Peritoneal implantation of meningeal melanosis via ventriculoperitoneal shunt: A case report and review of the literature

Systemic spread of primary intracranial neoplasms is rare and may be due to ventriculoperitoneal shunt (VPS). The most common tumors to metastasize via VPS are germinoma of the pineal gland and medulloblastoma. We report a case of 16-yr-old girl with central nervous system malignant melanosis who developed subsequent peritoneal implants via VPS. To the best of our knowledge, this patient represents the third reported case of meningeal melanosis or melanoma which metastasized to the peritoneal cavity via VPS. The VPS should be considered as possible mode of systemic spread in patients with primary cranial malignancy. © 1995 Wiley-Liss, Inc.     

Melanocytes and melanosis of the oesophagus in Japanese subjects — analysis of factors effecting their increase

Summary Normal oesophagus specimens taken from 65 autopsy cases and surgical specimens from 127 oesophageal carcinoma cases were examined histopathologically to determine melanocyte incidence and distribution. Melanocytes were found in the epithelio-stromal junction in 7.7% of normal oesophagus specimens examined at autopsy, and in 29.9% of surgical cases with oesophageal carcinoma. Positive specimens in the latter groups, especially from pre-operatively irradiated individuals, showed a more remarkable increase of melanocytes than was evident in any of the normal oesophageal samples. There were no significant differences in incidence between males and females, or between age groups. In cases where the cancer invaded into deeper stroma, the melanocytes were mainly observed in the normal epithelium around the carcinomas. Epithelial and stromal elements of the melanotic mucosa commonly showed hyperplastic changes such as acanthosis or basal cell hyperplasia, and chronic oesophagitis. Melanocytes were observed most commonly in the lower part of the oesophagus, the site where malignant melanoma of the oesophagus, most often originates. These results strongly suggest that the melanocyte increase observed in areas of hyperplastic epithelium and chronic oesophagitis may play an important role as a precursor lesion for malignant melanoma in the oesophagus.     

The use of ablative lasers in the treatment of facial melasma

Melasma represents a pigmentary disorder that is difficult to treat. This study aims to broadly review the use of ablative lasers (Er:YAG and CO2) in the treatment of melasma, presenting the level of evidence of studies published to date. A total of 75 patients were enrolled in four case series studies (n=39), one controlled clinical trial (n=6) and one randomized controlled clinical trial (n=30). Studies on the Er:YAG laser showed better results with the use of short square-shaped pulses, which determined low rates of post-inflammatory hyperpigmentation and long-lasting maintenance of results. Likewise, studies on the CO2 laser proved the benefits of short pulse duration along with low-density energy. Post-treatment maintenance with the use of antipigmenting creams was necessary and effective to sustain long-term results. Ablative lasers may represent another useful and effective tool against melasma. Postinflammatory hyperpigmentation and difficulty in sustaining long-term results still represent the main limitations to a broader use of ablative lasers. Based on actual evidence, the use of this technology should be restricted to patients with recalcitrant disease. Further studies will help establish optimal laser parameters and treatment regimens.     

“Melanosis” in the small and large intestine

Deposition of pigment in the intestinal mucosa is commonly observed by the endoscopist, especially within the colon, and particularly during investigations for constipation. Pigment may also be detected in the small intestine. Although labeled as melanosis, electron microscopy and X-ray analytical methods have provided evidence that this pigment is not melanin at all, but lipofuscin. Often, herbal remedies or anthracene containing laxatives are often historically implicated, and experimental studies in both humans and animal models have also confirmed the intimate relationship with these pharmacological or pseudo-pharmacological remedies. The appearance of melanosis coli during colonoscopy is largely due to pigment granule deposition in macrophages located in the colonic mucosa. The pigment intensity is not uniform, being more intense in the cecum and proximal colon compared to the distal colon. Possibly, this reflects higher luminal concentrations of an offending agent in the proximal compared to distal colon, differential absorption along the length of the colon, or finally, differences in macrophage distribution within the colon. Mucosal lymphoid aggregates normally display a distinct absence of pigment producing a ＂starry sky＂ appearance, especially in the rectosigmoid region. Interestingly, some focal, usually sessile, colonic mucosal neoplastic lesions, rather than submucosal lesions, may be better appreciated as pigment deposition may be absent or limited. If detected, removal and further histopathologic analysis of the polyp may be facilitated.     

Melanosis coli

The occurrence of large-bowel melanosis was evaluated by microscopy in 200 large bowels at autopsy. Melanin was seen as yellow-brown pigment in the macrophages of the lamina propria. The pigment stained with diastase-alcian blue PAS, Fontana, and iron stains. One hundred nineteen of 200 (59.5 percent) bowels showed melanosis, which was equally common in both sexes. Usually more than one segment was involved (most commonly, four segments). Melanosis was common in the proximal part of the colon, but much rarer in distal parts (sigmoid and rectum). Affected segments were successive; negative segments between positive ones were exceptional. If the rectum was affected, all five proximal segments were affected in 11 of 12 cases. The intensity of melanosis was directly related to the number of segments involved. In the oral part of the colon, affected males had a higher intensity of melanosis than affected women, but about the same intensity in the sigmoid and rectum. The fraction of patients with melanosis increased with age. Of men and women in the age group of 20 to 54 years, 32 and 44 percent were affected, and above the age of 75 years, 76 and 67 percent, respectively.     

