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case_images: Esophagogastroduodenoscopy and colonoscopy findings. Esophagogastroduodenoscopy revealed a dense strawberry-like polyposis in the stomach (a, b). Colonoscopy showed a dense strawberry-like polyposis (c, d). NBI magnification showed sparse and dilated round pits.
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case_images: Esophagogastroduodenoscopy (EGD) revealed a dense strawberry-like polyposis in the stomach, particularly across the lower gastric corpus to the antrum (Figure 1a). Total colonoscopy similarly revealed a dense strawberry-like polyposis throughout the large intestine (Figure 1c). NBI magnification showed the sparse and dilated round pit on the polyps in both the stomach and large intestine (Figure 1b,d). The hamartomatous and adenomatous lesions were MUC5AC-positive, but normal mucosa was negative (Figure S1a-c).
case_images: Colonoscopy showed adenoma coexisting with Cronkhite-Canada syndrome polyps (a, b). Magnified narrow-band imaging revealed a regular distribution of microvessels and a regular reticular pattern on the adenoma; the microvessels of Cronkhite-Canada syndrome polyps developed a regularly elongated and network formation (c, d).
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case_images: However, twelve of the colorectal CCS polyps had a coexisting light reddish elevated component (Figure 2a,b). Expert Team classification, which is indicative of adenoma (Figure 2c,d). Endoscopic polypectomy was then performed on the 12 polyps.
case_images: Histological findings. Polyps were a mixture of juvenile (hamartomatous) polyps and low-grade adenoma (a, b). Cystically dilated crypts similar to juvenile (hamartomatous) polyps at the base of the polyp (b: yellow box, [c]). Dysplastic epithelium with hyperchromatic elongated nuclei compatible with low-grade tubular adenoma (b: red box, [d]).
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case_images: In accordance with the NBI findings, while the base of the resected polyps consisted of hamartoma, the superficial layer contained a low-grade tubular adenoma (Figure 3).
case_images: Pathological examination of the polyp. The paraffin section of polyps was stained with anti-Ki-67 antibody (a, b), and anti-p53 antibody (c, d). Significantly higher labeling indices were seen in adenomatous lesions (b, d).
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case_images: Immunohistochemical analysis showed a significant increase in Ki-67 index and p53 staining in adenomatous lesions, in contrast to the hamartomatous component (Figure 4).