Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 7, 2009; 15(33): 4193-4195
Published online Sep 7, 2009. doi: 10.3748/wjg.15.4193
Neuroendocrine carcinomas arising in ulcerative colitis: Coincidences or possible correlations?
Roberto Grassia, Paolo Bodini, Paolo Dizioli, Teresa Staiano, Elena Iiritano, Guglielmo Bianchi, Federico Buffoli
Roberto Grassia, Paolo Bodini, Paolo Dizioli, Teresa Staiano, Elena Iiritano, Guglielmo Bianchi, Federico Buffoli, Digestive Endoscopy and Gastroenterology Unit, A.O. “Istituti Ospitalieri di Cremona”, Viale Concordia 1, 26100 Cremona, Italy
Author contributions: Grassia R, Bodini P, Dizioli P, Staiano T, Iiritano E, Bianchi G, Buffoli F contributed equally to this work; Grassia R and Dizioli P performed the research; Grassia R wrote the paper.
Correspondence to: Roberto Grassia, MD, Digestive Endoscopy and Gastroenterology Unit, A.O. “Istituti Ospitalieri di Cremona”, Viale Concordia 1, 26100 Cremona, Italy. robertograssia@yahoo.it
Telephone: +39-372-405255-244 Fax: +39-372-405654
Received: June 7, 2009
Revised: August 6, 2009
Accepted: August 13, 2009
Published online: September 7, 2009
Abstract

Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal malignancies. Adenocarcinoma is the commonest type of colorectal neoplasm associated with ulcerative colitis (UC) and Crohn’s disease, but other types of epithelial and non-epithelial tumors have also been described in inflamed bowel. With regards to non-epithelial malignancies, lymphomas and sarcomas represent the largest group of tumors reported in association with IBD, especially in immunosuppressed patients. Carcinoids and in particular neuroendocrine neoplasms other than carcinoids (NENs) are rare tumors and are infrequently described in the setting of IBD. Thus, this association requires further investigation. We report two cases of neoplasms arising in mild left-sided UC with immunohistochemical staining for neuroendocrine markers: a large cell and a small cell neuroendocrine carcinoma of the rectum. The two patients were different in age (35 years vs 77 years) and disease duration (11 years vs 27 years), and both had never received immunosuppressant drugs. Although the patients underwent regular endoscopic and histological follow-up, the two neoplasms were locally advanced at diagnosis. One of the two patients developed multiple liver metastases and died 15 mo after diagnosis. These findings confirm the aggressiveness and the poor prognosis of NENs compared to colorectal adenocarcinoma. While carcinoids seem to be coincidentally associated with IBD, NENs may also arise in this setting. In fact, long-standing inflammation could be directly responsible for the development of pancellular dysplasia involving epithelial, goblet, Paneth and neuroendocrine cells. It has yet to be established which IBD patients have a higher risk of developing NENs.

Keywords: Colorectal cancer; Large cell carcinoma; Neuroendocrine carcinoma; Small cell carcinoma