Distribution of lanthanum carbonate in the gastric mucosa confirmed by electron microscopy with a magnified endoscopy: a case report and literature review

AbstractWe describe the case of a 70-year-old man with diabetic nephropathy undergoing hemodialysis. Four years following hemodialysis, he started taking lanthanum carbonate 1500 mg/day and lansoprazole 30 mg/day. Nine years following hemodialysis, he underwent screening esophagogastroduodenoscopy, which demonstrated the presence of the whitish cobblestone-like mucosa in the gastric corpus and multiple reddish depressed lesions with annular whitish mucosa in the antrum. With magnified narrow-band imaging endoscopy, a yellowish–white substance was observed in the villous structure, and subepithelial vessels were observed on the yellowish–white substance. Biopsies were taken from the whitish cobblestone-like mucosa of the upper corpus, a reddish depressed part of the antrum. Histologically, aggregates of cells containing amphophilic fine granular material were found in the mucosal interstitium. These cells stained positive for CD68 and were identified as histiocytes. Since he had been taking lanthanum carbonate for 5 years, we considered the possibility of histiocyte-mediated phagocytosis of lanthanum. Digital mapping via scanning electron microscopy with energy-dispersive X-ray spectrometry showed the presence of lanthanum and phosphorus in the interstitium and cytoplasm of histiocytes. The white, rough mucosa in the gastric body appeared 6 months following the commencement of lanthanum administration and still exists 3 years and 5 months after discontinuation of lanthanum.

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A Case of Esophageal Xanthoma with Epithelial Reactive Inflammation with a Characteristic Finding of Narrow-Band Imaging Magnifying Endoscopy

Digestive Diseases ◽

10.1159/000501448 ◽

2019 ◽

Vol 38 (1) ◽

pp. 85-88

Author(s):

Hideki Mori ◽

Motohiko Kato ◽

Toshio Uraoka

Keyword(s):

Biopsy Specimen ◽

Narrow Band ◽

Narrow Band Imaging ◽

Basal Layer ◽

Excisional Biopsy ◽

Magnifying Endoscopy ◽

Thoracic Esophagus ◽

Characteristic Finding ◽

Capillary Loop ◽

White Substance

A 75-year-old woman had a 5 mm slightly elevated yellowish lesion in her thoracic esophagus. Narrow-band imaging magnifying endoscopy (NBI-ME) revealed aggregations of a tiny white substance beneath each intrapapillary capillary loop with weaving, dilatation, and a different shape. In this case, an irregular caliber was absent. The biopsy specimen taken from the lesion showed cells with large nuclei and increased chromatin clumping in the basal layer. These cells were positive for p53. Endoscopic submucosal dissection was performed for the purpose of excisional biopsy. Finally, it was diagnosed as an esophageal xanthoma with a benign epithelial reactive inflammation. This is the first report of esophageal xanthoma showing the characteristic NBI-ME finding of esophageal xanthoma. Further studies are required to determine whether the characteristic finding of NBI-ME is generally found in esophageal xanthomas.

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Usefulness of endoscopic brushing and magnified endoscopy with narrow band imaging (ME-NBI) to detect intestinal phenotype in columnar-lined esophagus

Journal of Gastroenterology ◽

10.1007/s00535-012-0589-9 ◽

2012 ◽

Vol 47 (10) ◽

pp. 1108-1114 ◽

Cited By ~ 5

Author(s):

Takahisa Murao ◽

Akiko Shiotani ◽

Yoshiyuki Yamanaka ◽

Yoshiki Kimura ◽

Hideaki Tsutsui ◽

...

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

Intestinal Phenotype ◽

Columnar Lined Esophagus ◽

Magnified Endoscopy

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Magnifying Endoscopic Features of Follicular Lymphoma Involving the Stomach: A Report of Two Cases

Case Reports in Gastrointestinal Medicine ◽

10.1155/2016/2082698 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Masaya Iwamuro ◽

Katsuyoshi Takata ◽

Seiji Kawano ◽

Nobuharu Fujii ◽

Yoshiro Kawahara ◽

...

Keyword(s):

Lymph Nodes ◽

Follicular Lymphoma ◽

Narrow Band ◽

Narrow Band Imaging ◽

Gastric Body ◽

Mesenteric Lymph Nodes ◽

Mesenteric Lymph ◽

Endoscopic Observation ◽

Structural Differences ◽

Detection And Recognition

A 70-year-old woman presented with follicular lymphoma involving the stomach, duodenum, jejunum, bone, and lymph nodes. Esophagogastroduodenoscopy revealed multiple depressed lesions in the stomach. Examination with magnifying endoscopy showed branched abnormal vessels along with gastric pits, which were irregularly shaped but were preserved. The second case was a 45-year-old man diagnosed with stage II1follicular lymphoma with duodenal, ileal, and colorectal involvement, as well as lymphadenopathy of the mesenteric lymph nodes. Esophagogastroduodenoscopy performed six years after the diagnosis revealed multiple erosions in the gastric body and angle. Magnifying endoscopic observation with narrow-band imaging showed that the gastric pits were only partially preserved and were destroyed in most of the stomach. Branched abnormal vessels were also seen. Pathological features were consistent with follicular lymphoma in both cases. The structural differences reported between the two cases appear to reflect distinct pathologies. Disappearance of gastric pits in the latter case seems to result from loss of epithelial cells, probably due to chronic inflammation. In both cases, branched abnormal vasculature was observed. These two cases suggest that magnified observations of abnormal branched microvasculature may facilitate endoscopic detection and recognition of the extent of gastric involvement in patients with follicular lymphoma.

