Small bowel pseudomelanosis: Difference between revisions

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'''~~Pseudomelanosis duodeni~~''' is benign change of the [[~~duodenum~~]] that mimics melanin deposition.

{{ Infobox diagnosis

| Name = {{PAGENAME}}

| Image = Small bowel pseudomelanosis - alt -- intermed mag.jpg

| Width =

| Caption = Small bowel pseudomelanosis. [[H&E stain]].

| Synonyms = pseudomelanosis duodeni (for [[duodenum]])

| Micro = dark pigment in the lamina propria macrophages

| Subtypes =

| LMDDx =

| Stains = iron stain +ve

| IHC =

| EM =

| Molecular =

| IF =

| Gross =

| Grossing =

| Staging =

| Site = [[small bowel]], [[stomach]]

| Assdx = iron deficiency [[anemia]], [[end-stage renal disease]], [[hypertension]]

| Syndromes =

| Clinicalhx = iron supplementation

| Signs =

| Symptoms =

| Prevalence = rare

| Bloodwork =

| Rads =

| Endoscopy = +/-dark spots

| Prognosis = benign

| Other =

| ClinDDx =

| Tx =

}}

'''Small bowel pseudomelanosis''' is benign change of the [[small bowel]] that mimics melanin deposition.

In the [[duodenum]] it is known as ''' pseudomelanosis duodeni'''.

Pseudomelanosis is described in the [[stomach]], [[duodenum]] and [[jejunum]].<ref name=pmid24492404>{{Cite journal | last1 = Rustagi | first1 = T. | last2 = Mansoor | first2 = MS. | last3 = Gibson | first3 = JA. | last4 = Kapadia | first4 = CR. | title = Pseudomelanosis of stomach, duodenum, and jejunum. | journal = J Clin Gastroenterol | volume = 49 | issue = 2 | pages = 124-6 | month = Feb | year = 2015 | doi = 10.1097/MCG.0000000000000081 | PMID = 24492404 }}</ref>

==General==

*Rare.

*Rare and benign.<ref name=pmid22493558>{{Cite journal | last1 = de Magalhães Costa | first1 = MH. | last2 = Fernandes Pegado | first2 = Mda G. | last3 = Vargas | first3 = C. | last4 = Castro | first4 = ME. | last5 = Madi | first5 = K. | last6 = Nunes | first6 = T. | last7 = Zaltman | first7 = C. | title = Pseudomelanosis duodeni associated with chronic renal failure. | journal = World J Gastroenterol | volume = 18 | issue = 12 | pages = 1414-6 | month = Mar | year = 2012 | doi = 10.3748/wjg.v18.i12.1414 | PMID = 22493558 }}</ref>

*Consists of iron and lipofuscin.<ref name=pmid2458404>{{Cite journal | last1 = Lin | first1 = HJ. | last2 = Tsay | first2 = SH. | last3 = Chiang | first3 = H. | last4 = Tsai | first4 = YT. | last5 = Lee | first5 = SD. | last6 = Yeh | first6 = YS. | last7 = Lo | first7 = GH. | title = Pseudomelanosis duodeni. Case report and review of literature. | journal = J Clin Gastroenterol | volume = 10 | issue = 2 | pages = 155-9 | month = Apr | year = 1988 | doi = | PMID = 2458404 }}

</ref>

Associations:<ref name=pmid18253910/>

Associations in a series of 17 individuals:<ref name=pmid18253910/>

*[[Hypertension]] ~90% of cases.

*Iron supplementation ~75% of cases.

*End-stage renal disease ~60% of cases.

*[[End-stage renal disease]] ~60% of cases.

Note:

Line 21:

Line 57:

*Dark pigment in the lamina propria macrophages.

Images:

===Images===

====Case 1====

Image: Small bowel pseudomelanosis -- low mag.jpg | SBP - low mag. (WC/Nephron)

Image: Small bowel pseudomelanosis -- intermed mag.jpg | SBP - intermed. mag. (WC/Nephron)

Image: Small bowel pseudomelanosis - alt -- intermed mag.jpg | SBP - intermed. mag. (WC/Nephron)

Image: Small bowel pseudomelanosis -- high mag.jpg | SBP - high mag. (WC/Nephron)

Image: Small bowel pseudomelanosis -- very high mag.jpg | SBP - very high mag. (WC/Nephron)

Image: Small bowel pseudomelanosis - iron -- intermed mag.jpg | SBP - intermed. mag. (WC/Nephron)

Image: Small bowel pseudomelanosis - iron -- high mag.jpg | SBP - high mag. (WC/Nephron)

