Melanosis Coli - An Atypical Presentation

BackgroundMelanosis Coli is described as black or brown discolouration of the mucosa of the colon. Its a benign condition, which arises from anthraquinone laxative abuse and has no symptoms of its own. The main importance of diagnosing Melanosis Coli correctly lies in the fact that if its extensive, there may be difficulty in differentiating it from ischemic colitis.Case presentationWe present a case of extensive Melanosis Coli involving the whole of large bowel that appeared gangrenous. A sub total colectomy was performed on presumed diagnosis of ischemic bowel.ConclusionThis report reminds the clinicians that extensive Melanosis Coli may mimic ischemic colitis and thus must be considered as a differential diagnosis.

We report the case of a 74-year-old female with an extreme picture of melanosis coli of the whole colon after chronic use of anthraquinone laxatives for the treatment of constipation over many decades. Endoscopic work-up revealed an impressive deep black pigmentation of the whole colon mucosa which could be verified by histopathology as a widespread lipofuscin granulation. In addition, various adenomas but no colorectal carcinoma could be detected. The term melanosis coli describes a brown or black pigmentation of the colonic mucosa. Induction of melanosis coli by anthraquinone laxatives and their derivatives can be regarded as verified. The question if melanosis coli predisposes for colorectal neoplasia is discussed controversially. Based on the current literature, an association of melanosis coli between colorectal adenomas, but not colorectal carcinomas, is under discussion but the mechanisms to effect the development of colorectal neoplasia are not completely understood. Considering our case and the current scientific backround, we conclude that due to pharmaceutical side effects of anthraquinone derivatives such as electrolytic shift and water loss in addition to the risk of developing melanosis coli, anthraquinone laxatives should not be used for long-term therapy of constipation.

Melanosis coli is a condition in which the colon develops a brown to black discoloration. It is associated with chronic laxative use and frequently diagnosed incidentally during colonoscopy or histopathologic evaluation. A 74-year-old woman presented to the Emergency Department with severe abdominal pain and bilious emesis. During a cecal volvulus repair, her melanosis coli was nearly misdiagnosed as bowel ischemia. Melanosis coli is a diagnostic finding that can easily be confused with bowel ischemia, which may create a dilemma for the surgeon who is attempting to make a decision regarding the extent of a colonic resection. As such, a pathology consult is warranted in any patient with suspected ischemic colitis and concerns for concomitant melanosis coli.

Melanosis coli (MC) is a benign condition found in 1% of general population. It is associated with high intake of anthranoid laxatives [1]. We herein report two cases of elderly patients with MC in whom this condition masked underlying diseases.

Melanosis coli (MC) combined with pneumatosis intestinalis (PI) is an exceedingly rare condition. We present the case of an 85-year-old male with a history of chronic constipation, hypertensive heart disease, and type 2 diabetes mellitus. The patient was admitted to the hospital because of an acute sigmoid volvulus with complete intestinal obstruction. After 3 days of conservative treatment, surgical intervention was performed, consisting of sigmoidectomy with volvulus reduction and formation of a descending colostomy. Histopathological examination confirmed MC with PI and associated mucosal necrosis. The patient, unfortunately, developed severe complications and eventually died of hemorrhagic shock and circulatory failure 22 days after surgery. This case explores the potential mechanisms underlying MC complicated by PI, emphasizing the need for increased clinical vigilance in elderly diabetic patients with chronic constipation and pre-existing cardiovascular disease, particularly following the use of anthraquinone-based laxatives and alpha-glucosidase inhibitors (αGIs).

Adverse effects of laxatives: fact and fiction.

