PMC5967158_01
Esophagogastroduodenoscopy findings (white light and narrow band imaging). A subepithelial lesion with a 10-mm central umbilication with a loss of gland duct on the superficial depressed surface was identified.
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Although magnification did not show irregular epithelium or vessels at the margin around the lesions, loss of gland ducts was clearly observed on the superficial depressed surface (Figure 1).
Endoscopic ultrasonography findings (UM-3R and GF-UE260, Olympus). A solid and hypoechoic mass with hypervascularity on color Doppler imaging that proliferating mainly in the submucosal layer was found.
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A partial exposure of the tumor on the superficial layer was found (Figure 2).
Histological findings of biopsy specimen: (A) HE, (B) CD7, (C) CD20, (D) MIB-1, (E) Vimentin, (F) CD10. These findings suggested the gastric metastasis from clear cell renal cell carcinoma.
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Immunostaining (Figure 3) revealed negativity for all epithelial markers, (CK7, CK20, EMA, CK5/6, p63).
Computed tomography showed a large mass with early enhancement in the right kidney (C) with inferior vena cava invasion (B). In addition, metastatic lesion in the liver (A) and lung (D) also observed.
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Metastasis was suggested for a 10-mm mass observed in the right lung, S9 (Figure 4).