Lanthanum Gastropathy in Gastrectomy Specimen: A Case Report

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Introduction: Lanthanum carbonate is a non-calcemic phosphate binder that is used in end-stage renal disease (ESRD.) It has few adverse effects due to its poor systemic absorption. Gastrointestinal lanthanum deposition was first reported in 2015 and is likely due to alterations in epithelial permeability from inflammation in chronic kidney disease. Endoscopy findings include gastritis, erosions, ulcerations, and polyps, with a diffusely white mucosa and fine granular deposits. It is challenging to detect these findings in cases with minimal microscopic deposition and may be missed on biopsy. Case Description: A 36-year-old with ESRD secondary to hypertension was started on lanthanum in 2017. She was evaluated by bariatric surgery in 2019 for sleeve gastrectomy and endoscopy was completed as part of the pre-operative workup. Findings were significant for gastritis and multiple gastric polyps. Biopsies demonstrated aggregates of histiocytes with granular eosinophilic material in the lamina propria. She underwent sleeve gastrectomy in 2022 in which the excised portion showed similar histiologic findings. There have been no further studies or adverse events reported since the surgery. Discussion: This case allows for the evaluation of a gross specimen as there have been no reports to date describing lanthanum gastropathy in specimens larger than biopsy. Not all patients taking lanthanum undergo endoscopic and histologic evaluation, but studies have found deposits in 60-85% of those evaluated. One case report found concurrent neoplastic changes, though this is the only description of such. The findings in this case were not consistent with neoplasm despite prolonged lanthanum use, but further studies must be conducted to determine long-term effects in patients with ESRD.Gastrectomy gross specimenEndoscopic findings

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