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Clinicopathologic features and treatment outcomes in Cronkhite-Canada syndrome: support for autoimmunity.
Dig Dis Sci. 2012 Feb; 57(2):496-502.DD

Abstract

BACKGROUND AND AIMS

Cronkhite-Canada syndrome (CCS) is a noninherited condition, associated with high morbidity, and characterized by gastrointestinal hamartomatous polyposis, alopecia, onychodystrophy, hyperpigmentation, and diarrhea. All features may respond to immunosuppressive therapy, but little is known about the etiology. An autoimmune origin has been suggested but not proved. From a retrospectively selected cohort, we evaluated clinicopathologic features, including immunostaining for IgG4 (an antibody associated with autoimmunity), and therapeutic outcomes in a cohort of CCS patients to provide further insights into this disease.

METHODS

Cases included 14 consecutive CCS patients seen at the Mayo Clinic on whom tissue and follow-up were available. All histology was reviewed by an expert gastrointestinal pathologist. Immunostaining for IgG4 was performed on 42 polyps from CCS cases and on control tissues, including 46 histologically similar hamartomas [from juvenile polyposis syndrome (JPS)] and 20 normal mucosae (six stomach, three small bowel, and 11 colon). Clinical features and treatment outcomes were descriptive.

RESULTS

All CCS cases had both upper and lower gastrointestinal polyps; most had typical dermatologic features of alopecia, hyperpigmentation, and onychodystrophy; and most had evidence of protein-losing enteropathy. Ten patients (71%) had adenomatous polyps and 2 (14%) had colorectal cancer. IgG4 immunostaining was positive (>5 cells/HPF) in 52% of CCS polyps compared to 12% of JPS polyps (P = 0.001); IgG4 staining was negative in all other control tissues. Of 11 CCS patients treated with oral corticosteroids, 91% achieved remission. Relapse was common with steroid tapering. Five patients who initially responded to corticosteroids were maintained in remission on azathioprine (2 mg/kg/day) with no relapse after a median of 4.5 years.

CONCLUSIONS

Immunostaining for the autoimmune-related IgG4 antibody is significantly increased in CCS polyps compared to disease and normal control tissues. Furthermore, immunosuppression by corticosteroids or long-term azathioprine may eradicate or lessen manifestations of CCS. These histologic findings and treatment responses are consistent with an autoimmune mechanism underlying CCS.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. sweetser.seth@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21881972

Citation

Sweetser, Seth, et al. "Clinicopathologic Features and Treatment Outcomes in Cronkhite-Canada Syndrome: Support for Autoimmunity." Digestive Diseases and Sciences, vol. 57, no. 2, 2012, pp. 496-502.
Sweetser S, Ahlquist DA, Osborn NK, et al. Clinicopathologic features and treatment outcomes in Cronkhite-Canada syndrome: support for autoimmunity. Dig Dis Sci. 2012;57(2):496-502.
Sweetser, S., Ahlquist, D. A., Osborn, N. K., Sanderson, S. O., Smyrk, T. C., Chari, S. T., & Boardman, L. A. (2012). Clinicopathologic features and treatment outcomes in Cronkhite-Canada syndrome: support for autoimmunity. Digestive Diseases and Sciences, 57(2), 496-502. https://doi.org/10.1007/s10620-011-1874-9
Sweetser S, et al. Clinicopathologic Features and Treatment Outcomes in Cronkhite-Canada Syndrome: Support for Autoimmunity. Dig Dis Sci. 2012;57(2):496-502. PubMed PMID: 21881972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinicopathologic features and treatment outcomes in Cronkhite-Canada syndrome: support for autoimmunity. AU - Sweetser,Seth, AU - Ahlquist,David A, AU - Osborn,Neal K, AU - Sanderson,Schuyler O, AU - Smyrk,Thomas C, AU - Chari,Suresh T, AU - Boardman,Lisa A, Y1 - 2011/09/01/ PY - 2011/05/17/received PY - 2011/08/12/accepted PY - 2011/9/2/entrez PY - 2011/9/2/pubmed PY - 2012/4/13/medline SP - 496 EP - 502 JF - Digestive diseases and sciences JO - Dig Dis Sci VL - 57 IS - 2 N2 - BACKGROUND AND AIMS: Cronkhite-Canada syndrome (CCS) is a noninherited condition, associated with high morbidity, and characterized by gastrointestinal hamartomatous polyposis, alopecia, onychodystrophy, hyperpigmentation, and diarrhea. All features may respond to immunosuppressive therapy, but little is known about the etiology. An autoimmune origin has been suggested but not proved. From a retrospectively selected cohort, we evaluated clinicopathologic features, including immunostaining for IgG4 (an antibody associated with autoimmunity), and therapeutic outcomes in a cohort of CCS patients to provide further insights into this disease. METHODS: Cases included 14 consecutive CCS patients seen at the Mayo Clinic on whom tissue and follow-up were available. All histology was reviewed by an expert gastrointestinal pathologist. Immunostaining for IgG4 was performed on 42 polyps from CCS cases and on control tissues, including 46 histologically similar hamartomas [from juvenile polyposis syndrome (JPS)] and 20 normal mucosae (six stomach, three small bowel, and 11 colon). Clinical features and treatment outcomes were descriptive. RESULTS: All CCS cases had both upper and lower gastrointestinal polyps; most had typical dermatologic features of alopecia, hyperpigmentation, and onychodystrophy; and most had evidence of protein-losing enteropathy. Ten patients (71%) had adenomatous polyps and 2 (14%) had colorectal cancer. IgG4 immunostaining was positive (>5 cells/HPF) in 52% of CCS polyps compared to 12% of JPS polyps (P = 0.001); IgG4 staining was negative in all other control tissues. Of 11 CCS patients treated with oral corticosteroids, 91% achieved remission. Relapse was common with steroid tapering. Five patients who initially responded to corticosteroids were maintained in remission on azathioprine (2 mg/kg/day) with no relapse after a median of 4.5 years. CONCLUSIONS: Immunostaining for the autoimmune-related IgG4 antibody is significantly increased in CCS polyps compared to disease and normal control tissues. Furthermore, immunosuppression by corticosteroids or long-term azathioprine may eradicate or lessen manifestations of CCS. These histologic findings and treatment responses are consistent with an autoimmune mechanism underlying CCS. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/21881972/Clinicopathologic_features_and_treatment_outcomes_in_Cronkhite_Canada_syndrome:_support_for_autoimmunity_ L2 - https://doi.org/10.1007/s10620-011-1874-9 DB - PRIME DP - Unbound Medicine ER -