2023 Volume 65 Issue 10 Pages 2187-2193
A 65-year-old man previously treated for Helicobacter pylori infection underwent hemodialysis for chronic renal failure and received lanthanum carbonate for 3 years. Lanthanum carbonate was approved for preventing hyperphosphatemia in patients undergoing dialysis for chronic renal failure in 2009, and is considered a highly safe drug because it shows little absorption in the gastrointestinal tract. Screening endoscopy demonstrated a reddish depressed lesion on the lesser curvature of the lower gastric body, and fine white granular discoloration was noted throughout the stomach, with intestinal metaplasia and mucosal atrophy. Biopsy specimens from the depressed lesion and surrounding mucosa revealed adenocarcinomas, including the presence of macrophages engulfing the brownish substance, which was suspected to be lanthanum carbonate in the nontumor gastric mucosa surrounding the cancer lesions. We made a diagnosis of intramucosal gastric cancers and performed one-piece ESD to remove both cancers. Based on the pathological examination, the two gastric cancer lesions were intramucosal well-differentiated adenocarcinomas with little lanthanum deposition in the tumor regions. Since lanthanum deposition may be associated with regenerative change, intestinal metaplasia, and/or foveolar hyperplasia of the gastric mucosa, endoscopic screening for gastric cancer may be effective in patients with chronic renal failure who are receiving lanthanum carbonate.
