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Cronkhite-Canada syndrome - A Case report.

Carlos A Rubio1, Jan Björk2

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Summary
This summary is machine-generated.

Cronkhite-Canada syndrome (CCS) patients may have traditional serrated adenomas (TSA) that can be missed during colonoscopy. Early detection of TSA in CCS patients is crucial for preventing colorectal cancer.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Pathology

Background:

  • Cronkhite-Canada syndrome (CCS) is a rare, non-inherited disorder characterized by gastrointestinal hamartomatous polyps, alopecia, onychodystrophy, and skin pigmentation.
  • CCS patients exhibit an increased risk of developing colonic traditional serrated adenomas (TSA), which are precursors to colorectal cancer.
  • While over 500 CCS cases are reported, predominantly in Asian populations, the syndrome is infrequently documented in Western countries.

Observation:

  • A 73-year-old female with a history of alopecia and nail atrophy presented with iron deficiency anemia and gastrointestinal bleeding.
  • Initial colonoscopy revealed multiple broad-based polyps, but no TSA was identified.
  • Subsequent coloproctectomy due to persistent bleeding unexpectedly revealed 50 hamartomas and a TSA with high-grade dysplasia in the cecum.

Findings:

  • The TSA was either overlooked during the initial colonoscopy or misidentified among the numerous hamartomatous polyps.
  • This case highlights the potential for missed TSA diagnoses in CCS patients, even with colonoscopic examination.
  • The TSA found had high-grade dysplasia, indicating a significant risk of malignant transformation.

Implications:

  • Endoscopists encountering CCS patients, particularly in Western regions where the syndrome is rare, must perform meticulous colonoscopies.
  • Utilizing advanced techniques like chromoscopy and targeted biopsies of irregular polyps is recommended to enhance TSA detection.
  • Prompt identification and management of TSA in CCS patients are vital for preventing the development of invasive colorectal cancer.