Published in:
19-12-2022 | Endoscopy | Image of the Month
Speckled Pigment of Upper GI Tract Mucosa on Endoscopy: A Case of Pseudomelanosis of the Stomach and Proximal Small Bowel
Published in: Digestive Diseases and Sciences | Issue 4/2023
Login to get accessExcerpt
An 84-year-old female with a medical history of coronary artery disease and chronic kidney disease was referred for iron deficiency anemia. Push enteroscopy revealed hyperpigmentation and altered mucosal texture in the entire stomach (Fig. 1), duodenum (Fig. 2), and jejunum. These changes were more pronounced in the stomach and proximal small intestine. On colonoscopy, the colonic mucosa was normal, and a diffuse area of mild melanosis was found in the terminal ileum. Biopsies revealed pseudomelanosis of the stomach, duodenum, jejunum, and terminal ileum. Special staining of the tissue samples was done using both iron (Fig. 3) and Fontana stains. Both stains were found to be positive in intraepithelial pigment. The patient continued with iron supplementation with noted improvement in hemoglobin and iron studies on 1-month follow-up.
Fig. 1
Prepyloric stomach
Fig. 2
Fourth portion of duodenum
Fig. 3
Iron stain of the jejunum using Perl’s method. This method stains ferric iron (Fe3+) blue, nuclei red, and cytoplasm pink
× ![]()
× ![]()
× ![]()
…