Difference between revisions of "Small bowel pseudomelanosis"

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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.


It is also described in [[stomach]] 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>
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.
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*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)].


==Stains==
==Stains==
*Prussian blue +ve ~80% of cases.<ref name=pmid18253910/>
*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==
==See also==
*[[Pseudomelanosis coli]].
*[[Pseudomelanosis coli]].
*[[Melanocytic lesions]].


==References==
==References==

Latest revision as of 01:40, 15 July 2019

Small bowel pseudomelanosis
Diagnosis in short

Small bowel pseudomelanosis. H&E stain.
Synonyms pseudomelanosis duodeni (for duodenum)
LM dark pigment in the lamina propria macrophages
Stains iron stain +ve
Site small bowel, stomach
Associated Dx iron deficiency anemia, end-stage renal disease, hypertension
Clinical history iron supplementation
Prevalence rare
Endoscopy +/-dark spots
Prognosis benign

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.[1]

General

  • Rare and benign.[2]
  • Consists of iron and lipofuscin.[3]

Associations in a series of 17 individuals:[4]

Note:

Gross/endoscopic

  • Dark spots ~35% of cases.[4]

Microscopic

Features:

  • Dark pigment in the lamina propria macrophages.

Images

Case 1

  • SBP - low mag. (WC/Nephron)

  • SBP - intermed. mag. (WC/Nephron)

  • SBP - intermed. mag. (WC/Nephron)

  • SBP - high mag. (WC/Nephron)

  • SBP - very high mag. (WC/Nephron)

  • SBP - intermed. mag. (WC/Nephron)

  • SBP - high mag. (WC/Nephron)

Case 2

  • PI - very low mag. (WC)

  • PI - low mag. (WC)

  • PI - intermed. mag. (WC)

  • PI - high mag. (WC)

  • PI - high mag. (WC)

  • PI - very high mag. (WC)

www

Stains

  • Prussian blue +ve ~80% of cases.[4]

Sign out

Small bowel

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.

Duodenum

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.

See also

References

  1. ↑ Rustagi, T.; Mansoor, MS.; Gibson, JA.; Kapadia, CR. (Feb 2015). "Pseudomelanosis of stomach, duodenum, and jejunum.". J Clin Gastroenterol 49 (2): 124-6. doi:10.1097/MCG.0000000000000081. PMID 24492404.
  2. ↑ de Magalhães Costa, MH.; Fernandes Pegado, Mda G.; Vargas, C.; Castro, ME.; Madi, K.; Nunes, T.; Zaltman, C. (Mar 2012). "Pseudomelanosis duodeni associated with chronic renal failure.". World J Gastroenterol 18 (12): 1414-6. doi:10.3748/wjg.v18.i12.1414. PMID 22493558.
  3. ↑ Lin, HJ.; Tsay, SH.; Chiang, H.; Tsai, YT.; Lee, SD.; Yeh, YS.; Lo, GH. (Apr 1988). "Pseudomelanosis duodeni. Case report and review of literature.". J Clin Gastroenterol 10 (2): 155-9. PMID 2458404.
  4. ↑ 4.0 4.1 4.2 Giusto, D.; Jakate, S. (Feb 2008). "Pseudomelanosis duodeni: associated with multiple clinical conditions and unpredictable iron stainability - a case series.". Endoscopy 40 (2): 165-7. doi:10.1055/s-2007-995472. PMID 18253910.
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