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

Abstract

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.

Novel case of laparoscopically resected gastric adenocarcinoma concurrent with lanthanum deposition

“…Gastric carcinoma shows variable findings with endoscopy. In previous reports, early gastric cancer with lanthanum deposition was observed as a depressed area surrounded by annular whitish lanthanum‐deposited mucosa 8,13 and resected by endoscopy. Yabuki et al 11 summarized the cases of three patients with concurrent gastric cancer who underwent laparoscopic distal gastrectomy, but the endoscopic findings showed a clear boundary between the malignant tissue and surrounding mucosa with lanthanum deposition.…”

“…Lanthanum carbonate is one of the widely used phosphate binders that is taken orally to reduce the serum phosphate levels in patients with chronic kidney disease undergoing dialysis 1 Lanthanum carbonate. binds to dietary phosphate to form insoluble complexes that are excreted via the fecal route; however, recently lanthanum carbonate deposition has been reported in the gastric and duodenal mucosa of patients taking these medications 2–8 …”

“…1 Lanthanum carbonate binds to dietary phosphate to form insoluble complexes that are excreted via the fecal route; however, recently lanthanum carbonate deposition has been reported in the gastric and duodenal mucosa of patients taking these medications. [2][3][4][5][6][7][8] The endoscopic findings of gastric lanthanum deposition have been described as white lesions, elevations, erosions, and ulcerations. Moreover, sometimes those features might resemble those of carcinoma.…”

Gastropathy associated with lanthanum phosphate deposition that was endoscopically tracked for 3 years. A case report

“…Lanthanum carbonate is commonly used in dialysis patients to improve the hyperphosphatemia associated with chronic kidney disease. Specific gastric mucosal findings associated with the deposition of lanthanum have been reported in recent years in patients taking lanthanum carbonate [ 1 – 4 ]. Various endoscopic findings, such as white granular mucosa, ulcers, and erosion, are associated with lanthanum deposition; however, there have been no reports of changes over time in endoscopic findings in a single case from the onset of these changes.…”