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Gastric involvement by mantle cell lymphoma observed by magnified endoscopy with narrow-band imaging

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.10.018 ◽

2012 ◽

Vol 75 (2) ◽

pp. 421-422 ◽

Cited By ~ 2

Author(s):

Daisuke Norimura ◽

Hajime Isomoto ◽

Kunihiro Tsukasaki ◽

Daisuke Niino ◽

Kayoko Matsushima ◽

...

Keyword(s):

Mantle Cell Lymphoma ◽

Narrow Band ◽

Cell Lymphoma ◽

Narrow Band Imaging ◽

Mantle Cell ◽

Magnified Endoscopy

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Sa1695 Usefulness of the Demarcation Line in Magnified Endoscopy-Combined Narrow Band Imaging for Determining the Expanded Area of Early-Stage Differentiated Gastric Carcinoma

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.04.215 ◽

2012 ◽

Vol 75 (4) ◽

pp. AB247

Author(s):

Kouichi Nonaka ◽

Masaaki Namoto ◽

Hideki Kitada ◽

Michio Shimizu ◽

Yasutoshi Ochiai ◽

...

Keyword(s):

Gastric Carcinoma ◽

Narrow Band ◽

Narrow Band Imaging ◽

Early Stage ◽

Demarcation Line ◽

Magnified Endoscopy

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Comprehensive Investigation of Areae Gastricae Pattern in Gastric Corpus using Magnifying Narrow Band Imaging Endoscopy in Patients with Chronic Atrophic Fundic Gastritis

Helicobacter ◽

10.1111/j.1523-5378.2012.00938.x ◽

2012 ◽

Vol 17 (3) ◽

pp. 224-231 ◽

Cited By ~ 23

Author(s):

Hiromitsu Kanzaki ◽

Noriya Uedo ◽

Ryu Ishihara ◽

Kengo Nagai ◽

Fumi Matsui ◽

...

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

Comprehensive Investigation ◽

Gastric Corpus

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Differences in image-enhanced endoscopic findings between Helicobacter pylori-associated and autoimmune gastritis

Endoscopy International Open ◽

10.1055/a-1287-9767 ◽

2021 ◽

Vol 09 (01) ◽

pp. E22-E30

Author(s):

Minoru Kato ◽

Noriya Uedo ◽

Ervin Toth ◽

Satoki Shichijo ◽

Akira Maekawa ◽

...

Keyword(s):

Helicobacter Pylori ◽

Narrow Band ◽

Narrow Band Imaging ◽

Autoimmune Gastritis ◽

Autofluorescence Imaging ◽

Mucosal Atrophy ◽

Endoscopic Findings ◽

Gastric Corpus ◽

H Pylori ◽

Lesser Curvature

Abstract Background and study aims The aim of this study was to elucidate the differences in image-enhanced endoscopy (IEE) findings between Helicobacter-pylori-associated and autoimmune gastritis. Patients and methods Seven H. pylori-naïve, 21 patients with H. pylori-associated gastritis and seven with autoimmune gastritis were enrolled. Mucosal atrophy in the corpus was evaluated using autofluorescence imaging and classified into small, medium and large. In a 2 × 2-cm area of the lesser curvature of the lower corpus, micromucosal pattern was evaluated by magnifying narrow band imaging and proportion of foveola (FV)- and groove (GR)-type mucosa was classified into FV > 80 %, FV 50 % to 80 %, GR 50 % to 80 %, and GR > 80 %, then a biopsy specimen was taken. Results Fifteen of 21 (71 %) H. pylori-associated gastritis patients exhibited medium-to-large atrophic mucosa at the corpus lesser curvature. All autoimmune gastritis patients had large atrophic mucosa throughout the corpus (P < 0.001). All H. pylori-naïve patients had the FV > 80 % micromucosal pattern. Nineteen of 21 (90 %) H. pylori-associated gastritis patients had varying proportions of GR- and FV-type mucosae and five of seven (71 %) autoimmune gastritis patients showed FV > 80 % mucosa (P < 0.001). Compared with patients who were H. pylori-naïve, patients with H. pylori-associated and autoimmune gastritis exhibited a higher grade of atrophy (P < 0.001), but only patients with H. pylori-associated gastritis showed a higher grade of intestinal metaplasia (P = 0.022). Large mucosal atrophy with FV > 80 % micromucosal pattern had sensitivity of 71 % (95 % CI: 29 %–96 %) and specificity of 100 % (95 % CI: 88 % to 100 %) for diagnosis of autoimmune gastritis. Conclusions IEE findings of the gastric corpus differed between H. pylori-associated and autoimmune gastritis, suggesting different pathogenesis of the two diseases.

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