Ulcerative colitis is known to predispose to the development of neoplasia, especially adenocarcinoma. Microcarcinoids represent small nests of gut endocrine cells located in the mucosa and submucosa of the bowel. Such lesions have been identified in association with chronic inflammation and the concern is that they may represent a precursor lesion for invasive carcinoid tumors. Yet carcinoid tumors are rarely reported in patients with ulcerative colitis. This case report documents a 56-year-old male with ulcerative colitis who was found on random biopsies to have microcarcinoids in his rectal submucosa. Following treatment of his colitis, there was complete resolution of both the inflammation and the microcarcinoids. However, on subsequent follow-up at six months, the patient's colitis has returned and so have the microcarcinoids. We explore the issue of whether these lesions represent true neoplasias that should be resected, or whether they represent cellular hyperplasia in response to the inflammatory stimulus.