Lanthanum deposition in the gastrointestinal mucosa and regional lymph nodes in dialysis patients: Analysis of surgically excised specimens and review of the literature

Yabuki, Kei; Shiba, Eisuke; Hano, Hiroshi; Uchihashi, Kazuyoshi; Matsuyama, Atsuji; Haratake, Joji; Hisaoka, Masanori

doi:10.1016/j.prp.2016.07.017

Cited by 23 publications

(30 citation statements)

References 22 publications

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“…We named this under‐recognized condition “gastric lanthanosis” and defined it as La deposition in the gastric mucosa of dialysis patients treated with LaC. There were several previous studies on gastric lanthanosis, but most of these were case reports from Japan . The present report is the first comprehensive study with a proposed mechanism.…”

Section: Discussionmentioning

confidence: 87%

“…There were several previous studies on gastric lanthanosis, but most of these were case reports from Japan. [5][6][7][8][9][10][11][12] The present report is the first comprehensive study with a proposed mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…However lanthanum (La) deposition in the liver and bone has been reported in animal experiments . Contrary to conventional wisdom, there have been several reports of La deposition in the human gastric mucosa of dialysis patients treated with LaC since 2015 . In 2009, an autopsy report of a case of nephrogenic systemic fibrosis with La deposition in the mesenteric lymph nodes was published, but findings in the stomach were not described .…”

mentioning

confidence: 99%

“…2,4 Contrary to conventional wisdom, there have been several reports of La deposition in the human gastric mucosa of dialysis patients treated with LaC since 2015. [5][6][7][8][9][10][11][12] In 2009, an autopsy report of a case of nephrogenic systemic fibrosis with La deposition in the mesenteric lymph nodes was published, but findings in the stomach were not described. 13 This under-reported lesion has not been comprehensively investigated, and the clinical significance and mechanism remains unclear.…”

mentioning

confidence: 99%

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Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate

Yuki

Nishida

Kusaba

et al. 2017

Pathology International

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Lanthanum carbonate (LaC) is used to prevent hyperphosphatemia in dialysis patients. It is commonly believed that there is little LaC absorption from the intestines. However, La deposition in the gastric mucosa, which we coined "gastric lanthanosis", was recently reported. We describe here the clinicopathological features of and a possible mechanism for gastric lanthanosis. This study included 23 patients with definite gastric lanthanosis. We extracted characteristic clinicopathological features of gastric lanthanosis by computed tomography (CT) imaging and endoscopic, histologic, electron-microscopic, and element analysis examinations. The Helicobacter pylori infection rate in the lanthanosis group was much lower than that among the general population. The clinicopathological features characteristic of gastric lanthanosis were mucosal high-density linear appearance by CT, reflective bright-white spots (BWS) by gastroscopy, eosinophilic histiocytes occasionally phagocytizing foreign materials by histology, and numerous electron-dense particles in the histiocytes. The particles had burr-like skeletons resembling La crystals. Gastric lanthanosis is an under-reported, but not a rare lesion. It is characterized by endoscopic BWS and histologic eosinophilic histiocytes in dialysis patients treated with LaC. The proposed mechanism for gastric lanthanosis is that LaC is dissolved by gastric juice, crystallized within the mucosa and is phagocytized by histiocytes.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate

Yuki

Nishida

Kusaba

et al. 2017

Pathology International

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“…Histopathologically, lanthanum deposition in the gastric mucosa was first demonstrated by Makino et al in 2015 [2]. To date, numerous case reports have been published on lanthanum deposition [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Previous reports of endoscopic findings of lanthanum deposition in the gastric mucosa have varied widely.…”

Section: Introductionmentioning

confidence: 99%

Distribution of lanthanum carbonate in the gastric mucosa confirmed by electron microscopy with a magnified endoscopy: a case report and literature review

Yamada

Oyama

Tomori

et al. 2019

Clin J Gastroenterol

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We describe the case of a 70-year-old man with diabetic nephropathy undergoing hemodialysis. Four years following hemodialysis, he started taking lanthanum carbonate 1500 mg/day and lansoprazole 30 mg/day. Nine years following hemodialysis, he underwent screening esophagogastroduodenoscopy, which demonstrated the presence of the whitish cobblestone-like mucosa in the gastric corpus and multiple reddish depressed lesions with annular whitish mucosa in the antrum. With magnified narrow-band imaging endoscopy, a yellowish-white substance was observed in the villous structure, and subepithelial vessels were observed on the yellowish-white substance. Biopsies were taken from the whitish cobblestone-like mucosa of the upper corpus, a reddish depressed part of the antrum. Histologically, aggregates of cells containing amphophilic fine granular material were found in the mucosal interstitium. These cells stained positive for CD68 and were identified as histiocytes. Since he had been taking lanthanum carbonate for 5 years, we considered the possibility of histiocyte-mediated phagocytosis of lanthanum. Digital mapping via scanning electron microscopy with energy-dispersive X-ray spectrometry showed the presence of lanthanum and phosphorus in the interstitium and cytoplasm of histiocytes. The white, rough mucosa in the gastric body appeared 6 months following the commencement of lanthanum administration and still exists 3 years and 5 months after discontinuation of lanthanum.

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Gastric lanthanosis (lanthanum deposition) in an immunosuppressed patient that discontinued lanthanum carbonate seven years ago

Ullmann¹,

Erbersdobler²

2021

Clinical Case Reports

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A 72‐year‐old female patient used the oral phosphate binder lanthanum carbonate for 6 years, before discontinuing it after receiving a pancreas and kidney transplant. Now, 7 years after discontinuation, the patient developed bilious emesis. An upper gastrointestinal endoscopy showed an unspecific gastritis. Biopsies showed subepithelial crystalline deposits consistent with gastric lanthanosis.

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Lanthanum deposition in the gastrointestinal mucosa and regional lymph nodes in dialysis patients: Analysis of surgically excised specimens and review of the literature

Cited by 23 publications

References 22 publications

Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate

Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate

Distribution of lanthanum carbonate in the gastric mucosa confirmed by electron microscopy with a magnified endoscopy: a case report and literature review

Gastric lanthanosis (lanthanum deposition) in an immunosuppressed patient that discontinued lanthanum carbonate seven years ago

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