Ewing sarcoma of the kidney: a rare entity

Renal Ewing sarcoma with inferior vena cava (IVC) tumor thrombosis; A case report

Ewing sarcoma (ES) is a rare group of undifferentiated tumors that originate from neuroectoderm. Although the overall prognosis is poor, early diagnosis and treatment by a multidisciplinary team with multimodal therapy can improve outcomes. Therefore, we present a 22-year-old female patient with primary renal ES with tumor thrombosis up to the vena cava who had radical nephrectomy and IVC tumor thrombectomy followed by adjuvant chemotherapy because a preoperative percutaneous biopsy was confirmed the diagnosis.

Primary Ewing's Sarcoma of the Kidney Mimicking Renal Cell Carcinoma With Widespread Metastasis: A Case Report and a Brief Review of the Literature

Ewing's sarcoma family of tumors (ESFTs) are a group of small round cell tumors with common morphological and genetic features, including Ewing's sarcoma of bone, primary extra-skeletal Ewing tumors, extraosseous Ewing sarcoma (EES), and Askin tumors. EES presenting as a primary renal mass is an exceedingly uncommon aggressive tumor with limited reported cases in the literature and often mimics other renal malignancies on imaging. We present a case of a 31-year-old man presenting with left flank pain and abdominal fullness of short duration. Radiological imaging studies showed a large heterogenous mass from the left kidney, confirmed to be Ewing's sarcoma on post-operative histopathological examination (HPE) and immunohistochemistry (IHC) studies. Subsequent follow-up showed extensive metastatic disease. EES of the kidney has a nonspecific presentation and imaging appearance necessitating a multi-disciplinary approach comprising radiological imaging with a high index of suspicion, HPE, IHC, and molecular analysis for the correct diagnosis.

An Incidental Diagnosis of Extraosseous Ewing's Sarcoma in the Kidney

Ewing's sarcoma is generally observed in the skeletal and connective tissues of paediatric individuals. The occurrence of extraosseous neuroectodermal tumours is uncommon. Renal Ewing's sarcoma usually presents with flank pain, haematuria, or as an abdominal mass. Immunohistochemistry and fluorescence in situ hybridization (FISH) techniques are essential in its diagnosis and differentiation from other tumours. We present asymptomatic renal Ewing's sarcoma in a 19-year-old female patient who was diagnosed incidentally, and the CT scan confirmed a 2.8 cm left mid-pole renal mass suggestive of malignancy. She was managed with a robotic partial nephrectomy. Tumour immunohistochemistry and the FISH technique confirmed the diagnosis of Ewing's sarcoma. The patient made an uneventful recovery and was referred for chemotherapy. This case report illustrates that despite the aggressiveness of the tumour, it can be detected earlier despite an asymptomatic presentation and be successfully treated with nephron-sparing surgery and chemotherapy.

Pediatric Ewing Sarcoma of Kidney: A Case Series and Review of Literature

Introduction

Renal Ewing sarcoma is an aggressive and rare malignancy affecting children and adolescents. Limited data on its management contribute to uncertainties in treatment.

Case description

We present two pediatric cases of renal Ewing sarcoma. Both cases emphasize the significance of accurate diagnosis, multimodal treatment, and long-term follow-up in achieving favorable outcomes. Accurate diagnosis of renal Ewing sarcoma is crucial for effective management. Multimodal treatment involving neoadjuvant chemotherapy, surgical resection and staging with lymph node sampling, and chemotherapy continuation has shown promising results in our cases. Long-term follow-up is essential for monitoring disease progression and ensuring optimal outcomes.

Practical Implications

There is limited data published about these renal tumors, especially in the pediatric population, and most studies lack long-term follow-up, with uncertain management due to limited data. This data will add to the newer, multimodal approach and form the basis for future meta-analysis to help formulate guidelines for upcoming international meetings. Continued research efforts are necessary to optimize strategies and improve the prognosis for pediatric patients with renal Ewing sarcoma.

Unveiling the Uncommon: A Case of Metastatic Ewing Sarcoma of the Kidney

Primary Ewing sarcoma of the kidney (ESK) is a rare and aggressive entity, with a poor prognosis. It often presents as metastatic disease with the lungs being the most common site. In adults, the occurrence of these tumors is uncommon, with patients exhibiting non-specific symptoms such as weight loss, flank pain, hematuria, and an abdominal mass. The combination of these vague clinical symptoms and the rarity of these tumors often results in a delayed diagnosis, leading to poorer outcomes for these patients. We present a case of a 38-year-old female with metastatic ESK. The patient initially presented with abdominal pain, vomiting, and a four-day history of constipation. The diagnosis was confirmed through computed tomography scans, ultrasound-guided biopsy of the lesion, and fluorescence in situ hybridization that revealed translocation of the EWS gene on chromosome 22q12. She was managed with chemotherapy regimens and palliative care; however, the disease progressed and she passed away six months after her initial diagnosis.

