Cronkhite–Canada Syndrome

  • Chapter
  • First Online:
Intestinal Polyposis Syndromes

Abstract

Cronkhite–Canada syndrome (CCS) is a noninherited condition, associated with high morbidity, and characterized by gastrointestinal inflammatory polyposis, alopecia, onychodystrophy, hyperpigmentation, and diarrhea. The etiology of CCS is unknown, although evidence continues to emerge supporting an autoimmune basis. The diagnosis of CCS is clinicopathological and remains challenging. Corticosteroids and nutritional support remain the cornerstone of management, however, newer immunomodulatory agents have emerged as viable alternatives in recent years. The role of surgery remains limited to complications refractory to medical management. The question of whether polyps in CCS possess malignant potential remains controversial. Optimal cancer screening protocols have not been developed for CCS patients, owing to the rarity of the disease. However, careful surveillance is recommended.

In this chapter, we provide a succinct overview of the history, etiology, risk factors, clinical manifestations, diagnosis, and management of CCS. The latest evidence on the pathogenesis of CCS, as well as novel treatment options, will be incorporated. We anticipate that this chapter will enhance the knowledge of clinicians on this rare condition, hel** to facilitate an appropriate diagnosis and enhance the management of patients with CCS going forward.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Cronkhite Jr LW, Canada WJ. Generalized gastrointestinal polyposis; an unusual syndrome of polyposis, pigmentation, alopecia and onychotrophia. N Engl J Med. 1955;252(24):1011–5.

    Article  PubMed  Google Scholar 

  2. Jarnum S, Jensen H. Diffuse gastrointestinal polyposis with ectodermal changes. A case with severe malabsorption and enteric loss of plasma proteins and electrolytes. Gastroenterology. 1966;50(1):107–18.

    CAS  PubMed  Google Scholar 

  3. Goto A. Cronkhite-Canada syndrome: epidemiological study of 110 cases reported in Japan. Nihon Geka Hokan. 1995;64(1):3–14.

    CAS  PubMed  Google Scholar 

  4. Vernia P, Marcheggiano A, Marinaro V, Morabito S, Guzzo I, Pierucci A. Is Cronkhite-Canada Syndrome necessarily a late-onset disease? Eur J Gastroenterol Hepatol. 2005;17(10):1139–41.

    Article  PubMed  Google Scholar 

  5. Ward EM, Wolfsen HC. Review article: the non-inherited gastrointestinal polyposis syndromes. Aliment Pharmacol Ther. 2002;16(3):333–42.

    Article  CAS  PubMed  Google Scholar 

  6. Daniel ES, Ludwig SL, Lewin KJ, Ruprecht RM, Rajacich GM, Schwabe AD. The Cronkhite-Canada syndrome. An analysis of clinical and pathologic features and therapy in 55 patients. Medicine. 1982;61(5):293–309.

    Article  CAS  PubMed  Google Scholar 

  7. Chadalavada R, Brown DK, Walker AN, Sedghi S. Cronkhite-Canada syndrome: sustained remission after corticosteroid treatment. Am J Gastroenterol. 2003;98(6):1444–6.

    Article  PubMed  Google Scholar 

  8. Doyle T, Jarvis R. Reversal of changes in Cronkhite-Canada syndrome. Australas Radiol. 1984;28(1):19–22.

    Article  CAS  PubMed  Google Scholar 

  9. Goto A. Cronkhite-Canada syndrome: observations about treatment, course and prognosis of 123 cases reported in Japan. Nihon Geka Hokan. 1988;57(5):427–33.

    CAS  PubMed  Google Scholar 

  10. Lin HJ, Tsai YT, Lee SD, Lai KH, Ng WW, Tam TN, et al. The Cronkhite-Canada syndrome with focus on immunity and infection. Report of a case. J Clin Gastroenterol. 1987;9(5):568–70.

    Article  CAS  PubMed  Google Scholar 

  11. Qiao M, Lei Z, Nai-Zhong H, Jian-Ming X. Cronkhite-Canada syndrome with hypothyroidism. South Med J. 2005;98(5):575–6.

    Article  PubMed  Google Scholar 

  12. Kubo T, Hirose S, Aoki S, Kaji T, Kitagawa M. Canada-Cronkhite syndrome associated with systemic lupus erythematosus. Arch Intern Med. 1986;146(5):995–6.

