title: Peculiar histiocytic lesions with massive lanthanum deposition in dialysis patients treated with lanthanum carbonate.
abstract: Pathologic lesions caused by lanthanum carbonate (LC), a recently developed phosphate-binding agent, have not been recorded. A peculiar gastroduodenal histiocytic lesion associated with a mucosal lanthanum overload was reported. Our routine gastrointestinal biopsy series included 6 cases with heavy lanthanum burden in the gastroduodenal mucosa. In addition to routine histopathologic examinations, a series of immunohistochemical analysis and electron microscopic examinations associated with x-ray diffraction and elemental analysis were performed. Six cases, 3 of male and 3 of female individuals with ages from 59 to 69 years, were all patients of end-stage renal diseases managed under dialysis and treated with LC for >21 months. Endoscopic examinations demonstrated gastric erosions in 3, gastric polyps in 2, and duodenal ulcer in 1. In the mucosal layer, there were numerous non-Langerhans cell histiocytes, stained with CD68 but not S100 protein, engulfing a large amount of mineral-like materials. An electron microscopic and elemental analysis revealed a similar distribution of lanthanum and phosphorus in the histiocytes. Long-standing LC administration can cause massive mucosal accumulation of lanthanum in the tissue histiocytes associated with several forms of gastroduodenal lesions. A long-standing outcome is not clear at present; hence, careful follow-up studies of these patients may be needed.
authors.affiliation: *Division of Pathology †The Kidney Center ‡Division of Endoscopic Research and Gastroenterology, Saiseikai Yahata General Hospital Departments of §Surgical Pathology ∥Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Haratake
authors.forename: Chikao
authors.initials: C
authors.lastname: Yasunaga
authors.forename: Akifumi
authors.initials: A
authors.lastname: Ootani
authors.forename: Shohei
authors.initials: S
authors.lastname: Shimajiri
authors.forename: Atsuji
authors.initials: A
authors.lastname: Matsuyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Hisaoka
mesh_terms: D000368:Aged; D004386:Duodenum / Q000737:chemistry / Q000473:pathology; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006644:Histiocytes / Q000737:chemistry / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007811:Lanthanum / Q000009:adverse effects* / Q000032:analysis; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000628:therapy
chemical_list: C119467:lanthanum carbonate; D007811:Lanthanum