Endoscopically identified pseudomelanosis duodeni: striking yet harmless

A Rare Case of Duodenal Pseudomelanosis

“…Duodenal biopsy samples stained with routine hematoxylin and eosin (B) showed aggregates of pigment-laden macrophages in the lamina propria of the apical portion of the villi, which tested intensely positive with Perl's stain for iron; enterocytes demonstrated a faint positivity for Perl's Prussian blue underneath the microvilli (B, inset). These findings were consistent for duodenal pseudomelanosis, a benign condition which harbors no known clinical sequelae[1][2][3][4][5][6][7][8][9][10][11][12][13].…”

A Case of Pseudomelanosis Duodeni: Striking Endoscopic Features With Subtle but Characteristic Pathologic Findings

“…Pseudomelanosis duodeni is seen in middle-aged to elderly adults with slight female predominance. 1,2 Most of the patients with pseudomelanosis duodeni are asymptomatic. Although the exact etiology remains unknown, pseudomelanosis duodeni has been reported to be associated with several medical conditions such as end-stage renal disease, hypertension, diabetes, heart failure, gastrointestinal hemorrhage, and medications including oral iron therapy, furosemide, hydralazine, thiazide, and iron sulfate.…”

“…Although the exact etiology remains unknown, pseudomelanosis duodeni has been reported to be associated with several medical conditions such as end-stage renal disease, hypertension, diabetes, heart failure, gastrointestinal hemorrhage, and medications including oral iron therapy, furosemide, hydralazine, thiazide, and iron sulfate. 1,2 Our patient has a medical history of chronic kidney disease, hypertension, diabetes, and coronary artery disease. The finding of diffuse brown to black speckled spots is an endoscopic hallmark of pseudomelanosis duodeni.…”

“…Results of iron stain with Prussian blue is characteristically variable and unpredictable due to the autoxidation of iron sulfide to iron oxide, which stains positive with iron stain, whereas iron sulfide does not. 1,2 There has been no previous report demonstrating duodenitis, fibrosis, or ulceration caused by pseudomelanosis duodeni.…”

Pseudomelanosis Duodeni and Duodenal Polyp

“…There was only minimal iron deposition in this polyp ( Picture 4 ). Pseudomelanosis duodeni is an uncommon condition which is known to be associated with hypertension, diabetes mellitus, hemochromatosis, chronic kidney disease, and gastrointestinal bleeding ( 1 , 2 ). This is a rare description of a duodenal polyp in the context of pseudomelanosis duodeni that showed similar endoscopic findings to those typically seen in colonic polyps in melanosis coli.…”