Purpose: Melanosis is abnormal dark coloration of skin/mucosa. Although melanosis coli is common, it rarely involves the upper GI tract mucosa. Melanosis duodeni is a rare, benign clinical entity characterized by dark pigmentation of duodenal mucosa of uncertain etiology. We report a case with clinical, endoscopic and pathologic correlation of duodenal melanosis. Methods: A 69-year-old female with PMH of chronic GERD, HTN (treated with hydralazine and carvedilol), CHF, chronic renal disease on hemodialysis and anemia was referred by otorhinolaryngologist for endoscopic evaluation after laryngoscopy showed edema of posterior commissure consistent with GERD. She was seen by ENT for a chronic cough and dysphagia. Prior endoscopic findings five years ago were significant for reflux esophagitis, gastritis and PUD. She denied any symptoms of hematemesis, melena, diarrhea or constipation. Physical examination was unremarkable, including rectal exam and occult bleeding. Results: Laboratory findings were significant for anemia and renal failure. Panendoscopy was done where EGD revealed pigmented duodenal mucosa, erosive esophagitis and antral gastritis without active bleeding. Upon biopsy, microscopic histopathologic findings of chronic inflammatory cell infiltrates and foci of brown-black pigment in lamina propria were consistent with melanosis. H.pylori was negative. Colonoscopy was unremarkable except for diverticulosis and AV malformation without any pigmentation. Conclusions: Melanosis duodeni: endoscopically seen as discrete, flat, small, brown-black dark pigmented spots in the duodenal mucosa, and is generally considered to be local deposition of iron from oral iron intake. There is no known association with pigmentation elsewhere in the GI tract, or with the use of laxatives. On literature review, the exact mechanism is unknown; it is found to be associated with history of oral iron intake, upper GI bleeding, co-morbid conditions like HTN, ESRD, CHF, DM and certain medications like hydralazine or diuretics, most of which were present in our case. Although it is a benign condition of unclear clinical importance that does not require any specific therapy, endoscopists and pathologists must be aware of this rare entity.Figure: Chronic inflammatory cell infiltrates and foci of brown-black pigment in lamina propria consistent with melanosis in duodenum.

BackgroundMelanosis coli is a benign condition characterized by deposition of lipofuscin in colonic mucosa due to long-term laxative use.Case presentationHere I am reporting a case of an 85-year-old man who presented with constipation, with a history of long-term herbal medication intake as laxatives, and upon evaluation, he was found to have melanosis coli.ConclusionMelanosis coli is a common adverse effect of chronic laxative use which is more common in elderly population with constipation.

Melanosis coli is a brownish discoloration of the colonic mucosa caused by the accumulation of pigment in macrophages of the lamina propria. We reported a 62 years old woman with prolonged constipation since 10 years ago. She underwent haemorhoidectomy when 17 years old. Since 4 years ago she regularly comsumted herbal laxative. On 27 january 2015 underwent colonoscopy at Sardjito hospital Yogyakarta. Colonoscopic examination revealed Melanosis coli.

Peculiar Pigmented Polyp

Congenital left atrial appendage aneurysm is a rare condition caused by dysplasia of the atrial muscles. We report a case of a 14-year-old boy, with a 5-month history of cough and in sinus rhythm. Transthoracic echocardiography and computerized tomographic angiography confirmed the aneurysm of the left atrial appendage which was resected through median sternotomy on cardiopulmonary bypass. This case is presented not only for its rarity but also for its atypical clinical presentation.

Upper tract urothelial carcinoma (UTUC) is a rare clinical condition primarily characterized by symptoms such as gross or microscopic hematuria, flank pain, and renal colic. Although computed tomography urography (CTU) is currently the most accurate imaging modality for diagnosis, atypical presentations and physical examination findings can sometimes obscure lesions, posing diagnostic challenges. In this report, three patients exhibited atypical symptoms, sharing a common complaint of flank pain. Notably, the first patient, who had recently undergone laparoscopic right duplex nephrectomy, presented with microscopic hematuria, whereas the other two did not show any gross or microscopic hematuria. Computed tomography urography revealed hydronephrosis and infection without significant renal pelvic space-occupying lesions, with persistently elevated white blood cell (WBC) counts, but no fever. These atypical clinical presentations confounded clinicians, delaying the diagnosis of upper tract urothelial carcinoma until postoperative pathological examination for the first two patients and resulting in advanced-stage diagnosis for the third patient. Postoperative pathology confirmed high-grade invasive upper tract urothelial carcinoma in all three patients. Upper tract urothelial carcinoma can manifest atypically without hematuria and may be challenging to visualize on computed tomography urography, potentially leading to misdiagnosis. Therefore, clinicians should maintain a high level of suspicion for malignant tumors when patients exhibit hydronephrosis, infection on imaging, and persistently elevated white blood cell counts without fever, even in the absence of typical signs of upper urothelial carcinoma on computed tomography urography.

