Clinical Snapshot
Gastric Lanthanosis—A Rare Place to Find a Rare-Earth Element
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A 57-year-old dialysis-dependent man listed for transplantation presented for diagnostic endoscopy; he had no abdominal symptoms. The examination revealed a clearly coarsened gastric mucosa with bright granular mucosal inclusions resembling multiple xanthelasmas. Histology found chronic type C/R gastritis with aggregated, in some cases multinuclear tissue macrophages featuring incorporated mineral/crystal structures (coarse particulate/fine granular [Prussian blue, Figure], brownish/eosinophil [hematoxylin and eosin, not shown]). On the basis of the patient’s medication history, the findings pointed to mucosal deposition of the rare-earth element lanthanum (so-called gastric lanthanosis), which is administered orally in the form of lanthanum carbonate (La2(CO3)3) to dialysis patients for control of hyperphosphatemia. Crystalline formations identified by electron microscopy of dried tissue sections showed spectral peaks specific for lanthanum on electron-dispersive X-ray spectroscopy (REM-EDX). Lanthanum binds to nutritional phosphates, subsequently precipitates as lanthanum phosphate, and is largely excreted. The residue is deposited in the gastrointestinal tract and downstream organ systems. According to the literature, mucosal lanthanum deposits are a prevalent yet underdiagnosed phenomenon. Depending on the amount of deposits, resulting organ dysfunction (for example, gastrointestinal dysmotility) has been reported. In view of the uncertain clinical relevance (no change of medication in our case), the findings should be documented and, if required, alternative treatment options considered.
Dr. med. Sanjai Shah Hauschild, Medizinisches Versorgungszentrum (MVZ) für Klinische Pathologie, Klinikum Darmstadt GmbH
sanjai.shahhauschild@mail.klinikum-darmstadt.de
Dr. med. Frank Sackmann, Gastroenterologische Praxis Erbach, Medizinisches Versorgungszentrum (MVZ) am Gesundheitszentrum Odenwaldkreis GmbH, Erbach
Dr. rer. nat. Felix Reinauer, Eduard Zintl-Institut für Anorganische und Physikalische Chemie, Technische Universität Darmstadt
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Hauschild SS, Sackmann F, Reinauer F: Gastric lanthanosis—a rare place to find a rare-earth element. Dtsch Arztebl Int 2021; 118: 874. DOI: 10.3238/arztebl.m2021.0087
