Synchronous colitic cancers and microcarcinoids in a patient with long-standing and extensive ulcerative colitis: a case report and review of the literature.

We report a case of colitic cancer detected by target biopsies at surveillance colonoscopy in a patient with long-standing and extensive ulcerative colitis. At first, the detected colitic cancer was removed by endoscopic mucosal resection as the patient refused surgical resection. However, total proctocolectomy with an ileal-J-pouch anal anastomosis was performed additionally after informed consent had been obtained from the patient, as the resected specimen included invasive cancer histologically. Surprisingly, histologic examination of the surgical specimens revealed another flat invasive colitic cancer and 2 microcarcinoids, which were not detectable by preoperative colonoscopy or by macroscopic investigation of the surgically resected specimen. The occurrence of carcinoid in patients with ulcerative colitis has been reported only sporadically. In addition, coexistence of colitic cancer and carcinoids is extremely rare. Cases of this rare combination reported previously in the English literature are summarized and discussed.