Cronkhite-Canada Syndrome With Advanced Gastric Cancer
Notice bibliographique
Résumé
CASE REPORT A 60-year-old man was diagnosed 11 years ago as having Cronkhite-Canada syndrome (CCS) based on multiple gastric polyps, diarrhea, hypoalbuminemia, and skin symptoms. There were multiple hamartomatous polyps in the colon but no polyps in the small intestine. After starting oral prednisolone (30 mg/day) 6 years ago, some polyps had reduced in size, but a protruding lesion of the gastric antrum tended to increase. Routine esophagogastroduodenoscopy showed a mixture of typical red caviar-like non-neoplastic polyps with edema and hyperemia and a protruding lesion with irregular surface pattern suspected of being a neoplasticity (Figures 1 and 2). Biopsy revealed irregular tubular structures suspicious for gastric cancer, so laparoscope-assisted distal gastrectomy was performed.Figure 1.: Esophagogastroduodenoscopy showed a mixture of typical red caviar-like non-neoplastic polyps and a lesion of suspected neoplasticity.Figure 2.: Narrow-band imaging clarified irregular surface-patterned lesion suggestive of neoplasticity.Surgical specimens showed a mixture of non-neoplastic tissue characterized by stromal edema and dilated glandular ducts and diverse neoplastic tissue such as tubular adenocarcinoma, signet-ring cell carcinoma, and adenoma (Figures 3 and 4). Chemotherapy was begun because the cancer had invaded the subserosa and metastasized to numerous lymph nodes. The patient died 1 year and 2 months after starting chemotherapy.Figure 3.: Surgical specimen with mixed non-neoplastic tissue and tubular adenocarcinoma (100× magnification).Figure 4.: Surgical specimen with mixed signet-ring cell carcinoma and adenoma (100× magnification).CCS is a rare gastrointestinal polyposis syndrome diagnosed on the basis of gastrointestinal symptoms such as chronic diarrhea and skin symptoms such as alopecia, onychodystrophy, and pigmentation. CCS requires caution because of complications of adenoma and carcinoma. In Japan, the gastric cancer complication rate for CCS is reported to be 10.2%.1 Durable polyp regression is associated with decreased cancer risk. Oral prednisolone at doses of 30 mg/day or more is appropriate for inducing clinical remission and regression of polyps.2 Endoscopic screening is also recommended at least once a year.1 The Helicobacter pylori antibody in this case was negative. The surgical specimens showed a mixture of non-neoplastic and neoplastic tissue, which strongly suggests that the cancer originated from a CCS polyp. Although this patient had advanced cancer, we believe this to be a valuable case in which preoperative observation with narrow-band imaging revealed the complication of neoplastic lesions. DISCLOSURES Author contributions: A. Goto: writing-original draft. S. Hashimoto: creating images. K. Yamamoto: creating images. J. Nishikawa: writing-original draft. T. Takami: supervision. A. Goto is the article guarantor. Financial disclosure: None to report. Previous presentation: Yamaguchi University Gastrointestinal Conference; November 29, 2023; Yamaguchi University Hospital. Informed consent was obtained for this case report.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».