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Huang J, Zhang J, Dong B, Chen Y, Kong W, Liu Q, Xue W, Liu D, Huang Y. Primitive neuroectodermal tumor of the kidney: a single-institute series of six patients from China. Urol Int 2012; 90:174-8. [PMID: 23108259 DOI: 10.1159/000342647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Renal primitive neuroectodermal tumor (PNET) is a rare and highly malignant neoplasm. Our study aims to present the clinical findings and prognosis of 6 patients with renal PNET from China. MATERIAL AND METHODS From January 2003 to February 2012, 6 patients with renal PNET confirmed by immunohistochemical staining and fluorescence in situ hybridization (FISH) treated in our institution were reviewed retrospectively and our data compared with the literature. RESULTS There were 4 male and 2 female patients with a mean age of 35.0 years. The mean diameter was 13.3 cm. Five of the masses had renal vein thrombosis, and 3 extended into the inferior vena cava. A lymph node metastasis was detected in 1 patient and a liver metastasis in another patient. Radical nephrectomy was performed in all cases, with 5 patients following chemotherapy and 1 receiving Sutent treatment. Within a median follow-up of 7.5 months (range 1-71), median overall survival was 22.1 months. CONCLUSIONS The diagnosis of renal PNET should be considered in young patients presenting with renal mass and venous thrombosis. It seems that Asian renal PNET patients had a higher rate of venous thrombosis than Caucasian populations. CD99 positivity on immunohistochemistry and EWS-FL1 chimera gene detected by FISH support the diagnosis. The prognosis is poor despite multimodal treatment.
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Affiliation(s)
- Jiwei Huang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Abstract
Primitive neuroectodermal tumors exist as a part of the Ewing sarcoma/primitive neuroectodermal tumor family. These tumors most commonly arise in the chest wall and paraspinal regions; cases with a renal origin are rare entities, but have become increasingly reported in recent years. Although such cases occur across a wide age distribution, the average age for a patient with a renal primitive neuroectodermal tumor is the mid- to late 20s, with both males and females susceptible. Histologically, these tumors are characterized by pseudorosettes. Immunohistochemically, CD99 is an important diagnostic marker. Clinically, these are aggressive tumors, with an average 5-year disease-free survival rate of only 45% to 55%. Given that renal primitive neuroectodermal tumor bears many similarities to other renal tumors, it is important to review the histologic features, immunostaining profile, and genetic abnormalities that can be used for its correct diagnosis.
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Affiliation(s)
- Tanner Bartholow
- Department of Pathology, University of Pittsburgh School of Medicine,UPMC Shadyside Hospital, 5230 Centre Ave, Pittsburgh, PA15232, USA
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53
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Primary Renal Soft Tissue Sarcoma in Children. Urology 2012; 80:698-702. [DOI: 10.1016/j.urology.2012.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/08/2012] [Accepted: 05/14/2012] [Indexed: 01/16/2023]
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Weissferdt A, Moran CA. Primary pulmonary primitive neuroectodermal tumor (PNET): a clinicopathological and immunohistochemical study of six cases. Lung 2012; 190:677-83. [PMID: 22802134 DOI: 10.1007/s00408-012-9405-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 06/23/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND The clinicopathological and immunohistochemical features of six primary pulmonary primitive neuroectodermal tumors (PNETs) are reported. METHODS The patients were four men and two women aged 22-56 years (mean = 32.3 years). The main presenting symptoms included chest pain, shortness of breath, and cough. The tumor size ranged from 4 to 9.6 cm. RESULTS Macroscopically, the tumors were circumscribed, yellow-white in color, and of soft and friable consistency. Histologically, the lesions were composed of a monomorphic population of solidly packed round cells with a round-to-ovoid nucleus, fine chromatin, small nucleoli, and scanty pale cytoplasm. Immunohistochemically, the tumor cells were uniformly positive for CD99, neuron-specific enolase, and vimentin, and single cases focally expressed cytokeratin and S100. Fluorescence in situ hybridization analysis performed in two cases showed positive rearrangement for the EWSR1 gene at the 22q12 locus. Follow-up information available for four patients showed that three had died 24-54 months after diagnosis and one patient is alive 11 months after diagnosis. Two patients were lost to follow-up. CONCLUSION Primary PNETs of the lung are rare tumors that need to be added to the differential diagnosis of primary pulmonary neoplasms composed of small cells. Awareness of this entity as a primary pulmonary neoplasm is required in order to avoid misdiagnosis and unsuitable treatment of patients.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Affiliation(s)
