Small bowel pseudomelanosis: Difference between revisions
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{{ 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. | '''Small bowel pseudomelanosis''' is benign change of the [[small bowel]] that mimics melanin deposition. | ||
In the duodenum it is known as ''' pseudomelanosis duodeni'''. | 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== | ==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 }} | *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> | </ref> | ||
Associations:<ref name=pmid18253910/> | Associations in a series of 17 individuals:<ref name=pmid18253910/> | ||
*[[Hypertension]] ~90% of cases. | *[[Hypertension]] ~90% of cases. | ||
*Iron supplementation ~75% of cases. | *Iron supplementation ~75% of cases. | ||
| Line 25: | Line 57: | ||
*Dark pigment in the lamina propria macrophages. | *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)]. | *[http://path.upmc.edu/cases/case616.html Pseudomelanosis duodeni - several images (upmc.edu)]. | ||
| Line 45: | Line 98: | ||
Comment: | Comment: | ||
Pseudomelanosis may be seen in the context of iron supplementation, hypertension | Pseudomelanosis may be seen in the context of iron supplementation, hypertension | ||
or chronic renal failure. | |||
The macrophages are positive with an iron stain. | 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> | </pre> | ||
==See also== | ==See also== | ||
*[[Pseudomelanosis coli]]. | *[[Pseudomelanosis coli]]. | ||
*[[Melanocytic lesions]]. | |||
==References== | ==References== | ||