Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2022; 14(10): 642-647
Published online Oct 16, 2022. doi: 10.4253/wjge.v14.i10.642
Cronkhite-Canada syndrome: First case report from Egypt and North Africa
Ahmed Elsayed Alzamzamy, Ashraf Aboubakr, Hussein H Okasha, Abeer Abdellatef, Shaimaa Elkholy, Mahmoudd Wahba, Mohamed Alboraie, Hussein Elsayed, Mohamed O Othman
Ahmed Elsayed Alzamzamy, Ashraf Aboubakr, Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11711, Egypt
Hussein H Okasha, Abeer Abdellatef, Shaimaa Elkholy, Mahmoudd Wahba, Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Cairo University, Cairo 11311, Egypt
Mohamed Alboraie, Department of Internal Medicine, Al-Azhar University, Cairo 11311, Egypt
Hussein Elsayed, Department of Pathology, Military Medical Academy, Cairo 11711, Egypt
Mohamed O Othman, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77082, United States
Author contributions: Alzamzamy A contributed to data acquisition, analysis, and interpretation, all endoscopies, and drafting of the manuscript; Aboubakr A, Okasha H, and Othman M edited the manuscript and supervised the research; Alzamzamy A and Abdelatif A wrote the manuscript; Elsayed H contributed to the histopathology work and result analysis; Elkholy S, Wahba M, and Alboraie M contributed to data acquisition, analysis, and interpretation; all authors approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ahmed Elsayed Alzamzamy, MD, PhD, Consultant Physician-Scientist, Senior Lecturer, Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Maadi Kornich El Nile, Cairo 11728, Egypt.
Received: June 3, 2022
Peer-review started: June 3, 2022
First decision: June 27, 2022
Revised: July 29, 2022
Accepted: September 13, 2022
Article in press: September 13, 2022
Published online: October 16, 2022

Gastrointestinal (GI) polyposis is a rare condition in GI diseases. To date about 500 cases of Cronkhite-Canada syndrome (CCS) have been reported worldwide.


We report a 60-year-old female patient who presented with dyspepsia, abdominal pain, and weight loss of 1-year duration. Her physical examination showed alopecia and onychodystrophy. Upper endoscopy revealed diffuse markedly thickened gastric mucosa involving the whole stomach with thickened gastric rugae and numerous polypoidal lesions. Histopathological examination showed marked hyperplasia of the foveolar glands with inflammatory cell infiltration. Endoscopic ultrasound showed a significantly hypertrophic mucosa and muscularis mucosa, while the submucosa and the muscularis propria were spared, favouring its benign nature. Colonoscopy showed multiple sessile polyps scattered at different parts of the colon. Histopathological examination revealed tubular adenomatous polyps with low-grade dysplasia. Differential diagnoses included CCS, Menterier disease (MD), other polyposis syndromes, lymphoma, amyloidosis, and gastric malignancies. The presence of alopecia, nail dystrophy, GI polyposis, markedly thickened gastric mucosa and folds, abdominal pain, weight loss, and marked foveolar gland hyperplasia; all was in favour of CCS. Lymphoma was excluded due to sparing of the muscularis propria. The presence of colonic polyps and antral and duodenal infiltration, and the absence of hypoproteinaemia decreased the possibility for MD.


The patient was diagnosed as having CCS.

Keywords: Gastrointestinal polyposis, Thickened gastric mucosa, Cronkhite-Canada syndrome, Case report

Core Tip: Cronkhite-Canada syndrome (CCS) is a rare acquired polyposis with unknown aetiology. To date about 500 cases have been reported worldwide. We herein report an Egyptian patient with CCS. Most of CCS cases were reported from Japan, and to our knowledge, our case is the first case reported from Egypt and North Africa. Cases presenting with gastrointestinal (GI) polyposis and marked thickened gastric mucosa and folds represent challenging cases and diagnostic dilemmas. The diagnosis was based on history, physical examination, endoscopic findings, and histology. CCS is typically characterized by GI symptoms, such as diarrhea and skin changes (e.g., alopecia, pigmentation, and nail dystrophy), while endoscopic features include diffuse polyps throughout the entire GIT, except for the esophagus. Pathological types of polyps in CCS mainly include inflammatory, hyperplastic, hamartomatous, and/or adenomatous polyps. CCS can be complicated by many diseases and has a malignant tendency with a high mortality rate. Till now, there has been no uniform standard treatment for CCS.