Background: Egypt has an unusually high proportion of early-onset colorectal cancer under age 40 years. Adenomatous 
polyps are not common among Egyptians. Aberrant crypts foci (ACF) have been postulated to be the earliest identifiable 
precursor of colon cancer developing prior to adenoma-carcinomas sequence. 
Objectives: The objective of the present study was to determine whether aberrant crypt foci (ACF) could be identified in 
the colon of Egyptian patients with colorectal cancer. 
Material and Methods: colorectal surgical resections from 42 consecutive patients with primary colorectal cancer. 
Examinations were made on the macroscopically normal mucosa surrounding the cancer and on the resection margins (at least 2 cm from the tumor). 
Results: In the mucosa surrounding the tumors, microadenomas were seen in 11 patients (26.13%), adenomatous changes in the basal cells in 11 patients (26.13%) and hyperplastic glands in 7 patients (16.67%). In the mucosa taken from the resection margins (at least 2 cm from the tumor), macroscopic adenomas were found in two patients (4.76%), while microadenomas were seen in another two patients (4.76%). Neither hyperplastic glands nor adenomatous changes in the basal cells could be demonstrated in the colorectal resection margins. 
Conclusions: The present study is the first to demonstrate the presence of pre-neoplastic lesions in the grossly normalappearing colonic mucosa of Egyptian patients with colorectal cancer that resemble those described previously in the colons of western patients. Accordingly, it is suggested that accelerated progression of ACF to carcinoma is the accepted model for development of colorectal cancer in Egypt and may explain the low incidence of adenoma and higher rate of colorectal cancer in young Egyptians.