{"id":4571,"date":"2020-12-29T09:00:27","date_gmt":"2020-12-29T09:00:27","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/melanosis-coli\/"},"modified":"2022-06-17T13:40:24","modified_gmt":"2022-06-17T13:40:24","slug":"melanosis-coli","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/melanosis-coli\/","title":{"rendered":"Melanose c\u00f3lica \u2013 Melanosis coli"},"content":{"rendered":"

Melanose c\u00f3lica (<\/span>Melanosis coli<\/span><\/i> ou Lipofuscinose) consiste na presen\u00e7a de pigmento marrom em macr\u00f3fagos na mucosa do intestino grosso [1],[2]. A condi\u00e7\u00e3o, descrita pela primeira vez por Cruveilhier em 1829 [3] e chamada de <\/span>Melanosis coli<\/span><\/i> por Virchow em 1857 [4], foi inicialmente pensada como sendo devido \u00e0 presen\u00e7a de melanina. No entanto, estudos mostraram a presen\u00e7a de gr\u00e2nulos de lipofuscina ao inv\u00e9s de melanina em macr\u00f3fagos do c\u00f3lon [2],[5]. Desse modo, muitos sugerem o uso dos termos \u201cpseudomelanosis coli\u201d ou \u201clipofuscinose\u201d do c\u00f3lon para descri\u00e7\u00e3o dessa altera\u00e7\u00e3o.<\/span><\/p>\n

Existe uma forte associa\u00e7\u00e3o entre <\/span>Melanosis coli<\/span><\/i> e o uso excessivo de laxantes, em particular derivados de antraquinona [6], embora tamb\u00e9m possa ser visto em pacientes com doen\u00e7a inflamat\u00f3ria intestinal [5], diarreia cr\u00f4nica [7] ou com o uso de anti-inflamat\u00f3rios n\u00e3o esteroidais [8]. \u00c9 causada pela apoptose de c\u00e9lulas epiteliais do c\u00f3lon induzida pela antraquinona, seguida de fagocitose dos restos celulares por macr\u00f3fagos [9].<\/span><\/p>\n

A <\/span>Melanosis coli<\/span><\/i> \u00e9 mais frequentemente detectada durante a investiga\u00e7\u00e3o da constipa\u00e7\u00e3o de longa data e associa\u00e7\u00e3o com uso cr\u00f4nico de cat\u00e1rticos de antraquinona (incluindo c\u00e1scara sagrada, senna, aloe vera e ruibarbo). Essa pigmenta\u00e7\u00e3o ocorre, em geral, de forma mais pronunciada em c\u00f3lon direito e raramente acomete o \u00edleo, no entanto sua localiza\u00e7\u00e3o e intensidade podem ser vari\u00e1veis [6]. Vide figuras 1 e 2.<\/span><\/p>\n

Clique nas imagens para ampli\u00e1-las!<\/i><\/strong><\/p>\n

Figura 1: <\/span>Melanosis coli<\/span><\/i> em ceco<\/span>
\n\"melanosis<\/p>\n

Figura 2: <\/span>Melanosis coli<\/span><\/i> em sigmoide<\/span>
\n\"melanosis<\/a><\/p>\n

A presen\u00e7a de <\/span>Melanosis coli<\/span><\/i> tem associa\u00e7\u00e3o com um aumento significativo na detec\u00e7\u00e3o de adenomas, em especial \u2264 5 mm e isolados. Isso se deve \u00e0 maior facilidade de visualiza\u00e7\u00e3o dos adenomas mais claros em um fundo pigmentado (vide figuras 3, 4 e 5) [10]. Os adenomas raramente s\u00e3o pigmentados, embora haja relatos de melanosis neles [11].<\/span><\/p>\n

Figura 3: adenoma em paciente com <\/span>Melanosis coli<\/span><\/i>
\n<\/a>\"<\/a><\/p>\n

 <\/p>\n

Figura 4: aspecto com cromoscopia \u00f3ptica (NBI)<\/span><\/p>\n

\"aspecto<\/a><\/p>\n

 <\/p>\n

Figura 5: fotomicrografia de polipectomia. \u00c1rea central (n\u00e3o pigmentada) correspondente a adenoma.<\/span><\/p>\n

\"fotomicrografia<\/a><\/p>\n

 <\/p>\n

Como mostrado nas figuras 6 e 7, uma bi\u00f3psia submetida \u00e0 colora\u00e7\u00e3o de hematoxilina eosina mostra macr\u00f3fagos em l\u00e2mina pr\u00f3pria preenchidos com gr\u00e2nulos de pigmento de cor marrom.<\/span><\/p>\n

Figura 6: fotomicrografia mostrando macr\u00f3fagos com gr\u00e2nulos de pigmento na l\u00e2mina pr\u00f3pria<\/span><\/p>\n

\"fotomicrografia\"<\/a><\/p>\n

Figura 7: fotomicrografia mostrando macr\u00f3fagos com gr\u00e2nulos de pigmento (maior aumento)<\/span><\/p>\n

\"fotomicrografia\"<\/a><\/p>\n

A pigmenta\u00e7\u00e3o pode ocorrer ap\u00f3s o curto prazo de uso do laxativo, sendo encontrados relatos ap\u00f3s 6 meses de uso. Al\u00e9m disso, esta \u00e9 uma condi\u00e7\u00e3o revers\u00edvel, podendo regredir ap\u00f3s 1 ano de interrup\u00e7\u00e3o [12].<\/span><\/p>\n

