title: Lanthanum deposition from oral lanthanum carbonate in the upper gastrointestinal tract.
abstract: OBJECTIVE
  Lanthanum carbonate is used as an alternative to calcium-based phosphate binders to manage hyperphosphataemia in patients with renal failure. The deposition of lanthanum within gastroduodenal mucosa of patients treated with the medication has been described, but given the relative novelty of this entity, the histiocytic deposits in the gastroduodenal mucosa can be confused with a variety of other processes, including infections and other drug-induced forms of injury.
  
  
  RESULTS
  We describe five cases of lanthanum phosphate deposition in upper gastrointestinal (GI) tract biopsies. Three cases were confirmed with scanning electron microscopy and energy dispersive X-ray analysis, including one unique patient, status post-renal transplant for polycystic kidney disease, who had last taken lanthanum 7 years prior to biopsy.
  
  
  CONCLUSIONS
  Lanthanum deposition in the upper GI tract is a mimic of other drug-related forms of GI injury, including iron pill-related gastropathy. The key to making this diagnosis is a thorough drug history and awareness of the histological features.
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Raza S
authors.initials: RS
authors.lastname: Hoda
authors.affiliation: Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Soma
authors.initials: S
authors.lastname: Sanyal
authors.affiliation: Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Jerrold L
authors.initials: JL
authors.lastname: Abraham
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Everett
authors.affiliation: Department of Medicine, Nephrology Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Hundemer
authors.affiliation: Department of Pathology, Beth Israel Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Eric
authors.identifier: http://orcid.org/0000-0001-9643-6439
authors.initials: E
authors.lastname: Yee
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.affiliation: Department of Medicine, Nephrology Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Tolkoff-Rubin
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joseph
authors.identifier: http://orcid.org/0000-0001-8912-6889
authors.initials: J
authors.lastname: Misdraji
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications; D007811:Lanthanum / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D041742:Upper Gastrointestinal Tract / Q000187:drug effects* / Q000473:pathology*
chemical_list: C119467:lanthanum carbonate; D007811:Lanthanum
keywords: duodenum; histiocytosis; lanthanum carbonate; stomach