    Article  CAS  PubMed  Google Scholar 

  13. Takeuchi Y, Yoshikawa M, Tsukamoto N, Shiroi A, Hoshida Y, Enomoto Y, et al. Cronkhite-Canada syndrome with colon cancer, portal thrombosis, high titer of antinuclear antibodies, and membranous glomerulonephritis. J Gastroenterol. 2003;38(8):791–5.

    Article  PubMed  Google Scholar 

  14. Wen XH, Wang L, Wang YX, Qian JM. Cronkhite-Canada syndrome: report of six cases and review of literature. World J Gastroenterol WJG. 2014;20(23):7518–22.

    Article  PubMed  Google Scholar 

  15. Murata I, Yoshikawa I, Endo M, Tai M, Toyoda C, Abe S, et al. Cronkhite-Canada syndrome: report of two cases. J Gastroenterol. 2000;35(9):706–11.

    Article  CAS  PubMed  Google Scholar 

  16. Sampson JE, Harmon ML, Cushman M, Krawitt EL. Corticosteroid-responsive Cronkhite-Canada syndrome complicated by thrombosis. Dig Dis Sci. 2007;52(4):1137–40.

    Article  PubMed  Google Scholar 

  17. Takahashi H, Yamamoto M, Suzuki C, Naishiro Y, Shinomura Y, Imai K. The birthday of a new syndrome: IgG4-related diseases constitute a clinical entity. Autoimmun Rev. 2010;9(9):591–4.

    Article  CAS  PubMed  Google Scholar 

  18. Nishimori I, Otsuki M. Autoimmune pancreatitis and IgG4-associated sclerosing cholangitis. Best Pract Res Clin Gastroenterol. 2009;23(1):11–23.

    Article  CAS  PubMed  Google Scholar 

  19. Kim MH, Moon SH, Kamisawa T. Major duodenal papilla in autoimmune pancreatitis. Dig Surg. 2010;27(2):110–4.

    Article  PubMed  Google Scholar 

  20. Riegert-Johnson DL, Osborn N, Smyrk T, Boardman LA. Cronkhite-Canada syndrome hamartomatous polyps are infiltrated with IgG4 plasma cells. Digestion. 2007;75(2-3):96–7.

    Article  PubMed  Google Scholar 

  21. Sweetser S, Ahlquist DA, Osborn NK, Sanderson SO, Smyrk TC, Chari ST, et al. Clinicopathologic features and treatment outcomes in Cronkhite-Canada syndrome: support for autoimmunity. Dig Dis Sci. 2012;57(2):496–502.

    Article  PubMed  Google Scholar 

  22. Bettington M, Brown IS, Kumarasinghe MP, de Boer B, Bettington A, Rosty C. The challenging diagnosis of Cronkhite-Canada syndrome in the upper gastrointestinal tract: a series of 7 cases with clinical follow-up. Am J Surg Pathol. 2014;38(2):215–23.

    Article  PubMed  Google Scholar 

  23. Johnson GK, Soergel KH, Hensley GT, Dodds WJ, Hogan WJ. Cronkite-Canada syndrome: gastrointestinal pathophysiology and morphology. Gastroenterology. 1972;63(1):140–52.

    CAS  PubMed  Google Scholar 

  24. Kato K, Ishii Y, Mazaki T, Uehara T, Nakamura H, Kikuchi H, et al. Spontaneous regression of polyposis following abdominal colectomy and helicobacter pylori eradication for Cronkhite-Canada syndrome. Case Rep Gastroenterol. 2013;7(1):140–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Okamoto K, Isomoto H, Shikuwa S, Nishiyama H, Ito M, Kohno S. A case of Cronkhite-Canada syndrome: remission after treatment with anti-Helicobacter pylori regimen. Digestion. 2008;78(2-3):82–7.

    Article  PubMed  Google Scholar 

  26. Kim MS, Jung HK, Jung HS, Choi JY, Na YJ, Pyun GW, et al. A case of Cronkhite-Canada syndrome showing resolution with Helicobacter pylori eradication and omeprazole. Korean J Gastroenterol. 2006;47(1):59–64.

    PubMed  Google Scholar 

  27. Senesse P, Justrabo E, Boschi F, Goegebeur G, Collet E, Boutron MC, et al. Cronkhite-Canada syndrome and arsenic poisoning: fortuitous association or new etiological hypothesis? Gastroenterol Clin Biol. 1999;23(3):399–402.