</gallery>

====Case 2====

Image: Pseudomelanosis ileum -- very low mag.jpg | PI - very low mag. (WC)

Image: Pseudomelanosis ileum -- low mag.jpg | PI - low mag. (WC)

Image: Pseudomelanosis ileum -- intermed mag.jpg | PI - intermed. mag. (WC)

Image: Pseudomelanosis ileum -- high mag.jpg | PI - high mag. (WC)

Image: Pseudomelanosis ileum - alt -- high mag.jpg | PI - high mag. (WC)

Image: Pseudomelanosis ileum -- very high mag.jpg | PI - very high mag. (WC)

</gallery>

====www====

*[http://path.upmc.edu/cases/case616.html Pseudomelanosis duodeni - several images (upmc.edu)].

==Stains==

*Prussian blue +ve ~80% of cases.<ref name=pmid18253910/>

==Sign out==

===Small bowel===

<pre>

A. Stomach, Partial Excision as Part of a Sleeve Gastrectomy:

- Stomach wall within normal limits.

B. Small Bowel Wall, Partial Excision as Part of a Sleeve Gastrectomy:

- Small bowel wall with iron containing macrophages in the mucosa,

known as "pseudomelanosis", see comment.

- NEGATIVE for active inflammation.

- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Comment:

Pseudomelanosis may be seen in the context of iron supplementation, hypertension

or chronic renal failure.

The macrophages are positive with an iron stain.

</pre>

===Duodenum===

<pre>

Duodenum, Biopsy:

- Small bowel mucosa with pseudomelanosis, otherwise within

normal limits, see comment.

Comment:

Pseudomelanosis of the duodenum (pseudomelanosis duodeni) may be seen in the context of iron supplementation, hypertension or chronic renal failure. Endoscopically, it may manifest as dark spots.

The pigmented cells are POSITIVE with an iron stain, NEGATIVE with a PAS stain and NEGATIVE with a Fontana-Masson stain; these findings are in keeping pseudomelanosis duodeni.

</pre>

==See also==

*[[Pseudomelanosis coli]].

*[[Melanocytic lesions]].

