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Duodenal haemosiderosis using narrow-band imaging
Digestive and Liver Disease 44 (2012) 1048
Contents lists available at SciVerse ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Duodenal haemosiderosis using narrow-band imaging Eun Sun Kim a , Hoon Jai Chun a,∗ , Bora Keum a , Chulwhan Kim b a Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Republic of Korea b Department of Pathology, Korea University, Anam Hospital, Seoul, Republic of Korea
a r t i c l e
i n f o
Article history: Received 15 June 2012 Accepted 12 July 2012 Available online 24 August 2012
Fig. 2.
Fig. 1.
A 67-year-old female patient with iron deficiency anaemia who had been taking ferrous sulphate tablets for seven years was referred to our institution because of indigestion. Esophagogastroduodenoscopy showed tiny, diffuse, brownish spots in her duodenal bulb mucosa (Fig. 1A). Magnified endoscopic findings with white light revealed brownish, finger-like villous formations with smooth edges arranged normally. On magnifying narrowband imaging (NBI), the micro-surface structure of the villi became distinct with light blue crests visualized on their edges. However, the microvasculature architecture within the villi was not visible. Instead, dark reddish-brown pigmentation was noted under the villi epithelium (Fig. 1B). A biopsy was taken and histologic findings were indicative of haemosiderosis. Macrophages, singly and in small collections, contain brown-black pigment within lamina propria and iron stain was positive (Fig. 2A, 100×, H and E stain). A high magnification view of Prussian blue stained duodenal
mucosa showed a positive reaction (Fig. 2B, 400×, iron stain). The haemosiderosis was considered as secondary to long-term oral iron medication. There was no evidence of haemolysis or haemochromatosis. This report is the first description of a magnifying NBI finding of haemosiderosis in the gastrointestinal tract. Instances of iron overload secondary to increased oral iron intake are unusual in normal individuals. The most common secondary haemosiderosis is the iron overload that develops as a consequence of multiple blood transfusions or chronic ingestion of oral iron [1]. Funding source: The Grant of Korea University. Reference [1] Giusto D, Jakate S. Pseudomelanosis duodeni: associated with multiple clinical conditions and unpredictable iron stainability—a case series. Endoscopy 2008;40:165–7.
∗ Corresponding author at: Division of Gastroenterology and Hepatology, Institute of Digestive Disease and Nutrition, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea. Tel.: +82 2 920 6555; fax: +82 2 953 1943. E-mail address: [email protected] (H.J. Chun). 1590-8658/$36.00 © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dld.2012.07.005
Contents lists available at SciVerse ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Duodenal haemosiderosis using narrow-band imaging Eun Sun Kim a , Hoon Jai Chun a,∗ , Bora Keum a , Chulwhan Kim b a Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Republic of Korea b Department of Pathology, Korea University, Anam Hospital, Seoul, Republic of Korea
a r t i c l e
i n f o
Article history: Received 15 June 2012 Accepted 12 July 2012 Available online 24 August 2012
Fig. 2.
Fig. 1.
A 67-year-old female patient with iron deficiency anaemia who had been taking ferrous sulphate tablets for seven years was referred to our institution because of indigestion. Esophagogastroduodenoscopy showed tiny, diffuse, brownish spots in her duodenal bulb mucosa (Fig. 1A). Magnified endoscopic findings with white light revealed brownish, finger-like villous formations with smooth edges arranged normally. On magnifying narrowband imaging (NBI), the micro-surface structure of the villi became distinct with light blue crests visualized on their edges. However, the microvasculature architecture within the villi was not visible. Instead, dark reddish-brown pigmentation was noted under the villi epithelium (Fig. 1B). A biopsy was taken and histologic findings were indicative of haemosiderosis. Macrophages, singly and in small collections, contain brown-black pigment within lamina propria and iron stain was positive (Fig. 2A, 100×, H and E stain). A high magnification view of Prussian blue stained duodenal
mucosa showed a positive reaction (Fig. 2B, 400×, iron stain). The haemosiderosis was considered as secondary to long-term oral iron medication. There was no evidence of haemolysis or haemochromatosis. This report is the first description of a magnifying NBI finding of haemosiderosis in the gastrointestinal tract. Instances of iron overload secondary to increased oral iron intake are unusual in normal individuals. The most common secondary haemosiderosis is the iron overload that develops as a consequence of multiple blood transfusions or chronic ingestion of oral iron [1]. Funding source: The Grant of Korea University. Reference [1] Giusto D, Jakate S. Pseudomelanosis duodeni: associated with multiple clinical conditions and unpredictable iron stainability—a case series. Endoscopy 2008;40:165–7.
∗ Corresponding author at: Division of Gastroenterology and Hepatology, Institute of Digestive Disease and Nutrition, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea. Tel.: +82 2 920 6555; fax: +82 2 953 1943. E-mail address: [email protected] (H.J. Chun). 1590-8658/$36.00 © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dld.2012.07.005