    CAS  PubMed  Google Scholar 

  28. Patil V, Patil LS, Jakareddy R, Verma A, Gupta AB. Cronkhite-Canada syndrome: a report of two familial cases. Indian J Gastroenterol. 2013;32(2):119–22.

    Article  PubMed  Google Scholar 

  29. Blonski WC, Furth EE, Kinosian BP, Compher C, Metz DC. A case of Cronkhite-Canada syndrome with taste disturbance as a leading complaint. Digestion. 2005;71(4):201–5.

    Article  PubMed  Google Scholar 

  30. Kao KT, Patel JK, Pampati V. Cronkhite-Canada syndrome: a case report and review of literature. Gastroenterol Res Pract. 2009;2009:619378.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Goto A, Mimoto H, Shibuya C, Matsunami E. Cronkhite-Canada syndrome: an analysis of clinical features and follow-up studies of 80 cases reported in Japan. Nihon Geka Hokan. 1988;57(6):506–26.

    CAS  PubMed  Google Scholar 

  32. Nyam DC, Ho MS, Goh HS. Progressive ectodermal changes in the Cronkhite-Canada syndrome. Aust N Z J Surg. 1996;66(11):780–1.

    Article  CAS  PubMed  Google Scholar 

  33. Herzberg AJ, Kaplan DL. Cronkhite-Canada syndrome. Light and electron microscopy of the cutaneous pigmentary abnormalities. Int J Dermatol. 1990;29(2):121–5.

    Article  CAS  PubMed  Google Scholar 

  34. Ortonne JP, Bazex J, Berbis P. Cronkhite-Canada disease. Discussion apropos of a case and study of the pigmentation. Ann Dermatol Venereol. 1985;112(12):951–8.

    CAS  PubMed  Google Scholar 

  35. Berzin TM, Greenberger NJ, Levy BD, Loscalzo J. Clinical problem-solving. Worth a second look. N Engl J Med. 2012;366(5):463–8.

    Article  CAS  PubMed  Google Scholar 

  36. Watanabe C, Narimatsu K, Sato H, Usui S, Komoto S, Tomita K, Hokari R, Miura S. Clinical response to medical treatment and prognosis of Cronkhite-Canada syndrome – a Japanese nationwide survey. Gastroenterology. 2014;1:S-795.

    Google Scholar 

  37. Ishikawa E, Kudo M, Minami Y, Ueshima K, Kitai S, Ueda K. Cecal intussusception in an adult with Cronkhite-Canada syndrome relieved by colonoscopy. Intern Med. 2010;49(12):1123–6.

    Article  PubMed  Google Scholar 

  38. Macaron C, Leach BH, Burke CA. Hereditary colorectal cancer syndromes and genetic testing. J Surg Oncol. 2015;111(1):103–11.

    Article  PubMed  Google Scholar 

  39. Burke AP, Sobin LH. The pathology of Cronkhite-Canada polyps. A comparison to juvenile polyposis. Am J Surg Pathol. 1989;13(11):940–6.

    Article  CAS  PubMed  Google Scholar 

  40. de la Chapelle A. Genetic predisposition to colorectal cancer. Nat Rev Cancer. 2004;4(10):769–80.

    Article  PubMed  Google Scholar 

  41. Samoha S, Arber N. Cronkhite-Canada syndrome. Digestion. 2005;71(4):199–200.

    Article  PubMed  Google Scholar 

  42. Boardman LA. Heritable colorectal cancer syndromes: recognition and preventive management. Gastroenterol Clin North Am. 2002;31(4):1107–31.

    Article  PubMed  Google Scholar 

  43. Schreibman IR, Baker M, Amos C, McGarrity TJ. The hamartomatous polyposis syndromes: a clinical and molecular review. Am J Gastroenterol. 2005;100(2):476–90.

    Article  PubMed  Google Scholar 

  44. Half EE, Bresalier RS. Clinical management of hereditary colorectal cancer syndromes. Curr Opin Gastroenterol. 2004;20(1):32–42.

    Article  PubMed  Google Scholar 

  45. Jenkins D, Stephenson PM, Scott BB. The Cronkhite-Canada syndrome: an ultrastructural study of pathogenesis. J Clin Pathol. 1985;38(3):271–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Anderson RD, Patel R, Hamilton JK, Boland CR. Cronkhite-Canada syndrome presenting as eosinophilic gastroenteritis. Proc Natl Acad Sci USA. 2006;19(3):209–12.

