S2608 A Rare Case of Iron Deficiency Anemia: Cronkhite-Canada Syndrome
Bibliographic record
Abstract
Introduction: Cronkhite-Canada syndrome (CCS) is a rare, sporadically occurring, non-inherited disorder with an estimated incidence of 1 in 1,000,000 and only 500 reported cases worldwide. We present a case of chronic iron deficiency anemia (IDA) in a patient diagnosed with CCS. Case Description/Methods: A 37-year-old African American woman presented with 1 week of dyspnea on exertion, palpitations, and thirty-pound unintentional weight loss in 1 year. She had associated symptoms of ageusia and diffuse abdominal discomfort. She denied any overt gastrointestinal bleeding. Physical exam was notable for thinning of her hair, pale conjunctiva, and blue hyperpigmentation of the lips. She had clubbing and bilateral pitting edema. Laboratory workup was notable for a hemoglobin of 5.1g/dL and low iron studies consistent with IDA. The patient was adequately resuscitated and subsequently, an esophagogastroduodenoscopy (EGD) and colonoscopy were performed. The upper endoscopy revealed abnormal-appearing stomach mucosa characterized by a carpeting of frond-like, papillary-mucous appearing exophytic lesions. Colonoscopy showed a near-obstructive villous/frond-like mass at 60cm from the anal verge. Random biopsies were taken from the stomach and duodenum which showed enlarged, convoluted glands with edematous and inflamed mucosa. Transverse colon biopsies revealed hyperchromatic and crowded nuclei with preservation of polarity consistent with low-grade dysplasia. The histological findings along with the clinical presentation was consistent with a diagnosis of CCS (Figure 1). The patient was seen by the surgery and underwent exploratory laparotomy with partial transverse colectomy. On outpatient follow-up, she was started on systemic steroids with clinical course to be determined. Discussion: CCS is characterized by the presence of multiple gastrointestinal hamartomatous polyps, chronic diarrhea, loss of appetite, alopecia, onychodystrophy, and cutaneous hyperpigmentation. The pathogenesis of CCS is unclear but there may be an autoimmune component given several case reports showing improvement with immunosuppression. Although there is limited data, the 5-year mortality is estimated to be 55% with a risk of colorectal cancer as high as 25%. Given the rarity of the disease and the rising cases of colon cancer, there are no consensus guidelines for gastrointestinal cancer surveillance as well as treatment options so further long-term data needs to be gathered to improve decision-making in patients with CCS.Figure 1.: 20x view of the transverse colon polyp: enlarged, convoluted glands within edematous and inflamed mucosa. The polyp also has conventional low-grade dysplasia with hyperchromatic and crowded nuclei with preservation of polarity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".