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Case of the Week #231

2 February 2012 - Case of the Week #231

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(1) Check out our new CME page, which has a link on the left side of the Home page.

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(3) We posted an article on our Management Page, Thoughts for the New Year (2012), by Mick Raich, Vachette Pathology, click here.

Case of the Week #231

Clinical History:

94 year old woman with GI bleed presents for upper and lower endoscopy. Endoscopist notes “spotty hyperpigmentation throughout duodenum without other associated abnormalities."

Micro images:

               

What is your diagnosis?































Diagnosis:

Melanosis duodeni

Discussion:

Melanosis duodeni, also known as pseudomelanosis duodeni, is due to brown-black pigment in macrophages in the lamina propria of the proximal duodenum. It is often, but not always, identified at endoscopy. It is due to iron or sulfur (J Formos Med Assoc 1995;94:632), and may be associated with oral iron intake, hypertension, diabetes or end stage renal disease (Endoscopy 2008;40:165). It is not associated with laxative abuse (J Clin Gastroenterol 1988;10:127). It is also not associated with lipofuscin pigment, which is identified in melanosis coli.

Melanosis duodeni has no known clinical significance.



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