    Google Scholar 

  47. Martinek J, Chvatalova T, Zavada F, Vankova P, Tuckova I, Zavoral M. A fulminant course of Cronkhite-Canada syndrome. Endoscopy. 2010;42 Suppl 2:E350–1.

    Article  PubMed  Google Scholar 

  48. Yuan B, ** X, Zhu R, Zhang X, Liu J, Wan H, et al. Cronkhite-Canada syndrome associated with rib fractures: a case report. BMC Gastroenterol. 2010;10:121.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Cao XC, Zhou B, Ding JJ, Lian J, Lu N, Wang BM. Clinical characteristics of Cronkhite-Canada syndrome in Chinese: meta-analysis of 35 cases. Zhonghua Yi Xue Za Zhi. 2007;87(44):3130–2.

    PubMed  Google Scholar 

  50. Monkemuller K, Neumann H, Evert M. Cronkhite-Canada syndrome: panendoscopic characterization with esophagogastroduodenoscopy, endoscopic ultrasound, colonoscopy, and double balloon enteroscopy. Clin Gastroenterol Hepatol. 2008;6(10):A26.

    Article  PubMed  Google Scholar 

  51. Samet JD, Horton KM, Fishman EK, Iacobuzio-Donahue CA. Cronkhite-Canada syndrome: gastric involvement diagnosed by MDCT. Case Rep Med. 2009;2009:148795.

    PubMed  PubMed Central  Google Scholar 

  52. Peart Jr AG, Sivak Jr MV, Rankin GB, Kish LS, Steck WD. Spontaneous improvement of Cronkhite-Canada syndrome in a postpartum female. Dig Dis Sci. 1984;29(5):470–4.

    Article  PubMed  Google Scholar 

  53. Ward EM, Wolfsen HC. Pharmacological management of Cronkhite-Canada syndrome. Expert Opin Pharmacother. 2003;4(3):385–9.

    Article  CAS  PubMed  Google Scholar 

  54. Jones AF, Paone DB. Canada-Cronkhite syndrome in an 82-year-old woman. Am J Med. 1984;77(3):555–7.

    Article  CAS  PubMed  Google Scholar 

  55. Ferney DM, DeSchryver-Kecskemeti K, Clouse RE. Treatment of Cronkhite-Canada syndrome with home total parenteral nutrition. Ann Intern Med. 1986;104(4):588.

    Article  CAS  PubMed  Google Scholar 

  56. Russell DM, Bhathal PS, St John DJ. Complete remission in Cronkhite-Canada syndrome. Gastroenterology. 1983;85(1):180–5.

    CAS  PubMed  Google Scholar 

  57. Russell DM, Bhathal PS, St John DJ. Sustained remission in Cronkhite-Canada syndrome. Gastroenterology. 1986;91(6):1580.

    CAS  PubMed  Google Scholar 

  58. Kopacova M, Urban O, Cyrany J, Laco J, Bures J, Rejchrt S, et al. Cronkhite-Canada syndrome: review of the literature. Gastroenterol Res Pract. 2013;2013:856873.

    PubMed  PubMed Central  Google Scholar 

  59. Goo YS, Lee YC, Shin MS, Kim WH, Kim H, Park IS. A case of Cronkhite-Canada syndrome involving the entire gastrointestinal tract. Endoscopy. 2001;33(4):385.

    Article  CAS  PubMed  Google Scholar 

  60. Ward E, Wolfsen HC, Ng C. Medical management of Cronkhite-Canada syndrome. South Med J. 2002;95(2):272–4.

    Article  PubMed  Google Scholar 

  61. Allbritton J, Simmons-O’Brien E, Hutcheons D, Whitmore SE. Cronkhite-Canada syndrome: report of two cases, biopsy findings in the associated alopecia, and a new treatment option. Cutis. 1998;61(4):229–32.

    CAS  PubMed  Google Scholar 

  62. Takakura M, Adachi H, Tsuchihashi N, Miyazaki E, Yoshioka Y, Yoshida K, Oryo F, Sawada T. A case of Cronkhite-Canada syndrome markedly improved with mesalazine therapy. Dig Endosc. 2004;16:74–8.