- Suraj Gupta
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Laura Billadello
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David D. Casalino
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Su CC, Liu CL, Lin CN, Lee YH, Shen KH. A rare, highly aggressive primitive neuroectodermal tumor of the kidney: Case report and literature review. UROLOGICAL SCIENCE 2012. [DOI: 10.1016/j.urols.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Richey SL, Rao P, Wood CG, Patel S, Tannir NM. Metastatic extraosseous Ewing's sarcoma (EES)/primitive neuroectodermal tumor (PNET) of the kidney: 8-year durable response after induction and maintenance chemotherapy. Clin Genitourin Cancer 2012; 10:210-2. [PMID: 22503609 DOI: 10.1016/j.clgc.2012.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/07/2012] [Accepted: 03/06/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Stephen L Richey
- University of Texas M.D. Anderson Cancer Center, Genitourinary Medical Oncology, Houston, TX 77030, USA
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Kairouani M, Mokrim M, Mellas N, Khennoussi B, M'rabti HE, Boutayeb S, Errihani H. Metastatic Ewing's sarcoma/PNET of kidney in 40 year old patient. Int J Surg Case Rep 2012; 3:215-7. [PMID: 22466114 DOI: 10.1016/j.ijscr.2011.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 12/13/2011] [Accepted: 12/25/2011] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Primary renal Ewing sarcoma/PNET is an uncommon and very aggressive tumor. PRESENTATION OF CASE : We report the case of a young woman who underwent nephrectomy for a renal mass from unknown etiology. Histologic analysis found small tumoral cells in rosette formation, and immunohistochemical staining was positive for CD99, and focally positive for vimentin and Protein S-100. A post operative abdominal computed tomography (CT) scan revealed a residual renal processus with hepatic wounds and abdominal metastatic nodes. After 6 cycles of chemotherapy including Vincristine, Doxorubicin, Cyclophosphamide, the response was considered as good. DISCUSSION Ewing's sarcoma/PNET of kidney is a member of the family of small round cell tumors and it should be differentiated from Wilms tumor, neuroblastoma, rhabdomyosarcoma and lymphoblastic lymphoma. The principle management of its treatment have been extrapolated from the treatment of osseous Ewing sarcoma of bone. CONCLUSION Despite aggressive treatment, primary renal Ewing sarcoma/PNET has a poor prognosis. It requires a multidisciplinary approach including oncologists, urologists and radiation oncologists.
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Affiliation(s)
- Mouna Kairouani
- Department of Medical Oncology, National Institute of Oncology, Rabat 10100, Morocco
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Osai WE, Demicco EG, Pagliaro LC. Malignant small round blue cell tumor of the kidney without EWSR1 rearrangement: report of a case and review of the literature. Clin Genitourin Cancer 2011; 10:63-5. [PMID: 22153153 DOI: 10.1016/j.clgc.2011.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 10/28/2011] [Accepted: 11/07/2011] [Indexed: 11/17/2022]
Affiliation(s)
- William E Osai
- Department of Genitourinary Medical Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA
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Histopathology of surgically treated renal tumours in young adults: a developing country perspective. J Cancer Res Clin Oncol 2011; 138:189-94. [PMID: 22083212 DOI: 10.1007/s00432-011-1082-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 11/01/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is no data on the histopathological characteristics of renal tumours in young adults in Pakistan. MATERIALS AND METHODS We retrospectively analysed 133 young adults (age: 16 to ≤40 years) who underwent nephrectomy for suspected renal cancer from 1994 till July 2010. The demographical and pathological parameters were determined from original surgical biopsy reports and case files, and analysed. RESULTS The mean age of patients was 33.3 ± 6.2 years. Overall, 121 (88.9%) renal tumours were malignant, and 15 (11%) benign. Among malignant tumours, renal cell carcinoma (RCC) was predominant (100/121; 82.6%). The subtypes of RCC included: clear cell RCC, 84 (84%); papillary RCC, 11 (11%), chromophobe RCC, 3 (3%) and sarcomatoid RCC, 2 (2%). Other malignant tumours included: transitional cell carcinoma (9/121; 7.4%), primitive neuroectodermal tumour (5/121; 4.1%), synovial sarcoma (2/121; 1.6%), Non-Hodgkin's lymphoma (2/121; 1.6%), leiomyosarcoma (1/121; 0.8%), malignant fibrous histiocytoma (1/121; 0.8%) and squamous cell carcinoma (1/121; 0.8%). Among benign tumours, there were 11 cases of angiomyolipoma (11/15; 73.3%), three cases of oncocytoma (3/15; 20%) and one case of schwannoma (1/15; 6.6%). Almost two-third (62.7%) patients had stage I/II tumours, 22 (18.1%) stage III and 23 (19%) stage IV disease at the time of surgery. CONCLUSION A wide variety of renal tumours is documented in young adults with large size of the tumours and late presentation in our population.
