A case of cronkhite-Canada syndrome and a review of gastrointestinal polyposis syndromes.

A 78-year-old Chinese man presented with weight loss, diarrhea, and an altered sense of taste for the past 6 months. The patient had a history of prostate and cecal cancers, for which he had undergone a right hemicolectomy in 1988. At that time, 2 of 18 lymph nodes were positive. Since then, the patient has been undergoing periodic surveillance colonoscopies, and hyperplastic polyps have occasionally been identified and removed. In 2000 and 2003, his colonoscopies had normal findings. In 2007, a colonoscopy revealed a normal anastomosis and a large inflammatory polyp 60 cm within the descending colon. On physical examination, the patient did not appear cachectic, and his abdomen was soft, nontender, and nondistended. He had hemoccult-positive stool. Of note, he had hyperpigmentation of both hands, alopecia, and atrophic nail changes (Figure 1). His carcinoembryonic antigen level was 3.3 ng/mL, his hemoglobin level was 14.4 g/dL, and his albumin level was 3.4 g/dL. The patient underwent an upper endoscopy and colonoscopy to further investigate his condition. The upper endoscopy revealed a carpet of predominantly sessile polyps coating the gastric body, antrum, and duodenum (Figure 2). Multiple new polyps were found in the patient’s remaining colon and rectum (Figures 3 and 4). Pathologic review of all specimens demonstrated multiple benign, juvenile-like polyps with cystically dilated and distorted hyperplastic glands; marked stromal edema; and a mixture of inflammatory cells, including eosinophils. In addition, there was a small adenoma in the Deepti Seshadri, MD1 Nikolaos Karagiorgos, MD1 Matthew J. Hyser, MD1,2 1Metropolitan Group Hospitals Residency in General Surgery, University of Illinois, Chicago, Illinois; 2St. Francis Hospital, Evanston, Illinois