Hoda Raza S, Sanyal Soma, Abraham Jerrold L, Everett Jamie M, Hundemer Gregory L, Yee Eric, Lauwers Gregory Y, Tolkoff-Rubin Nina, Misdraji Joseph
Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA.
Histopathology. 2017 Jun;70(7):1072-1078. doi: 10.1111/his.13178. Epub 2017 Mar 21.
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.
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.
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.
碳酸镧被用作钙基磷酸盐结合剂的替代品，用于治疗肾衰竭患者的高磷血症。已有文献描述了接受该药物治疗的患者胃十二指肠黏膜中镧的沉积情况，但鉴于该情况相对新颖，胃十二指肠黏膜中的组织细胞沉积可能会与多种其他病变相混淆，包括感染及其他药物性损伤形式。
我们描述了5例上消化道活检中磷酸镧沉积的病例。3例通过扫描电子显微镜和能量色散X射线分析得以确诊，其中包括1例独特的患者，该患者因多囊肾病接受肾移植，在活检前7年最后一次服用碳酸镧。
上消化道中镧的沉积类似于其他药物相关的胃肠道损伤形式，包括铁剂相关胃病。做出该诊断的关键是详尽的用药史以及对组织学特征的认识。
