Colorectal Microcarcinoids in Association with Long-Term Exposure to Urinary Content: A Case Report and Review of the Literature

Abstract

Long-term exposure of colonic mucosa to urinary content and its association with increased risk of infection, mechanical and biochemical irritation, and malignancy have been described in the literature. Existing case reports and studies depict the low but distinct risk of malignancy in gastrointestinal segments which come in contact with urinary content as a result of surgical correction of urinary tract abnormalities. However, these reports are largely limited to colonic adenocarcinoma and urothelial cell carcinoma. Late urointestinal carcinoma in patients with ileal incorporation into the urinary tract has also been reported. To the best of our knowledge, however, there is only one case report documenting neuroendocrine (NE) cell hyperplasia in colonic mucosa after long-term cystoplasty. Our case is the first to describe microcarcinoids and diffuse NE hyperplasia occurring in a patient with congenital anorectal anomalies, resulting in long-term exposure of colonic mucosa to fecal stream and urinary content. This case, in conjunction with the reported cases in the literature, raises the distinct possibility of an association between exposure of colonic mucosa to urine and long-term development of malignancy, including NE neoplasms.

A Novel Case of Carcinoid Tumor in a Pediatric Patient With Short Bowel Syndrome Secondary to Gastroschisis

“…There is no data on serum analysis of chromogranin A in patients with anastomotic inflammation or those experiencing bowel adaptation. There has been a single report of an infant with gastroschisis with congenital neuroblastoma, but ours is the first report of a patient with gastroschisis or SBS to have a carcinoid tumor ( 7 ).…”

“…Neuroendocrine cells in the GI tract proliferate with mucosal injury. NCH, a precursor to NETs, has been reported in celiac disease, autoimmune chronic atrophic gastritis ( 2 , 3 ) DC ( 3 , 4 ), inflammatory bowel disease ( 4 – 6 ), and chronic GI tract urinary exposure ( 7 ), all conditions with chronic GI tract inflammation. Our patient is the youngest case to have a NET with a background of NCH.…”

“…Neuroendocrine cell hyperplasia (NCH), a precursor to neuroendocrine tumors (NETs), has been reported with chronic mucosal inflammation (2). Microcarcinoids, or small NETs, have been reported in a few adults with diversion colitis (DC) (3,4), inflammatory bowel disease (4)(5)(6), and prolonged exposure to urine in the colon (7).…”

Composite intestinal adenoma-microcarcinoid: An update and literature review

“…MC has been observed in patients with chronic colitis, such as diversion colitis[ 16 ] and inflammatory bowel disease (IBD), especially in ulcerative colitis[ 17 - 21 ]. Likewise, Weyant et al [ 22 ] described a case of colonic MC and diffuse neuroendocrine cell hyperplasia following long-term cystoplasty[ 22 ]. These associations suggest that MC may represent an exaggerated proliferative response of gut mucosa to chronic inflammation.…”