Pseudomelanosis of the Stomach and Duodenum

胃與十二指腸偽黑色素沉著症

鄭詠霖(Yeong-Lin Tay) ； 黃彼得(Pi-Teh Huang) ； 許秋潤(Chiew-Loon Koo)

《童綜合醫學雜誌》 14卷1期 (2020/06) Pp. 48-50

https://doi.org/10.3966/207135922020061401009

摘要

Pseudomelanosis of the stomach and duodenum is a rare and generally benign disease. However, the disease mechanism remains unclear. Here, we report the case of a 74-year-old man with a history of chronic kidney disease and hypertension. He was admitted due to end-stage renal disease with uremic syndrome and received hemodialysis. A gastroenterologist was consulted for severe anemia and positive fecal occult blood test. Upper endoscopy resulted in the incidental discovery of multiple discrete tiny black spot lesions in the antrum and duodenum; a biopsy was performed at the same time. Histological assessment showed hemosiderin-laden macrophages and moderately mixed inflammatory infiltrate consisting of lymphocytes, plasma cells, and eosinophils in the lamina propria. The iron stain revealed hemosiderin pigment deposition. These findings were consistent with the diagnosis of pseudomelanosis of the stomach and duodenum. This disease is not associated with significant clinical impact or long-term complications. Treatment is discontinuation of medication as described in the article.

關鍵字

Chronic renal failure ； Anti hypertensive drugs ； Pseudomelanosis duodeni ； Pigmentation ； Iron ； Melanin

並列摘要

胃與十二指腸偽黑色素沉著症是罕見良性的狀況。目前還不知道它真正的機轉。我們報告一個74歲本身有慢性腎衰竭和高血壓的男性病人，此次住院是因為慢性腎衰竭併尿毒症而需要住院洗腎。住院中因為嚴重的貧血和糞便潛血反應陽性而會診腸胃科。上消化道內視鏡發現胃竇和十二腸有廣泛散布黑褐色細小斑點。病理切片顯示，在固有層（lamina propia）內有許多的發炎細胞和深褐色的色素顆粒聚集在巨噬細胞（macrophage）內，這些顆粒對鐵染色呈現陽性反應。根據以上的發現診斷為胃與十二指腸偽黑色素沉著症。本病症通常不會造成病人之不適，也不會有長期併發症，無須特別治療，只要停用相關之藥物或可避免加重黑色素沉著。

並列關鍵字

慢性腎衰竭 ； 高血壓用藥 ； 十二指腸偽黑色素沉著症 ； 色素沉著 ； 鐵 ； 黑色素