==References==

@@ Line 1: / Line 1: @@
-'''Pseudomelanosis duodeni''' is benign change of the [[duodenum]] that mimics melanin deposition.
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Small bowel pseudomelanosis - alt -- intermed mag.jpg
+| Width      =
+| Caption    = Small bowel pseudomelanosis. [[H&E stain]].
+| Synonyms   = pseudomelanosis duodeni (for [[duodenum]])
+| Micro      = dark pigment in the lamina propria macrophages
+| Subtypes   =
+| LMDDx      =
+| Stains     = iron stain +ve
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      =
+| Grossing   =
+| Staging    =
+| Site       = [[small bowel]], [[stomach]]
+| Assdx      = iron deficiency [[anemia]], [[end-stage renal disease]], [[hypertension]]
+| Syndromes  =
+| Clinicalhx = iron supplementation
+| Signs      =
+| Symptoms   =
+| Prevalence = rare
+| Bloodwork  =
+| Rads       =
+| Endoscopy  = +/-dark spots
+| Prognosis  = benign
+| Other      =
+| ClinDDx    =
+| Tx         =
+}}
+'''Small bowel pseudomelanosis''' is benign change of the [[small bowel]] that mimics melanin deposition.
+In the [[duodenum]] it is known as ''' pseudomelanosis duodeni'''.
+Pseudomelanosis is described in the [[stomach]], [[duodenum]] and [[jejunum]].<ref name=pmid24492404>{{Cite journal  | last1 = Rustagi | first1 = T. | last2 = Mansoor | first2 = MS. | last3 = Gibson | first3 = JA. | last4 = Kapadia | first4 = CR. | title = Pseudomelanosis of stomach, duodenum, and jejunum. | journal = J Clin Gastroenterol | volume = 49 | issue = 2 | pages = 124-6 | month = Feb | year = 2015 | doi = 10.1097/MCG.0000000000000081 | PMID = 24492404 }}</ref>
 ==General==
-*Rare.
+*Rare and benign.<ref name=pmid22493558>{{Cite journal  | last1 = de Magalhães Costa | first1 = MH. | last2 = Fernandes Pegado | first2 = Mda G. | last3 = Vargas | first3 = C. | last4 = Castro | first4 = ME. | last5 = Madi | first5 = K. | last6 = Nunes | first6 = T. | last7 = Zaltman | first7 = C. | title = Pseudomelanosis duodeni associated with chronic renal failure. | journal = World J Gastroenterol | volume = 18 | issue = 12 | pages = 1414-6 | month = Mar | year = 2012 | doi = 10.3748/wjg.v18.i12.1414 | PMID = 22493558 }}</ref>
 *Consists of iron and lipofuscin.<ref name=pmid2458404>{{Cite journal  | last1 = Lin | first1 = HJ. | last2 = Tsay | first2 = SH. | last3 = Chiang | first3 = H. | last4 = Tsai | first4 = YT. | last5 = Lee | first5 = SD. | last6 = Yeh | first6 = YS. | last7 = Lo | first7 = GH. | title = Pseudomelanosis duodeni. Case report and review of literature. | journal = J Clin Gastroenterol | volume = 10 | issue = 2 | pages = 155-9 | month = Apr | year = 1988 | doi =  | PMID = 2458404 }}
 </ref>
-Associations:<ref name=pmid18253910/>
+Associations in a series of 17 individuals:<ref name=pmid18253910/>
 *[[Hypertension]] ~90% of cases.
 *Iron supplementation ~75% of cases.
-*End-stage renal disease ~60% of cases.
+*[[End-stage renal disease]] ~60% of cases.
 Note:
@@ Line 21: / Line 57: @@
 *Dark pigment in the lamina propria macrophages.
-Images:
+===Images===
+====Case 1====
+<gallery>
+Image: Small bowel pseudomelanosis -- low mag.jpg | SBP - low mag. (WC/Nephron)
+Image: Small bowel pseudomelanosis -- intermed mag.jpg | SBP - intermed. mag. (WC/Nephron)
+Image: Small bowel pseudomelanosis - alt -- intermed mag.jpg | SBP - intermed. mag. (WC/Nephron)
+Image: Small bowel pseudomelanosis -- high mag.jpg | SBP - high mag. (WC/Nephron)
+Image: Small bowel pseudomelanosis -- very high mag.jpg | SBP - very high mag. (WC/Nephron)
+Image: Small bowel pseudomelanosis - iron -- intermed mag.jpg | SBP - intermed. mag. (WC/Nephron)
+Image: Small bowel pseudomelanosis - iron -- high mag.jpg | SBP - high mag. (WC/Nephron)
+</gallery>
+====Case 2====
+<gallery>
+Image: Pseudomelanosis ileum -- very low mag.jpg | PI - very low mag. (WC)
+Image: Pseudomelanosis ileum -- low mag.jpg | PI - low mag. (WC)
+Image: Pseudomelanosis ileum -- intermed mag.jpg | PI - intermed. mag. (WC)
+Image: Pseudomelanosis ileum -- high mag.jpg | PI - high mag. (WC)
+Image: Pseudomelanosis ileum - alt -- high mag.jpg | PI - high mag. (WC)
+Image: Pseudomelanosis ileum -- very high mag.jpg | PI - very high mag. (WC)
+</gallery>
+====www====
 *[http://path.upmc.edu/cases/case616.html Pseudomelanosis duodeni - several images (upmc.edu)].
 ==Stains==
 *Prussian blue +ve ~80% of cases.<ref name=pmid18253910/>
+==Sign out==
+===Small bowel===
+<pre>
+A. Stomach, Partial Excision as Part of a Sleeve Gastrectomy:
+- Stomach wall within normal limits.
+B. Small Bowel Wall, Partial Excision as Part of a Sleeve Gastrectomy:
+- Small bowel wall with iron containing macrophages in the mucosa,
+  known as "pseudomelanosis", see comment.
+- NEGATIVE for active inflammation.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+Comment:
+Pseudomelanosis may be seen in the context of iron supplementation, hypertension
+or chronic renal failure.
+The macrophages are positive with an iron stain.
+</pre>
+===Duodenum===
+<pre>
+Duodenum, Biopsy:
+- Small bowel mucosa with pseudomelanosis, otherwise within
+  normal limits, see comment.
+Comment:
+Pseudomelanosis of the duodenum (pseudomelanosis duodeni) may be seen in the context of iron supplementation, hypertension or chronic renal failure. Endoscopically, it may manifest as dark spots.
+The pigmented cells are POSITIVE with an iron stain, NEGATIVE with a PAS stain and NEGATIVE with a Fontana-Masson stain; these findings are in keeping pseudomelanosis duodeni.
+</pre>
 ==See also==
 *[[Pseudomelanosis coli]].
+*[[Melanocytic lesions]].
 ==References==

Small bowel pseudomelanosis: Difference between revisions

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