PMC3700488_01
Physical characteristics of the case. (A) Alopecia; (B) Tongue atrophy; (C, D) Onychatrophia.
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Multiple polyps found by lower GI endoscopy, combined with the presence of associated symptoms (alopecia, onychatrophia, pigmentation, and dysgeusia), resulted in the diagnosis of CCS (Figure 1).
Upper gastrointestinal (GI) series. A dense growth of small protrusions 10 mm or less are found in the stomach, including 10-25 mm type 0-I lesions, which are primarily found in the gastric antrum. In addition, type 0-IIc+III lesions are found in the gastric angle in the lesser curvature.
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An upper GI series found a dense growth in the stomach of small protrusions 10 mm or less, including 10-25 mm type 0-I lesions primarily in the gastric antrum, and type 0-IIc+III lesions in the gastric angle in the lesser curvature (Figure 2).
Upper GI endoscopy. Several 12-20 mm large protruding lesions indicative of type 0-I lesions are found in the gastric antrum in the greater curvature, the posterior wall of the stomach, and the pylorus in the posterior wall.
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Several 12-20 mm large protruding lesions indicative of type 0-I lesions were also found in the gastric antrum in the greater curvature, the posterior wall, and the pylorus in the posterior wall, which led us to suspect well-differentiated adenocarcinomas (Figure 3).
Large intestine endoscopy. Large intestine endoscopy reveals several large and small inflammatory polyps with rugged surfaces predominantly in the right side of the colon.
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Endoscopy of the large intestine revealed approximately 50 large and small inflammatory polyps with rugged surfaces predominantly in the right side of the colon (Figure 4).
Image of large intestinal lesion tissue. Gland duct growth indicating neoplastic change on part of the mucosal epithelium, which in turn indicates hyperplastic change (H&E, 40x magnification).
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Of these 4 lesions, 2 were at the location of gland duct growth indicating neoplastic change on part of the mucosal epithelium, which in turn indicates hyperplastic change; these were diagnosed as low-grade tubular adenomas (Figure 5).
Intraoperative findings. (A) Pigmentation is observed on the mesentery and the small intestinal wall. (B) Several polyps are observed in the surgical margin of the duodenum.
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Therefore, we used the double tract method for reconstruction (Figure 6).
Findings of the macroscopic examination of stomach resection using total gastrectomy. (A) Isolated sample; (B) Formalin-fixated isolated sample. Cancer cells are highlighted in yellow.
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Tumor cells were positive through full thickness for p53 and Ki67 and partially positive for MUC5AC and MUC2 (Figures 7 and 8).
Image of resected gastric tissue. A well-differentiated adenocarcinoma; submucosal (sm)2, intermediate type, lymphatic invasion (ly)1, venous invasion (v)0. The tumor shows expanding growth and a distinct border with the surrounding tissue (Infiltration Alpha). Tumor cells are positive for p53 and Ki67 through full thickness, and partially positive for MUC5AC and MUC2. (12.5x magnification). (A) H&E; (B) p53; (C) Ki67; (D) MUC5AC; (E) MUC2.
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Tumor cells were positive through full thickness for p53 and Ki67 and partially positive for MUC5AC and MUC2 (Figures 7 and 8).