case_images: PMC11199519_01
case_images: Enhanced CT showing right kidney mass, large curved cauliflower-like mass in the gastric body, multiple enhanced nodules in the pancreas, and splenic hilum.
case_images: fonc-14-1394784-g001.jpg
case_images: PMC11199519_01_fonc-14-1394784-g001.jpg
case_images: f1
case_images: After admission, the patient underwent an enhanced abdominal computed tomography (CT) scan, which suggested multiple metastases to the right kidney, pancreas, spleen, and stomach ( Figure 1 ).
case_images: (A) Gastroduodenoscopy showing a 4 cm x 5 cm protuberant lesion on the greater curvature of the gastric body. (B) The base of the tumor was thickly pedicled. (C) After injection of methylene blue around the tumor, we found that the base of the tumor was closely adhered to the muscularis propria layer. (D) Titanium clip was used to completely close the wound.
case_images: fonc-14-1394784-g002.jpg
case_images: PMC11199519_01_fonc-14-1394784-g002.jpg
case_images: f2
case_images: Gastroduodenoscopy revealed protuberant lesions measuring approximately 4 x 5 cm on the greater curvature of the gastric body, with an ulcerated surface and easy bleeding ( Figure 2A ). Figure 2B ), and endoscopic submucosal dissection (ESD) was planned. First, the area 0.5 cm away from the tumor was marked, and a 1:10,000 mixture of adrenaline and methylene blue was injected under the mucosa at the marked area. However, the dissection was close to the base of the tumor, the tumor adhered closely to the muscularis propria ( Figure 2C ), and ESD could not be continued; therefore, EFTR was performed. After observing that there is no bleeding at the site of gastric wall damage, the wound was sealed completely with a titanium clip ( Figure 2D ).
case_images: (A) HE x 100, the tubular structure in the upper left corner of the visual field was normal gastric mucosal gland, and the lamellar tumor cell nests were seen in the submucosa. (B) HE x 200, the cytoplasm of tumor cells is a translucent, low-grade nucleus surrounded by abundant capillaries. (C) IHC x 100, gastric mucosal epithelial CK7 staining was positive, and tumor cells were not expressed. (D) IHC x 100, PAX-8 staining was positive in tumor cells, but not in gastric mucosal epithelium.
case_images: fonc-14-1394784-g003.jpg
case_images: PMC11199519_01_fonc-14-1394784-g003.jpg
case_images: f3
case_images: Postoperative pathological results showed that the tumor of the greater curvature of the stomach was consistent with the metastasis of clear cell RCC ( Figures 3A, B ). Immunohistochemical results showed CAIX (+), CK broad-spectrum (+), Vimentin (+), PAX-8 (+), CD10 (+), CK7 (-), and Ki-67 (5%-10%) ( Figures 3C, D ), and finally a diagnosis of gastric metastasis of RCC.