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Rectal carcinoid tumors are rare representing approximately 2% of rectal malignancies [1]. While treatment approaches vary and can include endoscopic or surgical resection, small (<1cm) carcinoid tumors have extremely low rates of local recurrence and metastasis [1–3]. Our case is the first describing a delayed recurrence of rectal carcinoid tumor more than 20 years after initial endoscopic resection. A 67-year-old man presented for surveillance colonoscopy with a history of rectal carcinoid tumor. He had undergone endoscopic resection of a 4mm rectal carcinoid tumor 5cm from the anal verge 23 years earlier (●" Fig.1). Three surveillance colonoscopies since resection were negative for residual carcinoid tissue. Recent colonoscopy showed a scar in the rectum with a 5-mm raised area (●" Fig.2), which was resected via snare cautery polypectomy. Pathology was consistent with rectal carcinoid tumor (●" Fig.3 and ●" Fig.4). Immunohistochemical stain for synaptophysin was positive; chromogranin was negative (●" Fig.5). Less than 1% of cells stained positive for Ki-67, indicative of a low proliferative rate and metastatic potential (●" Fig.6) [4]. Flexible sigmoidoscopy 3 months later showed no recurrence. Rectal carcinoids are well-differentiated hindgut neuroendocrine tumors and are the most common location for colorectal carcinoids [1–3, 5]. Hindgut tumors typically display a trabecular growth pattern whereas midgut tumors usually show a nested pattern [5]. As in our case, the majority are found incidentally during endoscopic screening [1–3]. Lesions less Fig.1 Low power histologic image showing polygonal cells forming chords and small nests with intervening stroma consistent with carcinoid with trabecular growth pattern (H&E; original magnification: ×100).

Rectal carcinoid tumor: a delayed localized recurrence 23 years after endoscopic resection