I read with interest the report by Matsumoto and colleagues¹ of a patient with ulcerative colitis and multiple microcarcinoid tumours, and would like to describe a similar recent case encountered in our department. A 44 year old man with an 18 year history of ulcerative colitis underwent total colectomy after a diagnosis of high grade dysplasia in a rectal biopsy. The resection specimen revealed a mucinous adenocarcinoma of the rectum invading the submucosa, but not involving the muscularis propria, perirectal fat, or lymph nodes. There was also active ulcerative colitis of mild to moderate severity involving the distal 200 mm of the colon and rectum. The inflamed segment was extensively sampled and all sections showed multifocal endocrine cell proliferation within the muscularis mucosae and the superficial submucosa (fig 1). Most foci comprised clusters of between five and 50 cells, which were typically arranged in small nests and cords, but there were four larger endocrine cell aggregates from 1 to 2.5 mm maximum diameter. Some of the submucosal nests were closely apposed to nerves and ganglion cells. Immunohistochemistry on representative sections showed expression of cytokeratin, …