Silent ulcerative colitis adjacent to a regular sigmoid adenocarcinoma

There have been studies trying to elucidate the large spectrum and the variety of inflammatory bowel disease (IBD)-related colorectal cancer manifestations and natural history. A 57-year-old male patient underwent a regular screening colonoscopy in our department, which revealed a flat ulcerated mass in the sigmoid whereas the remaining bowel was normal on endoscopic appearance. Biopsies from the mass were compatible with sigmoid adenocarcinoma and the patient underwent left hemicolectomy. Pathology examination of the resected specimen also diagnosed ulcerative colitis adjacent to cancer. The otherwise healthy patient denied any history that could be related to IBD symptoms. Patient was started on 1.6 g of mesalazine and was advised to adhere to an endoscopic surveillance program. This case points toward a need for a more thorough understanding of the natural history of colorectal cancer in IBD to set clinically meaningful guidelines.