Pseudomelanosis of the duodenum. Endoscopic, histologic, and ultrastructural study of a case

A Rare Case of Duodenal Melanosis: Case Report

Pseudomelanosis (PM) is a rare condition of unknown etiology and pathogenesis, described as speckled black pigmentation of intestinal mucosa. It is usually discovered as an incidental finding during endoscopy. Although, etiology of PM is unclear, it has been associated with different medications and systemic diseases such as chronic renal disease and diabetes mellitus. In this report, we describe a case of a 72-year-old male with multiple co-morbidities who presented with epigastric pain, nausea and hematemesis. Subsequently, upper endoscopy performed revealed intestinal PM with no active bleeding. Although considered a benign condition, knowing the existence of PM is important to exclude other serious conditions with similar endoscopic findings.

Pseudomelanosis of stomach, duodenum, and jejunum

Pseudomelanosis is a rare finding during upper gastrointestinal endoscopy, and is most commonly seen in the duodenum. Involvement of other organs in the upper gastrointestinal tract is extremely rare, with only 1 reported case involving the stomach, duodenum, and jejunum. We present a case of a 60-year-old woman with mild anemia and hematemesis, who was found to have characteristic speckled pattern of gray-black pigmentation on endoscopic examination. To the best of our knowledge, this is the second reported case of pseudomelanosis involving the stomach, duodenum, and jejunum.

Duodenal pseudomelanosis (pseudomelanosis duodeni): a rare endoscopic finding

Duodenal pseudomelanosis (or pseudomelanosis duodeni) is a rare benign condition characterized by black-brown speckled pigmentation of the duodenal mucosa. Collections of pigment-laden macrophages are found in the tips of duodenal villi. The pigment is thought to be mostly composed of ferrous sulfide. Histochemichal stains for iron (Perl's prussian blue) or melanin (Masson-Fontana) may be positive, but are usually negative or unpredictable. Duodenal pseudomelanosis occurs predominantly in middle-aged to old adults and more commonly in females. It is associated with chronic renal failure, arterial hypertension, diabetes mellitus and gastrointestinal bleeding. Medications such as ferrous sulfate, hydralazine, propranolol, hydrochlorothiazide and furosemide are thought to play a role as well. We report a case of a 86-year-old female who presented with a history of watery diarrhea and melena. The patient had a history of high blood pressure and ischemic stroke episodes. She was on multiple medication including hidralazine, captopril, hydrochlorthiazide and aspirin. She was dehydrated, her blood pressure was 96 × 60 mmHg and neurologic examination showed complete left hemiplegia with central VII nerve palsy. Laboratory tests showed normal serum electrolytes and renal function. Hemoglobin level was 10.7 g%. An upper endoscopy showed multiple diminutive black spots throughout the distal duodenal bulb and second portion. Histology showed multiple foci of a brown-black granular pigment inside macrophages within the tips of the villi (pseudomelanosis). Stains for iron and melanin were negative. She was treated with omeprazol, parenteral fluid replacement with saline and partial fasting. After complete recovery she was discharged for ambulatory follow up.

As you like it

I have developed something of a reputation for criticizing freely and frequently at our meetings and in my writings. You say you like this and find it useful and entertaining. As you like it, you are welcome to more of it. My comments and criticisms are presented under the following headings: (1) criticize at your peril; (2) how it all started (unjustly accused!); (3) abbreviations (a source of perennial aggravation, confusion, and waste of time); (4) mysterious bodies in mesotheliomas; (5) call a crystal a "crystal," not a "crystalloid"; (6) electron microscopy-a study of osmium artifacts; (7) length-to-diameter ratio of microvilli (mission impossible); (8) lamellar bodies (a popular but debased term); (9) amyloid filaments, not fibers; (10) filaments and microtubules do not branch; (11) there is no such thing as pseudomelanosis; (12) botched histochemistry (just about every gastrointestinal tract pigment was misdiagnosed by histochemistry); (13) intranuclear Russell bodies, not "Dutcher bodies"; and (14) nuclear pores and virus-like particles (a new development in an old farce).

Melanosis peritonei associated with enteric duplication cyst. A case report

Melanosis peritonei is extremely rare, and only five cases have been reported in the English literature, four in association with ovarian dermoid cysts, and one with a peritoneal cyst. We describe an additional case occurring in a girl two years of age who also had an enteric cyst. This is the first reported case of melanosis peritonei not associated with an ovarian teratoma, but with an enteric duplication cyst. Melanophages were present focally in the submucosa, superficial muscle layer, and ulcer bases of the cyst and extensively as small nodules on the peritoneal surface and in the omentum. The tendency of perivascular nodular aggregation of melanophages favors a hematogenous (or lymphatic) spread rather than implantation. Although clear evidence of melanocytic aggregation is lacking, are speculate that the melanin originated from the esophageal-like squamous mucosa of the cyst.

Case reports: pseudomelanosis duodeni: association with systemic hypertension

Two male patients with mild gastrointestinal bleeding had peculiar dark pigmentation of their duodenum on upper endoscopy. These pigmented lesions were still present 3 months after the original endoscopy and after resolution of all other mucosal lesions. Both patients had other medical problems, including hypertension. They have been on multiple antihypertensive medications for many years. Biopsies of these duodenal lesions showed the pigment to be present inside the macrophages found in the lamina propria and in between the epithelial cells. Electron microscopy revealed a lysosomal localization of this pigment. This melanin-like pigment proved to contain varying amounts of iron, sulfur, and calcium. This pigmentation is closely associated with systemic hypertension, even in the pediatric population.

Melanosis of the esophagus. An endoscopic, histochemical, and ultrastructural study

Endoscopic, histological, and ultrastructural features of 21 cases of esophageal melanosis are described. These cases were detected during 1000 consecutive routine upper gastrointestinal endoscopies. Staining characteristics and ultrastructure of the pigment contained in the endoscopically visible lesions were found to be similar to those of true melanin.