Cutaneous melanocytic proliferations are diverse both morphologically as well as in their behavioural patterns. Both dermatologists and pathologists regularly encounter diagnostic dilemmas while interpreting such lesions. To study all cutaneous premalignant and malignant lesions with respect to their clinical features and histopathological findings. A retrospective study was done in the Department of Pathology over a period of 10 years (2004-14) on all the clinically pigmented lesions that were biopsied or excised. Out of these only premalignant and malignant melanocytic lesions were analysed with respect to their important clinical and histologic features. Immunohistochemistry was carried out using HMB-45 and S-100 where indicated. A total of 338 skin cancers were reported, out of these 27, 7.9% were cutaneous malignant melanoma. Premalignant lesions were 33. The mean age for premalignant lesions and melanomas was 43 years and 50.7 years respectively with a male predominance in both groups. The sole of foot/ankle was the most common site of involvement by melanoma (n=8,29.6%) while sun exposed sites like face and scalp were common sites for development of premalignant lesions like dysplastic nevi, lentigo simplex, pigmented seborrheic keratosis and Bowens disease. One case presented as post-traumatic scar tissue which turned out to be desmoplastic melanoma. One case of amelanotic melanoma presented as recurrent painful penile ulcers. Both cases were confirmed on Immunohistochemistry. All pigmented lesions should be regarded as tumours of uncertain malignant potential and treated with complete excision if possible with long term follow up.

Background: Psoas muscle abscess is an accumulation of pus in the muscle compartement caused by a deep infection. This can be either primary or secondary infection. Primary cases of psoas muscle abscess usually appear after infection of the hematoma or spread of bacteria from a distant location to the lymphatic passage. Secondary psoas muscle abscess is often the result of a direct infection or from infection of nearby organs, which may also be associated with trauma or other instruments of groin, thighs and spine or beyond the pillow area. Psoas abscess is rare condition and often delayed because of the presentation of nonspecific symptoms. Case presentation: We describe a case of patient admitted to the hospital with infection of interference screw site after 3 years anterior cruciate ligament reconstruction at the Department of Trauma - Orthopedic Surgery, Hue University of Medicine and Pharmacy Hospital of Medicine and Pharmacy. During treatment, patients present with atypical psoas abscess with high fever and diarrhea and thigh pain. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have attention of clinical suspicion for iliopsoas abscess in patients presenting withthigh pain and fever and diarhea with the aims of better treatment. Conclusion: It is necessary to consider iliopsoas abscess as a differential diagnosis in patients presenting with fever, thigh pain and diarrhea. The rare condition with the varied clinical presentation means that cross-sectional imaging should be indicated early to reduce the risk of sepsis and death. Key words: bilateral psoas muscle abscess, atypical presentation, infection of ACL interference screw site.

Actinic reticuloid (AR) is a severe idiopathic, chronic, predominantly eczematous photodermatosis of elderly patients, characterized by marked photosensitivity to both UVB (280-315 nm) and UVA (315–400 nm) spectral wavebands. Cutaneous histopathological changes include a deep, dense lymphohistiocytic infiltrate sometimes containing mononuclear cells with hyperchromatic and convoluted nuclei, giant cells, Pautrier-like micro-abscesses and a resemblance to cutaneous T cell lymphoma. It has been suggested that progression to lymphoma can occasionally occur1, although this remains controversial. Aneuploidy, the occurrence of abnormal chromosomes, is present in 70–90% of solid malignant tumours and has been observed in pre-malignant conditions such as chronic atrophic gastritis, congenital pigmented hairy naevi and Bowen's disease.2 It has not, however, so far been identified in any entirely benign condition and its presence is thus considered implicit of malignancy or malignant potential. Flow cytometry (FCM) using DNA-specific stains permits the analysis of cellular DNA content and thus identification of anomalous chromosomes (aneuploidy). We have performed FCM on biopsies from six male AR patients aged 59–79 years. Formalin-fixed skin was processed with a FACS analyser. Dermal inflammatory cells and keratinocytes were assessed separately. No evidence of aneuploidy was noted in any patient. This suggests that AR is not a pre-malignant condition.