Small bowel pseudomelanosis

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Pseudomelanosis duodeni is benign change of the duodenum that mimics melanin deposition.

It is also described in stomach and jejunum.[1]

General

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

Associations:[3]

Note:

Gross/endoscopic

  • Dark spots ~35% of cases.[3]

Microscopic

Features:

  • Dark pigment in the lamina propria macrophages.

Images:

Stains

  • Prussian blue +ve ~80% of cases.[3]

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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 
and chronic renal failure. 

The macrophages are positive with an iron stain. 

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. 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.
  3. 3.0 3.1 3.2 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.