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

• Published in: Pathology international Vol. 67; no. 8; pp. 389 - 397
• Main Authors: Shitomi, Yuki, Nishida, Haruto, Kusaba, Takahiro, Daa, Tsutomu, Yano, Shinji, Arakane, Motoki, Kondo, Yoshiyuki, Nagai, Takayuki, Abe, Takashi, Gamachi, Ayako, Murakami, Kazunari, Etoh, Tsuyoshi, Shiraishi, Norio, Inomata, Masafumi, Yokoyama, Shigeo
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.08.2017
• Subjects: Adult; Aged; Aged, 80 and over; Bright spots; Computed tomography; Crystallization; Crystals; Deposition; Dialysis; dialysis patient; Endoscopy; eosinophilic histiocytes; Feature extraction; Female; Gastric juice; Gastric mucosa; Gastric Mucosa - pathology; Gastroscopy; Helicobacter pylori; Hemodialysis; Histiocytes - ultrastructure; Histology; Humans; Hyperphosphatemia; Hyperphosphatemia - prevention & control; Infections; Intestine; Lanthanum; Lanthanum - adverse effects; Lanthanum - analysis; lanthanum deposition; Leukocytes (eosinophilic); Male; Middle Aged; Mucous membrane; Particle physics; Patients; Renal Dialysis - adverse effects; stomach; dialysis patient; stomach; lanthanum deposition; eosinophilic histiocytes
• ISSN: 1320-5463; 1440-1827
• DOI: 10.1111/pin.12558

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.