Pseudomelanosis duodeni is seen endoscopically as dark spots in the duodenal mucosa and is generally considered to be local deposition of iron from oral iron intake. However, pseudomelanosis duodeni may be identified histologically even before it becomes endoscopically evident; iron stainability within the mucosa is uneven and unpredictable, and multiple clinical conditions other than oral iron intake may be associated. We reviewed 17 adult patients with histologically detected pseudomelanosis duodeni, their endoscopic appearances, iron stainability, and clinical findings including oral iron and drug intake. Only 6/17 (35 %) had endoscopically apparent dark spots. Perl’s iron stain was entirely positive in 18 %, partially positive in 64 %, and negative in 18 % of cases. History of oral iron was present in 76 % of patients, but other clinical conditions consistently associated were hypertension in 88 %, end stage renal disease in 59 %, and diabetes mellitus in 35 % of patients.
References
-
1
Bisordi W, Kleinman M.
Melanosis duodeni.
Gastrointest Endosc.
1976;
23
37-38
-
2
Breslaw L.
Melanosis of the duodenal mucosa.
Gastrointest Endosc.
1980;
26
45-46
-
3
Cowen M, Humphries T.
Pseudomelanosis of the duodenum.
Gastrointest Endosc.
1980;
26
107-108
-
4
Ganju S, Adomavicius J, Salgia K. et al .
The endoscopic picture of melanosis in the duodenum.
Gastrointest Endosc.
1980;
26
44-46
-
5
Sharp J, Insalaco S, Johnson L.
Melanosis of the duodenum associated with a gastric ulcer and folic acid deficiency.
Gastroenterology.
1980;
78
366-369
-
6
Pounder D, Ghadially F, Mukherjee T.
Ultrastructure and electron-probe X-ray analysis of the pigment in melanosis duodeni.
J Submicrosc Cytol.
1982;
14
389-400
-
7
Steckman M, Bozymski E.
Hemosiderosis of the duodenum.
Gastrointest Endosc.
1983;
29
329-327
-
8
Fisher S, Kahn E, Ellis D.
Melanosis duodeni in a child with congenital hepatic fibrosis and renal failure.
J Pediatr Gastrtoenterol Nutr.
1983;
2
567-569
-
9
Yamase H, Norris M, Gillies C.
Pseudomelanosis duodeni: a clinicopathologic entity.
Gastrointest Endosc.
1985;
31
83-86
-
10
Pounder D.
The pigment of duodenal melanosis is ferrous sulfide [letter].
Gastrointest Endosc.
1983;
29
257
-
11
Gupta T, Weinstock J.
Duodenal pseudomelanosis associated with chronic renal failure.
Gastrointest Endosc.
1986;
32
358-360
-
12
Ghadially F, Walley V.
Pigments of the gastrointestinal tract: a comparison of light microscopic and electron microscopic findings.
Ultrastruct Pathol.
1995;
19
213-219
-
13
Castellano G, Canga F, Lopez I.
Pseudomelanosis of the duodenum.
J Clin Gastroenterol.
1988;
10
150-154
-
14
Lee H, O’Donnell D, Keren D.
Characteristics of melanosis duodeni: incorporation of endoscopy, pathology, and etiology.
Endoscopy.
1987;
19
107-109
-
15
Lin H, Tsay S, Chiang H.
Pseudomelanosis duodeni.
J Clin Gastroenterol.
1988;
10
155-159
-
16
Rex D, Jersild R.
Further characterization of the pigmentin pseudomelanosis duodeni in three patients.
Gastroenterology.
1988;
95
177-182
-
17
Kuo Y C, Wu C S.
Duodenal melanosis.
J Clin Gastroenterol.
1988;
10
160-164
-
18
Kang J Y, Wu A Y, Chia J L. et al .
Clinical and ultrastructural studies in duodenal pseudomelanosis.
Gut.
1988;
28
1673-81
-
19
Fernando S.
Pseudomelanosis duodeni: a case report with electron-probe X-ray analysis.
Pathology.
1990;
22
169-172
-
20
El-Newihi H, Lynch C, Mihas A.
Case reports: pseudomelanosis duodeni: association with systemic hypertension.
Am J Med Sci.
1995;
310
111-114
-
21
Wang K, Lin H J, Perng C L. et al .
Pseudomelanosis duodeni: report of eight cases.
J Formos Med Assoc.
1995;
94
632-634
-
22
Leong S.
Pseudomelanosis duodeni and the controversial pigment clinical study of 4 cases.
Ann Acad Med Sing.
1992;
21
394-398
-
23
Pueblitz S, Squires R, Timmons C.
Pseudomelanosis duodeni in an adolescent male: case report and review of the literature.
Pediatr Pathol Lab Med.
1997;
17
115-123
-
24
Arguedas M, Lazenby A, Wilcox C.
Pseudomelanosis duodeni.
Gastrointest Endosc.
2000;
52
753
-
25
Weinstock L, Katzman K, Wang H.
Pseudomelanosis of stomach, duodenum and jejunum.
Gastrointest Endosc.
2003;
58
578
-
26
Cantu J, Adler D.
Pseudomelanosis duodeni.
Endoscopy.
2005;
37
789
-
27
West B.
Pseudomelanosis duodeni.
J Clin Gastroenterol.
1988;
10
127-129
D. Giusto, MD
Department of Pathology
Rush University Medical Center
1750 West Harrison St
Chicago, IL 60126
USA
Fax: +1-312-942 4228
eMail: Deborah_Giusto@rush.edu
