West B
Department of Pathology, Yale University School of Medicine, New Haven, CT 06510.
J Clin Gastroenterol. 1988 Apr;10(2):127-9.
Pseudomelanosis duodeni, speckled black pigmentation of the duodenal mucosa, presents a striking appearance at endoscopy. Among the 14 reported cases there is a predominance of black women greater than 40 years old, but it can occur in any race and age group. There is no known association with pigmentation elsewhere in the gastrointestinal tract or with the use of laxatives. However, most reported patients were hypertensive (many treated with hydralazine and propranolol) and significant numbers suffered from upper gastrointestinal bleeding, chronic renal failure, or diabetes mellitus. The pigment is usually located in mucosal macrophages, in lysosomes. Histochemical studies and electron probe microanalysis suggest that several pigments may result in this endoscopic appearance, including lipomelanin, ceroid, iron sulfide, and hemosiderin. Additional studies, possibly using tissue from surgical resections or autopsies, are needed to determine the etiology and clinical significance of this heterogeneous entity.
十二指肠假黑色素沉着症，即十二指肠黏膜出现斑点状黑色色素沉着，在内镜检查时呈现出显著外观。在已报道的14例病例中，40岁以上的黑人女性占多数，但任何种族和年龄组均可发生。目前尚无证据表明其与胃肠道其他部位的色素沉着或泻药的使用有关。然而，大多数报道的患者患有高血压（许多人使用肼屈嗪和普萘洛尔治疗），并且有相当数量的患者患有上消化道出血、慢性肾衰竭或糖尿病。色素通常位于黏膜巨噬细胞的溶酶体中。组织化学研究和电子探针微分析表明，几种色素可能导致这种内镜表现，包括脂褐素、类蜡质、硫化铁和含铁血黄素。可能需要使用手术切除组织或尸检组织进行进一步研究，以确定这种异质性病变的病因和临床意义。
