Shitomi Yuki, Nishida Haruto, Kusaba Takahiro, Daa Tsutomu, Yano Shinji, Arakane Motoki, Kondo Yoshiyuki, Nagai Takayuki, Abe Takashi, Gamachi Ayako, Murakami Kazunari, Etoh Tsuyoshi, Shiraishi Norio, Inomata Masafumi, Yokoyama Shigeo
Department of Diagnostic Pathology, Faculty of Medicine Oita University, Oita, Japan.
Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine Oita University, Oita, Japan.
Pathol Int. 2017 Aug;67(8):389-397. doi: 10.1111/pin.12558. Epub 2017 Jun 28.
Lanthanum carbonate (LaC) is used to prevent hyperphosphatemia in dialysis patients. It is commonly believed that there is little LaC absorption from the intestines. However, La deposition in the gastric mucosa, which we coined "gastric lanthanosis", was recently reported. We describe here the clinicopathological features of and a possible mechanism for gastric lanthanosis. This study included 23 patients with definite gastric lanthanosis. We extracted characteristic clinicopathological features of gastric lanthanosis by computed tomography (CT) imaging and endoscopic, histologic, electron-microscopic, and element analysis examinations. The Helicobacter pylori infection rate in the lanthanosis group was much lower than that among the general population. The clinicopathological features characteristic of gastric lanthanosis were mucosal high-density linear appearance by CT, reflective bright-white spots (BWS) by gastroscopy, eosinophilic histiocytes occasionally phagocytizing foreign materials by histology, and numerous electron-dense particles in the histiocytes. The particles had burr-like skeletons resembling La crystals. Gastric lanthanosis is an under-reported, but not a rare lesion. It is characterized by endoscopic BWS and histologic eosinophilic histiocytes in dialysis patients treated with LaC. The proposed mechanism for gastric lanthanosis is that LaC is dissolved by gastric juice, crystallized within the mucosa and is phagocytized by histiocytes.
碳酸镧（LaC）用于预防透析患者的高磷血症。人们普遍认为肠道对LaC的吸收很少。然而，最近有报道称La在胃黏膜中沉积，我们将其称为“胃镧沉着症”。在此，我们描述胃镧沉着症的临床病理特征及可能的机制。本研究纳入了23例确诊为胃镧沉着症的患者。我们通过计算机断层扫描（CT）成像、内镜检查、组织学检查、电子显微镜检查和元素分析来提取胃镧沉着症的特征性临床病理特征。镧沉着症组的幽门螺杆菌感染率远低于普通人群。胃镧沉着症的特征性临床病理特征为CT显示黏膜高密度线性外观、胃镜检查可见反光性亮白色斑点（BWS）、组织学检查可见偶尔吞噬异物的嗜酸性组织细胞以及组织细胞内有大量电子致密颗粒。这些颗粒具有类似La晶体的毛刺状骨架。胃镧沉着症是一种报道不足但并不罕见的病变。其特征为在接受LaC治疗的透析患者中出现内镜下BWS和组织学嗜酸性组织细胞。胃镧沉着症的推测机制是LaC被胃液溶解，在黏膜内结晶并被组织细胞吞噬。
