Table of ContentsDefinition / general | Essential features | Epidemiology | Gross description | Microscopic (histologic) images | Negative stains | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1
Cite this page: Gonzalez RS. Lanthanum carbonate deposition. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachLCD.html. Accessed November 29th, 2021.
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 but also in the small intestine and colon (Am J Surg Pathol 2015;39:767, Int J Surg Pathol 2016;24:89)
- Lanthanum may become embedded in the mucosa following digestion by gastric acid; deposition may be detected years after cessation of therapy (Pathol Int 2017;67:389)
- Lanthanum deposition can be detected radiographically but is most often observed microscopically on biopsy tissue
- Patients with end stage renal disease
- Appears as aggregates of brown purple amorphous material in the mucosa, engulfed by epithelioid histiocytes
- Overlying mucosa may be intact or eroded
- Identity of the material can be confirmed by energy dispersive Xray spectrometry, if necessary
Sample pathology report
- Stomach, fundus, biopsy:
- Stomach mucosal with reactive change and focal lanthanum carbonate deposition (see comment)
- Comment: The patient’s history of end stage renal disease and use of oral lanthanum carbonate deposition is noted. The deposited material is negative on von Kossa special stain.
- Mucosal calcinosis:
- Positive on von Kossa stain
- Sodium polystyrene sulfonate (Kayexalate):
- May also be taken by patients with end stage renal disease
- 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)
- 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 style 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?