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Jeung JA, Cao D, Selli BW, Clapp WL, Oliai BR, Parwani AV, Allan RW. Primary renal carcinoid tumors: clinicopathologic features of 9 cases with emphasis on novel immunohistochemical findings. Hum Pathol 2011; 42:1554-61. [DOI: 10.1016/j.humpath.2010.12.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 12/18/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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Mohsin R, Hashmi A, Mubarak M, Sultan G, Shehzad A, Qayum A, Naqvi SAA, Rizvi SAUH. Primitive neuroectodermal tumor/Ewing's sarcoma in adult uro-oncology: A case series from a developing country. Urol Ann 2011; 3:103-7. [PMID: 21747604 PMCID: PMC3130473 DOI: 10.4103/0974-7796.82180] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 10/05/2010] [Indexed: 01/10/2023] Open
Abstract
Peripheral primitive neuroectodermal tumor/Ewing's sarcoma (PNET/EWS) is primarily a tumor of soft tissues and bones. Primary localization of PNET/EWS in genitourinary organs is rare. No data on this localization of PNET/EWS are available in literature from Pakistan. We searched our adult uro-oncology records from 1994 till date and identified all cases of adult genitourinary and adrenal PNET/EWS diagnosed on histology and immunohistochemistry. Their case records were reviewed to obtain data on demographics, presentation, pathologic features, management and outcome. Six cases were found; all were young and had aggressive disease at presentation. Four had renal PNET/EWS. One case each of prostate and adrenal PNET/EWS was seen. Surgery and chemotherapy formed the mainstay of management. Three patients (50%) died during treatment, two were lost to follow-up and one case with renal PNET/EWS showed good initial response to chemotherapy but was later on lost to follow-up. In conclusion, PNET/EWS should be considered in the differential diagnosis of genitourinary malignant tumors in young patients. These tumors are aggressive with poor outcome.
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Affiliation(s)
- Rehan Mohsin
- Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Civil Hospital, Karachi, Pakistan
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Primary Ewing's Sarcoma of the Kidney in a 73-Year-Old Man. Sarcoma 2011; 2011:978319. [PMID: 21776194 PMCID: PMC3137979 DOI: 10.1155/2011/978319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 01/03/2023] Open
Abstract
Objective. Ewing's sarcoma of the kidney is rare and is usually found in young adults. We present here a single case study of Ewing's sarcoma found in an elderly man. Material and methods. A 73-year-old man underwent routine surgery for hydrocoele of the testis. He developed urinary obstruction symptoms, and radiological examinations revealed a tumour in the right kidney. Results. Microscopical, immunohistochemical, and molecular pathological analysis of the tumour was consistent with Ewing's sarcoma. FISH showed rearrangement of chromosomes 22q12 (EWSR1). The patient subsequently underwent nephrectomy followed by 6 adjuvant chemotherapy cycles. Follow-up after 7 months shows no recurrence. Conclusion. This case report presents not only the rare finding of Ewing's sarcoma in the kidney, but also the occurrence of this tumour entity in an elderly patient. Treatment options for the different types of renal tumours are vastly different and the need for a correct diagnosis is, therefore, vital.
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Asiri M, Al-Sayyad A. Renal primitive neuroectodermal tumour in childhood: Case report and review of literature. Can Urol Assoc J 2010; 4:E158-60. [PMID: 21749811 PMCID: PMC3038375 DOI: 10.5489/cuaj.969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primitive neuroectodermal tumour (PNET) is presumed to be of neural crest origin, mostly presenting as bone or soft tissue masses. It usually occurs in the trunk or axial skeleton; while renal PNET is considered an extremely rare tumour. We report a case of 11-year-old male who presented with right flank pain and gross hematuria after suffering blunt trauma. During investigations, he was found to have a large renal mass on computed tomography. He underwent a right radical nephrectomy where the pathology report showed PNET of the kidney. The patient received chemotherapy afterwards. Despite the chemotherapy, he had a local tumour recurrence 3 months after and continued to deteriorate and developed distant metastasis. Primitive neuroectodermal tumour of the kidney is a distinct and rare entity. It is very aggressive, with a poor survival despite combined modality treatment.
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Affiliation(s)
- Maeed Asiri
- Department of Urology, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Al-Sayyad
- Department of Urology, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
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Primary Ewing’s sarcoma/primitive neuroectodermal tumor of the kidney that responded to low-dose chemotherapy with ifosfamide, etoposide, and doxorubicin. Int J Clin Oncol 2010; 15:210-4. [DOI: 10.1007/s10147-010-0031-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 08/28/2009] [Indexed: 11/26/2022]
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Tappouni R, El-Kady R, Raman J, Then M, Sarwani N. Renal neuroectodermal tumour presenting with hematuria. J Radiol Case Rep 2010; 4:12-20. [PMID: 22470742 DOI: 10.3941/jrcr.v4i7.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Peripheral primary neuroectodermal tumors (PNET) are uncommon tumors, with an overall incidence of 1% of all sarcomas. Renal PNET is extremely rare. It is an aggressive tumor, with a high incidence of local recurrence and early metastases. Radiological diagnosis can be challenging as it is often difficult to differentiate it from other primary renal neoplasms. Imaging features include a large heterogeneous mass with central low density areas due to necrosis. Intra tumor hemorrhage and calcification are rare. We present a rare case of a large PNET mimicking renal cell carcinoma in a 51 year old female that required arterial embolization and nephrectomy.
