Enteroendocrine cell hyperplasia, carcinoid tumours and adenocarcinoma in long‐standing ulcerative colitis

Abstract

Chronic ulcerative colitis may be accompanied by a variety of epithelial changes, including loss of goblet cells, Paneth cell metaplasia, villous metaplasia, and dysplasia. Total colitis is also accompanied by an increased incidence of adenocarcinoma. All these changes are assumed to be secondary to repeated mucosal damage, but how they develop is unknown. Little attention has been paid to the enteroendocrine cell population, despite the postulated role of these cells as producers of trophic hormones. We describe two patients with long-standing ulcerative colitis who developed both adenocarcinoma and carcinoid tumours. In both, there were increased numbers of enteroendocrine cells in the uninvolved colonic mucosa. We suggest that an increased enteroendocrine cell mass may be part of a non-specific reaction to chronic mucosal injury, and by producing an elevated level of trophic hormones may act as a promoter in the development of neoplasia.

Solitary Microcarcinoid of the Rectal Stump in Ulcerative Colitis

“…To date, 20 cases of colorectal carcinoid arising on ulcerative colitis have been reported [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17](table 1). Further carcinoids of the ileum or the appendix have been found in six patients with ulcerative colitis [19, 20].…”

“…Despite improvements in diagnostic technology, the frequency of case reports has not been increasing throughout the last 25 years: 12 cases from 1979 to 1991 [3,4,5,6,7,8,9,10,11], 6 cases from 1992 to present [12,13,14,15,16]. Hence, though the available literature might underestimate the actual incidence, the association of carcinoid with ulcerative colitis remains an exceptional event; accordingly, we could speculate that the coexistence of the two diseases represents independent events with no cause and effect relationship.…”

“…The coexistence of ulcerative colitis and carcinoid with neuroendocrine cell hyperplasia in several cases has, to several authors [4, 8, 13, 16,] suggested a stepwise sequence similar to that observed for microcarcinoid of the stomach in patients with pernicious anemia [21]. Though the parallel with gastric microcarcinoid might be inappropriate (on the contrary of ulcerative colitis, active mucosal inflammation is scarce in atrophic gastritis), the concept of chronic injury activating the sequence – normal endocrine cell, hyperplasia, microcarcinoid – remains to be disputed.…”

“…While carcinoma of the rectal stump is found in 4–6% of patients with chronic ulcerative colitis (CUC) [1, 2], only two carcinoids have been reported so far [3, 4]. During the last 25 years, an association of CUC with one or more foci of colorectal carcinoid has been described in 20 subjects [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17].…”

Small Cell Carcinoma Rectum With Liver Metastases: A Case Report

“…Neuroendocrine carcinomas are rare but behave aggressively when arising from colon and rectum.Large bowel small cell carcinomas are very rare in presentation and account for 0.2% of all large bowel malignancies 1,2 .Only upto 100 cases have been reported in English literature [3][4][5][6] .The tumor is thought to derive from pluripotent neuroendocrine stem cells 7 . Etiological factors are not known.…”