中枢神经系统黑色素瘤的影像诊断

目的：本文通过6例中枢神经系统黑色素瘤的分析，对其特征性影像表现做一总结。方法：6例术前均经MR平扫及增强检查。1例经CT检查。结果：单发肿瘤3例，肿瘤呈短T1短T2信号1例，短T1长T2信号2例，肿瘤信号不均匀，边缘清。多发肿瘤3例，短T1长T2信号2例，等T1等T2信号1例。注药后肿瘤可见均匀增强。肿瘤内可有坏死。结论：黑色素瘤因含有顺磁性的黑色素而具有特征性的短T1短T2信号，常见于中颅凹底，小脑，额叶脑膜。应与出血性的脑膜瘤相鉴别。     

滋阴润肠汤治疗阴虚肠燥型结肠黑变病30例临床观察

目的探讨滋阴润肠汤治疗阴虚肠燥型结肠黑变病(melanosis coli,MC)的临床疗效。方法将我院门诊就诊的60例证属阴虚肠燥型的结肠黑变病患者,随机分为观察组和对照组两组,观察组给予滋阴润肠汤治疗,对照组给予乳果糖口服液加小麦纤维素治疗,疗程3个月,治疗期间不使用其他通便药物,经治疗后,比较两组患者临床症状和肠镜改善的情况。结果观察组临床症状疗效总有效率(96.7%)明显高于对照组(76.7%),观察组结肠镜下临床疗效总有效率(90.0%)也明显高于对照组(63.3%),两组差异均有统计学意义(P0.05)。结论滋阴润肠汤治疗阴虚肠燥型结肠黑变病临床疗效确切,值得临床推广使用。     

反射式共聚焦显微镜联合皮肤镜在瑞尔黑变病诊断中的应用

目的探讨瑞尔黑变病在反射式共聚焦扫描显微镜(RCM)和皮肤镜下的主要敏感图像特征。方法招募7例经病理确诊为瑞尔黑变病的患者,所有患者均经RCM和皮肤镜成像,记录并分析图像特征。结果皮损处RCM主要敏感图像特征:真表皮交界处模糊不清,基底细胞环不完整。真表皮交界处、真皮乳头处数量不等的形状不规则的高折光细胞,散在中等折光类圆形细胞浸润。毛囊口扩张、其内见弱折光物质。皮损处皮肤镜主要敏感图像特征:假网状结构、灰色点状颗粒结构、毛囊周围白晕、毛囊角栓、毛细血管扩张是瑞尔黑变病最显著的特征。结论RCM和皮肤镜可作为瑞尔黑变病的无创诊断手段。     

结肠黑变病156例回顾性分析

目的探讨结肠黑变病（MC）的发病特点及与结、直肠息肉的关系。方法回顾分析156例MC临床特点和结肠镜下表现。结果MC男性检出率0．46％，低于女性（0．66％），男性平均年龄（65．53±13．08）岁大于女性（53．73±13．50）岁，2001年至2007年历年MC检出率呈下降趋势，80％患者有不同程度便秘和服用泻药史。131例（84．0％）患者表现为全结肠黑变，黑变部位无性别差异，43例（27．5％）患者伴发息肉，与同期息肉检出率差异无统计学意义（r=1．205，P=0．298），Logistic回归分析表明MC伴发息肉与年龄相关，年龄越大，发生全结肠黏膜黑变及伴发息肉的可能性越大。结论MC以全结肠黑变为多，女性发病年龄早，检出率高；年龄越大，MC检出率越高，且伴发息肉可能性越大。     

Effect of the tumor promoter 12-O-tetradecanoylphorbol-13-acetate and its nonpromoting analogue 4-O-methyl-TPA on dorsal dermal melanocytes of the Syrian golden hamster (Mesocricetus auratus)

Summary The effect of the tumor promoter TPA and its inactive structural analogue 4-O-methyl-TPA on the induction of dorsal skin melanosis in the normal Syrian golden hamster and on the promotion of melanomas in DMBA-initiated animals was investigated. Both phenomena were observed in TPA-treated hamsters but could not be detected after exposure of animals to 4-O-methyl-TPA. In contrast to results obtained with a variety of other laboratory animals, neither TPA nor 4-O-methyl-TPA were able to induce epidermal hyperplasia of hamster dorsal skin.Abbreviations DMBA 7,12-dimethylbenz(a)anthracene - TPA 12-O-tetradecanoylphorbol-13-acetate