae, Familial adenomatous polyposis: The practical applications of clinical and molecular screening. Familial Cancer, 2006; 5:227-335, with kind permission of Springer Science and Business Media). Panel C shows the occasional adenoma seen in attenuated FAP and the difficulty in making the endoscopic diagnosis of FAP. Panel D demonstrates the usefulness of taking random biopsies in attenuated FAP and finding an intramucosal microadenoma, consistent with the diagnosis of FAP. Note the appearance of dark stained and elongated dysplastic nuclei in a distorted crypt that does not protrude above the surrounding normal surface epithelium (Figures reproduced, with permission of the publishers, from reference [70]: Rozen P, Levin B, Young GP: Who are at risk for familial colorectal cancer and how can they be managed? In Colorectal Cancer in Clinical Practice: Prevention, Early Detection and Management Edited by: Rozen P, Young GP, Levin B, Spann SJ. London, Ed 2, Taylor and Francis 2002:55-66.