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• W2921133237 abstract "Pseudomelanosis duodeni is a rare endoscopic entity, characterized by black speckled pigmentation of the duodenum, with only a few cases reported in the literature. It has been associated with several medical conditions and various medications. A 65-year-old male with multiple medical comorbidities including coronary artery disease, end stage renal disease, heart failure, diabetes mellitus and peripheral vascular disease was admitted to our facility with right lower critical limb ischemia requiring balloon angioplasty. The patient's other medications included carvedilol, isosorbide dinitrate, hydralazine, ferrous sulfate, aspirin and atorvastatin. The patient's hospital course was complicated by onset of hematemesis requiring performance of an esophagogastroduodenoscopy which was notable for healing Mallory-Weiss tears and an incidental finding of diffuse speckled appearance of the entire duodenum. Duodenal biopsies revealed deposition of coarse dark-brown to black pigment, and SOX-10 and iron stains excluded the presence of melanocytic infiltration and hemosiderin deposition, respectively. Furthermore, the pigment was confirmed to be melanin using the Fontana Masson silver impregnation technique, indicating a diagnosis of pseudomelanosis duodeni (PMD). PMD is an uncommon but conspicuous endoscopic finding that is characterized by presence of multiple flat, small dark pigmented regions, seen primarily in the first and second parts of the duodenum. This benign condition has been reported infrequently in the literature and has been noted to occur predominantly in females in the sixth or seventh decade of life. Patients are most frequently asymptomatic but can present with gastrointestinal bleeding and epigastric pain in rare cases. PMD has been associated with end-stage renal disease, hypertension, congestive heart failure, diabetes mellitus, as well as many hypertensive medications and iron supplementation, such as was demonstrated in our patient. Although the exact pathogenesis and nature of pigment remains unknown, some believe it is secondary to iron sulfide and hemosiderin deposition within the macrophages of the duodenal lamina propria. However, in our case the iron stain was negative, and the true nature of pigment was confirmed to be melanin, making our patient's case even more unique. PMD can often lead to a diagnostic dilemma and cause apprehension, making accurate histopathologic diagnosis key in successful identification.2549_A Figure 1. Endoscopic image of pseudomelanosis duodeni present in the 2nd-3rd portions of the duodenum2549_B Figure 2. A: (H&E x200) Deposition of black pigment within duodenal villi. There is no inflammation, villous blunting or abnormal cell infiltrate accompanying the deposition. Immunostain for SOX-10 (B) confirms absence of melanocytic infiltration. The pigment is confirmed to be melanin by lack of staining with iron stain (C) and presence of silver impregnation on Fontana Masson stain (D)." @default.
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• W2921133237 date "2018-10-01" @default.
• W2921133237 modified "2023-09-25" @default.
• W2921133237 title "Pseudomelanosis Duodeni: A Rare Endoscopic Finding" @default.
• W2921133237 doi "https://doi.org/10.14309/00000434-201810001-02548" @default.
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