A 51-year-old woman without previous history of gastric surgery presented with repeated episodes of vomiting over the past several days. Gastrointestinal endoscopy revealed a gastric outlet obstruction caused by a 7-cm submucosal tumor in the prepyloric region (• " Fig. 1). Computed tomography and ultrasonography revealed a mass comprising several cysts, the largest of which was 6 cm in diameter. These examinations did not show any solid areas or the wall thickness of the cysts. Endoscopic ultrasonography revealed a multicystic mass in the submucosal layer (• " Fig. 2). Endoscopic ultrasound-guided fine-needle aspiration of the largest cyst produced serous fluid. Analysis of the aspirated fluid showed: CA19-9 4.7 × 10 6 U/mL, carcinogenic embryonic antigen 23 × 10 3 U/mL, amylase 3 IU/l, and no lipase (0 IU/L). A distal gastrectomy was carried out and macroscopic evaluation of the resected stomach revealed a large cyst with a solid portion and adjacent smaller cysts. Microscopically, the cysts were lined by MUC5AC-positive epithelium, which was partially proliferating in a papillary manner; the solid portion comprised proliferative MUC5AC-positive atypical cells infiltrating the subserous layer (• " Fig. 3).

Four resected specimens of hepatic angiomyolipoma in which uptake of Sonazoid was observed in the postvascular phase of Sonazoid-enhanced ultrasonography were analyzed. Macrophage localization in the tumor was revealed pathologically by immunohistochemical staining for CD68. CD68-positive cells were observed in the tumor in all cases. The density of CD68-positive cells was 100/mm², and the ratio of CD68-positive cell density in the tumor to that in the surrounding parenchyma was 32-171%. These results suggested that the uptake of the contrast agent Sonazoid was related to the density of CD68-positive cells.

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Here, we report the case of a 57‐year‐old Peruvian man on long‐term corticosteroid therapy for a drug allergy and proton pump inhibitors for chronic dyspepsia symptoms. Upper gastrointestinal endoscopy showed multiple white granular lesions and widespread erosions in the stomach. Our findings indicate that gastric strongyloidiasis should be carefully considered in high‐risk patients even if endoscopic findings are nonspecific.

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