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a pass between mountain peaks (同)gap
a condition characterized by abnormal deposits of melanin (especially in the skin) (同)melanism

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(山脈の)鞍部(あんぶ),山あい

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/22 02:55:12」(JST)

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Melanosis coli identified on colonoscopy as a brownish moiré pattern on the wall of the colon.

Micrograph of melanosis coli, with the characteristic mucosal lipofuscin-laden macrophages (brown).

Melanosis coli, also pseudomelanosis coli, is a disorder of pigmentation of the wall of the colon, often identified at the time of colonoscopy. It is benign, and may have no significant correlation with disease. The brown pigment is lipofuscin in macrophages, not melanin.

Etiology

The most common cause of melanosis coli is the extended use of laxatives, and commonly anthraquinone containing laxatives such as Senna and other plant glycosides.^[1] The anthranoid laxatives pass through the gastrointestinal tract unabsorbed until they reach the large intestine, where they are changed into their active forms. The resulting active compounds cause damage to the cells in the lining of the intestine and leads to apoptosis (a form of cell death). The damaged (apoptotic) cells appear as darkly pigmented bodies that may be taken up by scavenger cells known as macrophages. When enough cells have been damaged, the characteristic pigmentation of the bowel wall develops. The condition can develop after just a few months of laxative use.^[2]

However, other causes are identified, including an increase in colonic epithelial apoptosis.^[3] Endoscopically, the mucosa may show a brownish discoloration in a moire pattern.

Histologic appearance

On biopsy, melanosis coli shows characteristic pigment-laden macrophages within the mucosa on PAS staining.^[4]

The histologic differential diagnosis of mucosal pigmentation is: lipofuscin (melanosis coli), hemosiderin-laden macrophages, and melanin (rare).

Prognosis

No adverse effects or consequences of melanosis coli have been identified.^[4]

Relation to true melanoses

The condition is unrelated to true melanoses, such as Peutz-Jeghers syndrome and smoker's melanosis.^[5]

Peutz-Jegher syndrome causes pigmentation of the skin and mucous surfaces with melanin, and polyps in the digestive tract.

Non-colonic pseudomelanoses

Pseudomelanoses of other parts of the gastrointestinal tract have also been reported, and are of unclear relevance.^[6]

Patients with colostomies can have melanosis involving the stoma, which is also of no significance.^[7]

Additional images

Micrograph showing melanosis coli, which appears as brown pigmentation in the macrophages in the lamina propria.
Micrograph of melanosis coli. H&E stain.
Micrograph of melanosis coli. H&E stain.

References

^ Müller-Lissner, SA. (Oct 1993). "Adverse effects of laxatives: fact and fiction.". Pharmacology 47 (Suppl 1): 138–45. doi:10.1159/000139853. PMID 8234421.
^ http://www.medicinenet.com/melanosis_coli/page2.htm
^ Byers, R.J.; Marsh, P.; Parkinson, D.; Haboubi, N.Y (October 2003). "Melanosis coli is associated with an increase in colonic epithelial apoptosis and not with laxative use". Histopathology 30 (2): 160–164. doi:10.1046/j.1365-2559.1997.d01-574.x. PMID 9067741.
^ ^a ^b Wittoesch, JH.; Jackman, RJ.; McDonald, JR. "Melanosis coli: general review and a study of 887 cases.". Dis Colon Rectum 1 (3): 172–80. PMID 13537819.
^ Vellappally, S.; Fiala, Z.; Smejkalová, J.; Jacob, V.; Somanathan, R. (2007). "Smoking related systemic and oral diseases.". Acta Medica (Hradec Kralove) 50 (3): 161–6. PMID 18254267.
^ Ghadially, FN.; Walley, VM. (Sep 1994). "Melanoses of the gastrointestinal tract.". Histopathology 25 (3): 197–207. doi:10.1111/j.1365-2559.1994.tb01319.x. PMID 7821887.
^ Fleischer, I.; Bryant, D. (May 1995). "Melanosis coli or mucosa ischemia? A case report.". Ostomy Wound Manage 41 (4): 44, 46–7. PMID 7598783.

External links

Endoscopic video of Melanosis coli, via the DAVE Project

UpToDate Contents

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English Journal

Melanosis Coli in Hyperplastic Polyps and Adenomata.

Coyne JD.AbstractMelanosis coli is a well-known occurrence in colonic biopsies. The condition is, however, reportedly absent in both neoplastic and hyperplastic colonic polyps. Herein, we describe its occurrence in 10 hyperplastic coloniuc polyps, some of which showed melanosis in adjacent biopsied mucosa, and 2 colonic adenomata.
International journal of surgical pathology.Int J Surg Pathol.2012 Dec 5. [Epub ahead of print]
Melanosis coli is a well-known occurrence in colonic biopsies. The condition is, however, reportedly absent in both neoplastic and hyperplastic colonic polyps. Herein, we describe its occurrence in 10 hyperplastic coloniuc polyps, some of which showed melanosis in adjacent biopsied mucosa, and 2 col
PMID 23222807

The impact of colonoscopy for colorectal cancer screening.

Alberti LR, De Lima DC, Rodrigues KC, Taranto MP, Gonçalves SH, Petroianu A.SourceMedical School of Federal University of Minas Gerais, Minas Gerais, Brazil. luizronaldoa@yahoo.com.br
Surgical endoscopy.Surg Endosc.2012 Nov;26(11):3157-62. doi: 10.1007/s00464-012-2308-2. Epub 2012 May 2.
BACKGROUND: Colorectal cancer is the second leading cause of cancer-related death. Prevention of this neoplasm should be achievable by screening programs in asymptomatic patients. The objective of the present paper is to assess colonoscopic findings in asymptomatic people submitted to screening.METH
PMID 22549378