    Article  Google Scholar 

  63. Ohmiya N, Nakamura M, Yamamura T, Yamada K, Nagura A, Yoshimura T, et al. Steroid-resistant Cronkhite-Canada syndrome successfully treated by cyclosporine and azathioprine. J Clin Gastroenterol. 2014;48(5):463–4.

    PubMed  Google Scholar 

  64. Tran VT, Reicher S, Chung DS, Eysselein VE, Pham BV. Infliximab therapy in refractory Cronkhite-Canada syndrome. Gastroenterology. 2010;1:S364.

    Google Scholar 

  65. Nakayama M, Muta H, Somada S, Maeda T, Mutoh T, Shimizu K, et al. Cronkhite-Canada syndrome associated with schizophrenia. Intern Med. 2007;46(4):175–80.

    Article  PubMed  Google Scholar 

  66. Hanzawa M, Yoshikawa N, Tezuka T, Konishi K, Kaneko K, Akita Y, et al. Surgical treatment of Cronkhite-Canada syndrome associated with protein-losing enteropathy: report of a case. Dis Colon Rectum. 1998;41(7):932–4.

    Article  CAS  PubMed  Google Scholar 

  67. Samalavicius NE, Lunevicius R, Klimovskij M, Kildusis E, Zazeckis H. Subtotal colectomy for severe protein-losing enteropathy associated with Cronkhite-Canada syndrome: a case report. Colorectal Dis. 2013;15(3):e164–5.

    Article  CAS  PubMed  Google Scholar 

  68. Nagata J, Kijima H, Hasumi K, Suzuki T, Shirai T, Mine T. Adenocarcinoma and multiple adenomas of the large intestine, associated with Cronkhite-Canada syndrome. Dig Liver Dis. 2003;35(6):434–8.

    Article  CAS  PubMed  Google Scholar 

  69. Katayama Y, Kimura M, Konn M. Cronkhite-Canada syndrome associated with a rectal cancer and adenomatous changes in colonic polyps. Am J Surg Pathol. 1985;9(1):65–71.

    Article  CAS  PubMed  Google Scholar 

  70. Malhotra R, Sheffield A. Cronkhite-Canada syndrome associated with colon carcinoma and adenomatous changes in C-C polyps. Am J Gastroenterol. 1988;83(7):772–6.

    CAS  PubMed  Google Scholar 

  71. Jain A, Nanda S, Chakraborty P, Kundra A, Anuradha S, Reddy BS, et al. Cronkhite-Canada syndrome with adenomatous and carcinomatous transformation of colonic polyp. Indian J Gastroenterol. 2003;22(5):189–90.

    PubMed  Google Scholar 

  72. Yashiro M, Kobayashi H, Kubo N, Nishiguchi Y, Wakasa K, Hirakawa K. Cronkhite-Canada syndrome containing colon cancer and serrated adenoma lesions. Digestion. 2004;69(1):57–62.

    Article  PubMed  Google Scholar 

  73. Fujishima N. Proliferative activity of mixed hyperplastic adenomatous polyp/serrated adenoma in the large intestine, measured by PCNA (proliferating cell nuclear antigen). J Gastroenterol. 1996;31(2):207–13.

    Article  CAS  PubMed  Google Scholar 

  74. Tlsty TD, Coussens LM. Tumor stroma and regulation of cancer development. Annu Rev Pathol. 2006;1:119–50.

    Article  CAS  PubMed  Google Scholar 

  75. Sweetser S, Boardman LA. Cronkhite-Canada syndrome: an acquired condition of gastrointestinal polyposis and dermatologic abnormalities. Gastroenterol Hepatol. 2012;8(3):201–3.

    Google Scholar 

  76. Seshadri D, Karagiorgos N, Hyser MJ. A case of Cronkhite-Canada syndrome and a review of gastrointestinal polyposis syndromes. Gastroenterol Hepatol. 2012;8(3):197–201.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seth Sweetser M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Cotter, T.G., Al Bawardy, B.F., Sweetser, S. (2016). Cronkhite–Canada Syndrome. In: Boardman, L. (eds) Intestinal Polyposis Syndromes. Springer, Cham. https://doi.org/10.1007/978-3-319-28103-2_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-28103-2_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-28101-8

  • Online ISBN: 978-3-319-28103-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Navigation