Intestinal ceroid deposition - "brown bowel syndrome". A light and electron microscopic study

Thirteen cases classified in our files as ceroid pigmentation of the intestinal wall ("brown bowel syndrome") are described. Clinically, all patients in this series had some symptoms of chronic bowel disease. The gut in this condition grossly demonstrates a variable orange-brown coloration. The ceroid pigment is difficult to identify in routine hematoxylin-eosin sections but may be demonstrated by a variety of special stains. In addition, ceroid may be identified by its golden-yellow autofluorescence under ultraviolet light. By electron microscopy, the deposited granules resemble ceroid deposits described in experimental animals. In addition to its occurrence in cases of chronic bowel disease, ceroid pigment was also found in 36 of 90 cases of cystic fibrosis (40%) and in 7 of 13 cases of congenital biliary atresia (54%). On the basis of pigment distribution and staining characteristics, brown bowel syndrome may be differentiated from melanosis coli and rectal ceroid histiocytosis.