Purpose: Small cell carcinoma is most commonly associated with pathologic disease, affecting the pulmonary system; however, extrapulmonary disease, although a rare entity, does occur. Areas of reported primary manifestation outside the lungs include the urinary bladder, prostate, esophagus, stomach, colon, rectum, gallbladder, cervix, kidneys, salivary glands, thymus, ovaries, and skin, amongst others. Our patient was a 75-year-old man with a past medical history significant for hypertension, who presented for a chief complaint of night sweats and constipation. His symptoms had been present for two months. There was no associated weight loss, dysphagia, odynophagia, nausea, emesis, melena, hematochezia, cough, hemoptysis, hematemesis, shortness of breath, or chest pain. The patient had no history of smoking, drug, or alcohol use. Complete blood count showed normochromic, normocytic anemia. Liver function, kidney function, electrolytes, iron studies, CXR, and quantiferon gold were all normal. A colonoscopy with biopsies revealed a tubulovillous adenoma in the transverse ascending colon and hepatic flexure with features consistent with small cell carcinoma. The patient underwent a hemicolectomy. Final pathology returned as poorly differentiated high-grade invasive neuroendocrine carcinoma without extension into or through the muscularis propria, and with clear margins of resection. Staining showed weak positivity for synaptophysin, and negative for chromogranin. Fifteen regional mesenteric lymph nodes showed no evidence of metastasis. His tumor was classified at T1N0MO, and he was started on four cycles of treatment with carboplatin and etoposide every 21 days. Colorectal small cell carcinoma is a rare entity, comprising only about 1.5% of all colorectal tumors. Of these, only 12% arise in the transverse colon. The more common sites include the rectum, cecum, and ascending colon. Available data exists in the form of either retrospective studies or case reports, so much remains to be discovered regarding the pathophysiology of disease and recommended treatment options. Currently, there are no identifiable risk factors. At the time of diagnosis, most cases have either large primary tumors with lymph node involvement or distant metastasis, liver being the most common site. There are no recommended treatment guidelines, but most cases report surgical resection combined with chemotherapy and radiation. Selection of chemotherapy as either adjuvant therapy or for metastatic disease is on a case-by-case basis.