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Affiliation(s)
- Rafel Tappouni
- Department of Radiology, Penn State Milton Hershey Medical Center, Hershey, PA, USA
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Primitive neuroectodermal tumor of the kidney in an adult: a case report. CASES JOURNAL 2009; 2:6791. [PMID: 19829861 PMCID: PMC2740287 DOI: 10.4076/1757-1626-2-6791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 04/01/2009] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Primitive neuroectodermal tumors (PNETs) occur predominantly in childhood preferentially in the soft tissues of the lower extremity and the paraspinal region. We present here a rare case of a PNET of the kidney in an adult. CASE PRESENTATION A tumor adjacent to the right kidney was detected by ultrasound coincidentally at a routine check-up in a 46-year-old woman with irritable bowel syndrome in her medical history. The patient had no clinical signs. Contrast-enhanced computerized tomography scan of the abdomen demonstrated a highly vascularized renal tumor. A retroperitonealectomy with en-bloc resection of the kidney was performed, and histopathological work-up showed a primitive neuroectodermal tumor of the kidney with the characteristic translocation t(11;22)(q24;q12). CONCLUSION This tumor entity must be accurately distinguished from other renal neoplasms because of the prognostic and therapeutic impact.
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Primary Adult Renal Ewing's Sarcoma: A Rare Entity. Sarcoma 2009; 2009:504654. [PMID: 19478963 PMCID: PMC2686250 DOI: 10.1155/2009/504654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 01/12/2009] [Accepted: 03/13/2009] [Indexed: 11/18/2022] Open
Abstract
Background. Ewing's sarcoma of extraskeletal origin is uncommon and that is of primary renal origin in adults are rare. There is no consensus on the optimal management of Ewing's tumors of renal origin.
Methods. A retrospective review of the clinical features, treatment, and outcome of adult patients with primary renal extra-skeletal Ewing's sarcoma who were treated at the Royal Marsden hospital from January 1993–December 2007 is reported. Results. Seven adult patients with primary renal Ewing's sarcoma were identified. All four patients with nonmetastatic disease had radical nephrectomy and received adjuvant chemotherapy +/− radiotherapy. Two developed metastatic disease while on adjuvant chemotherapy, and one patient relapsed after 55 months. The three patients with metastatic disease at presentation did not have nephrectomy and were treated with chemotherapy. All three patients had disease progression with a dismal outcome. Only one patient in the whole group is alive and disease free. The median overall survival was 62.8 months, and the median disease-free survival in patients with nonmetastatic disease after combined modality treatment was 30.3 months. Conclusion. Primary adult renal Ewing's sarcoma is an aggressive tumor with a propensity for early metastasis. Radical nephrectomy with adjuvant combination chemotherapy produced the best results but the outlook remained poor with only one patient experiencing long disease-free survival.
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Ong PH, Manikandan R, Philip J, Hope K, Williamson M. Primitive neuroectodermal tumour of the kidney with vena caval and atrial tumour thrombus: a case report. J Med Case Rep 2008; 2:265. [PMID: 18694498 PMCID: PMC2527024 DOI: 10.1186/1752-1947-2-265] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 08/11/2008] [Indexed: 11/19/2022] Open
Abstract
Introduction Renal primitive neuroectodermal tumour is an extremely rare malignancy. Case presentation A 21-year-old woman presented with microscopic haematuria, a palpable right loin mass, dyspnoea, dizziness and fatigue. Initial ultrasound scan of the kidneys revealed an 11 cm right renal mass with venous extension into the inferior vena cava. Computed tomography of the thorax and abdomen revealed an extension of the large renal mass into the right renal vein, inferior vena cava and up to the right atrium. A small paracaval lymph node was noted and three small metastatic nodules were identified within the lung parenchyma. The patient underwent a radical nephrectomy and inferior vena caval tumour (level IV) thrombectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest. Immunohistochemical staining of the specimen showed a highly specific cluster of differentiation (CD) 99, thus confirming the diagnosis of a primitive neuroectodermal tumour. Conclusion It is important that a renal primitive neuroectodermal tumour be considered, particularly in young patients with a renal mass and extensive thrombus.
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Affiliation(s)
- Poh Ho Ong
- Department of Urology, University Hospital Aintree, Liverpool, UK.
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