You are here

Article Text

Article menu

Download PDFPDF

Images in…
Lanthanum deposition in the gastric mucosa in a patient treated with haemodialysis
Free
  1. Yasutoshi Shiratori and
  2. Noriaki Oguri
  1. Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
  1. Correspondence to Dr Yasutoshi Shiratori, shiraya{at}luke.ac.jp

https://doi.org/10.1136/bcr-2019-230550

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Description

    A 74-year-old man presented with chronic stomach discomfort and an episode of malaise that was associated with anaemia. The patient had a history of surgery for kidney cancer and was undergoing haemodialysis owing to a 7-year history of chronic renal failure; he had also been treated with lanthanum carbonate hydrate (62 months). Physical examination revealed mild pallor in his palpebral conjunctiva; however, no other abnormalities were observed. Plain CT revealed an area of high absorption along the lesser curvature of the stomach body (figure 1). Oesophagogastroduodenoscopy was subsequently performed. Although there were no signs of ulcers or tumours, white regional lesions, similar to those observed in cases involving xanthoma, were observed along the lesser curvature of the stomach body to the stomach antrum (figures 2 and 3). Atrophic changes were not found in most of the stomach body, but map-like redness was observed along the lesser curvature of the stomach body to the stomach angle. Histopathological analysis of the lesions showed increased histiocytes and lanthanum deposition (figure 4). In terms of gastric mucosa, regenerative changes and intestinal metaplasia were found. As the patient was taking lanthanum carbonate, we believed that the white lesions were due to lanthanum deposition. Lanthanum deposition in the stomach was classified as the endoscopic feature, diffuse whitish mucosa in the gastric body and annular whitish mucosa were observed in this case.1 It has been pointed out that lanthanum deposition may be associated with atrophic mucosa, intestinal metaplasia or foveolar hyperplasia.2–4 Although not all, those mucosal changes were thought to be associated with Helicobacter pylori infection. In our patient, anti-H. pylori immunoglobulin G antibody level was <3 U/mL, and pepsinogen-based test was positive, so this patient was thought as the prior H. pylori infection. This case was a typical case of lanthanum deposition with regenerative changes and intestinal metaplasia in the stomach.

    Figure 1
    Figure 1

    Plain CT revealed lanthanum deposition as an area of high-density absorption in the gastric mucosa (arrow).

    Figure 2
    Figure 2

    The white lesions were widely observed along the lesser curvature of the gastric body. The arrow indicates the biopsy sites.

    Figure 3
    Figure 3

    The white lesions extended to the gastric antrum.

    Figure 4
    Figure 4

    Biopsy of the white lesion revealed increased histiocytes and lanthanum deposition within the lamina propria (arrow). Regenerative changes and intestinal metaplasia were found in gastric mucosa.

    Learning points

    • Plain CT revealed an area of high absorption in stomach due to lanthanum deposition.

    • Lanthanum deposition in stomach also occurs in Helicobacter-negative patients.

    References

    1. ↵
      2. Murakami N ,
      3. Yoshioka M ,
      4. Iwamuro M , et al
      . Clinical characteristics of seven patients with lanthanum phosphate deposition in the stomach. Intern Med 2017;56:2089–95.doi:10.2169/internalmedicine.8720-16
      OpenUrl
    2. ↵
      2. Ban S ,
      3. Suzuki S ,
      4. Kubota K , et al
      . Gastric mucosal status susceptible to lanthanum deposition in patients treated with dialysis and lanthanum carbonate. Ann Diagn Pathol 2017;26:6–9.doi:10.1016/j.anndiagpath.2016.10.001
      OpenUrl
    3. ↵
      2. Hattori K ,
      3. Maeda T ,
      4. Nishida S , et al
      . Correlation of lanthanum dosage with lanthanum deposition in the gastroduodenal mucosa of dialysis patients. Pathol Int 2017;67:447–52.doi:10.1111/pin.12564
      OpenUrl
    4. ↵
      2. Iwamuro M ,
      3. Urata H ,
      4. Tanaka T , et al
      . Lanthanum deposition corresponds to white lesions in the stomach. Pathol Res Pract 2018;214:934–9.doi:10.1016/j.prp.2018.05.024
      OpenUrl

    Footnotes

    • Contributors NO and YS performed endoscopy. YS wrote and drafted this paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.