Stomach
Other non-neoplastic lesions
Lanthanum carbonate deposition

Authors: Raul S. Gonzalez, M.D. (see Authors page)

Revised: 13 December 2017, last major update December 2017

Copyright: (c) 2017, PathologyOutlines.com, Inc.

PubMed Search: lanthanum carbonate deposition
Cite this page: Gonzalez, R.S. Lanthanum carbonate deposition . PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachLCD.html. Accessed February 25th, 2018.
Definition / general
  • Lanthanum carbonate is an oral phosphate binder used to treat hyperphosphatemia in patients with end stage renal disease
  • Recent reports have indicated that the medication can deposit throughout the gastrointestinal tract mucosa, most commonly in the stomach (Am J Surg Pathol 2015;39:767) but also in the small intestine and colon (Int J Surg Pathol 2016;24:89)
Essential features
  • Lanthanum may become embedded in the mucosa following digestion by gastric acid (Pathol Int 2017;67:389), and deposition may be detected years after cessation of therapy
  • Lanthanum deposition can be detected radiographically but is most often observed microscopically on biopsy tissue
Epidemiology
  • Patients with end stage renal disease
Gross description
  • Appears as aggregates of brown purple amorphous material in the mucosa, engulfed by epithelioid histiocytes
  • The overlying mucosa may be intact or eroded
  • The identity of the material can be confirmed by energy dispersive X-ray spectrometry, if necessary
Microscopic (histologic) images

Images hosted on PathOut server, contributed by Dr. Raul S. Gonzalez, University of Rochester Medical Center:

Case of the Week #442

von Kossa,
COW #442

Positive stains
Differential diagnosis
  • Mucosal calcinosis
  • Sodium polystyrene sulfonate (Kayexalate) may also be taken by patients with end stage renal disease
  • Iron can deposit in the stomach in patients taking iron pills but it usually has a distinctive appearance, namely large, coarse, brown chunks of iron (ACG Case Rep J 2013;1:13)
  • OsmoPrep, a sodium phosphate tablet used to prepare the bowel for endoscopy - this material appears as coarse black purple deposits along the superficial gastric mucosa and the background stomach may show reactive change (Am J Surg Pathol 2016;40:1550)
Board review question #1
A 35 year old man with no history of renal failure undergoes upper endoscopy and colonoscopy for abdominal pain. Crystalline material is observed deposited in his gastric mucosa. What is the most likely identity of this material?

A. Calcium
B. Iron
C. Kayexalate
D. Lanthanum
E. OsmoPrep
Board review answer #1
E. OsmoPrep, used to prepare the bowel for endoscopy