Apesar da aus\u00eancia de rela\u00e7\u00e3o definida entre <\/span>Melanosis coli<\/span><\/i> e neoplasia [10], [11], esta pode n\u00e3o ser uma condi\u00e7\u00e3o inofensiva, visto que demonstra um sinal de agress\u00e3o cr\u00f4nica da mucosa, necessitando de mais estudos para uma conclus\u00e3o definitiva.<\/span><\/p>\n

Agradecimentos \u00e0 patologista Dra. Rafaela Pinheiro pelo fornecimento das figuras das l\u00e2minas.<\/span><\/p>\n

Como citar este artigo:<\/h2>\n

Oliveira JF. Melanose c\u00f3lica – Melanosis coli. Endoscopia Terap\u00eautica; 2020. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/melanosis-coli\/<\/span><\/p>\n

Refer\u00eancias:<\/h2>\n
    \n
  1. Steer HW, Colin-Jones DG. Melanosis coli: studies of the toxic effects of irritant purgatives. J Pathol. 1975; 115(4):199\u00b1205. https:\/\/doi.org\/10.1002\/path.1711150403 PMID: 1159566.<\/span><\/li>\n
  2. Ghadially FN, Parry EW. An electron-microscope and histochemical study of melanosis coli. J Pathol Bacteriol. 1966; 92(2):313\u00b17. https:\/\/doi.org\/10.1002\/path.1700920207 PMID: 5964370.<\/span><\/li>\n
  3. Cruveilhier J. Anatomie pathologique du corps humain, ou Descriptions, avec figures lithographie 301es et colorie301es, des diverses alte301rations morbides dont le corps humain est susceptible: Paris, 1829\u00b11835; 1835.<\/span><\/li>\n
  4. Virchow R. Die pathologischen Pigmente. Arch. Pathol. Ant, 1847; 1(2): 379\u00b1404. https:\/\/doi.org\/10. 1007\/BF01975874<\/span><\/li>\n
  5. Byers RJ, Marsh P, Parkinson D, et al. Melanosis coli is associated with an increase in colonic epithelial apoptosis and not with laxative use. Histopathology. 1997;30:160\u2013164.<\/span><\/li>\n
  6. 6. Freeman HJ. \u201cMelanosis\u201d in the small and large intestine. World J Gastroenterol. 2008;14:4296\u20134299.<\/span><\/li>\n
  7. 7. Marshall JB, Singh R, Diaz-Arias AA. Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal? Am J Gastroenterol. 1995; 90(3):372\u00b16. PMID: 7872272.<\/span><\/li>\n
  8. 8. Lee FD. Importance of apoptosis in the histopathology of drug related lesions in the large intestine. J Clin Pathol. 1993; 46(2):118\u00b122. PMID: 8459031.<\/span><\/li>\n
  9. 9. Walker NI, Smith MM, Smithers BM. Ultrastructure of human melanosis coli with reference to its pathogenesis. Pathology. 1993;25:120\u2013123.<\/span><\/li>\n
  10. 10. Blackett JW, Rosenberg R, Mahadev S, Green PHR, Lebwohl B. Adenoma Detection is Increased in the Setting of Melanosis Coli. J Clin Gastroenterol. 2018 Apr;52(4):313-318. doi: 10.1097\/MCG.0000000000000756. PubMed PMID: 27820223.<\/span><\/li>\n
  11. 11. Coyne JD. Melanosis coli in hyperplastic polyps and adenomas. Int J Surg Pathol. 2013;21:261\u2013263.<\/span><\/li>\n
  12. 12. Liu ZH, Foo DCC, Law WL, Chan FSY, Fan JKM, Peng JS. Melanosis coli: Harmless pigmentation? A case-control retrospective study of 657 cases. PLoS One. 2017 Oct 31;12(10):e0186668. doi: 10.1371\/journal.pone.0186668. eCollection 2017. PubMed PMID: 29088250; PubMed Central PMCID: PMC5663380.<\/span><\/li>\n<\/ol>\n

    Acesse o <\/span>Endoscopia Terap\u00eautica<\/span><\/a> para tomar contato com mais <\/span>artigos comentados<\/span><\/a>, <\/span>assuntos gerais<\/span><\/a>, <\/span>casos cl\u00ednicos<\/span><\/a>, <\/span>quizzes<\/span><\/a>, <\/span>classifica\u00e7\u00f5es<\/span><\/a> e mais!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    Melanose c\u00f3lica (Melanosis coli ou Lipofuscinose) consiste na presen\u00e7a de pigmento marrom em macr\u00f3fagos…<\/p>\n","protected":false},"author":2592,"featured_media":5268,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[146],"tipo":[156],"volume":[147],"class_list":["post-4571","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-146","tipo-colonoscopia","volume-volume-ii"],"yoast_head":"\nMelanose c\u00f3lica \u2013 Melanosis coli • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/melanosis-coli\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Melanose c\u00f3lica \u2013 Melanosis coli\" \/>\n<meta property=\"og:description\" content=\"Melanose c\u00f3lica (Melanosis coli ou Lipofuscinose) consiste na presen\u00e7a de pigmento marrom em macr\u00f3fagos na mucosa do intestino grosso ,. 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