Primary Ewing’s sarcoma of the kidney: a rare masquerader of renal cell carcinoma on imaging

Background

The Ewing sarcoma family of tumors comprises a group of high-grade small round cell tumors, including Ewing sarcoma of bone, extra-skeletal Ewing sarcoma, peripheral primitive neuro-ectodermal tumor (PNET), and Askin tumor (thoraco-pulmonary PNET). They are more prevalent in young children and adolescents. Ewing's Sarcoma is an aggressive tumor majorly described in bones. Primary renal Ewing's sarcoma is an extremely rare entity, characterized by a very aggressive course, with very few reported cases in the literature.

Case presentation

We present an 18-year-old girl who presented with sudden onset left flank pain and hematuria. The patient had histopathology-proven primary renal Ewing's sarcoma, which was initially misdiagnosed as renal cell carcinoma on imaging.

Conclusions

Owing to its non-specific radiological appearance, a high index of suspicion and a systematic approach is essential for detection of renal Ewing’s Sarcoma.

Ewing's sarcoma of the male external genitalia: a case report and review of the literature

BACKGROUND

Ewing's sarcoma (ES) within the genitourinary tract are relatively unheard of and those within the external male genitalia are even rarer. To our knowledge, this is the first known case of primary ES within the paratesticular region in an adult.

CASE PRESENTATION

We present a case of a 24-year-old man with a right sided testicular mass on examination that was initially characterized as an adenomatoid tumor on ultrasound. After the patient was lost to follow up over the course of 9 months, the testicular mass grew significantly and was excised with pathology revealing primary paratesticular Ewing's sarcoma. This rare case emphasizes the importance of elucidating between the broad differentials of paratesticular masses, including the rare presentation of primary ES and adds a review of the literature of ES in the external male genitalia.

CONCLUSIONS

Rare differentials such as this case should be considered in patients with paratesticular masses. Further diagnostic and management algorithms for extraosseous Ewing Sarcoma, particularly in the adult population, are warranted.

Metastatic renal Ewing's sarcoma in adult woman: Case report and review of the literature

Primary renal extra-skeletal Ewing sarcoma is a rare neoplasm, often metastatic at diagnosis, and with a poor outcome. A multimodal approach is often the treatment of choice in this aggressive neoplasm. We present a case of primary renal extra-skeletal sarcoma in a 45-year-old woman who underwent tumor resection without clear margins. After no response to the first cycle of chemotherapy, we documented an early onset of local recurrence. The patient refused any other treatment and died four months after surgery.

Primary Renal Ewing Sarcoma in Children and Young Adults

The Ewing sarcoma family of tumors (ESFT) are high-grade small round blue cell malignancies traditionally presenting in children and adolescents. The most common site of primary disease is bone, though extraskeletal primary sites are well-recognized. We present 6 cases of primary ESFT of the kidney and 1 case of the adrenal gland. Patients were 11 to 18 years of age at diagnosis. Metastases at diagnosis were present in most cases (n=6). All patients underwent surgery, and most received radiation (n=5). Five patients relapsed after initial remission. Comprehensive review of the primary renal ESFT literature was used to analyze various factors, including age, sex, disease metrics, metastases at diagnoses, and overall survival in a total of 362 cases. Notably, while the general ESFT population has reported rates of metastasis at diagnosis of 20% to 25%, this rate in the renal ESFT population was 53% with a rate of 59% in adolescent and young-adult patients (11 to 24 y). Nodal disease at diagnosis was present in 24% of renal ESFT cases compared with 3.2% in patients with primary skeletal ESFT. While this malignant process may share histologic and molecular features with its bone and soft tissue counterparts, primary renal ESFT presentations seem to be more aggressive and have worse outcomes.

Ewing Sarcoma With Emphasis on Extra-skeletal Ewing Sarcoma: A Decade's Experience From a Single Centre in India

INTRODUCTION

The diagnosis of Ewing sarcoma family of tumours (ESFT) is challenging, especially in adults and in extra-skeletal or visceral location. Several morphologic mimics with varied treatment options and prognosis confer diagnostic dilemmas. Application of ancillary diagnostic modalities in surgical pathology in clinical routine has enabled accurate diagnosis of ESFT in bone, soft tissues, and viscera.

AIM

The study aims to assess the clinicopathological features including molecular test results of ESFT with emphasis on sex, age, and location, especially extra-skeletal soft tissue and visceral location.

MATERIAL AND METHODS

Data of clinicopathological, molecular tests (wherever performed), diagnosis rendered in 302 ESFT over a decade from our centre were reviewed. Statistical comparison of skeletal and extra-skeletal tumours with reference to age and sex was done using SPSS package. The P value of <.05 was considered significant.

RESULTS

The cohort included 302 ESFTs with 49% skeletal and 51% extra-skeletal tumours. Thigh was most common site among skeletal tumours; chest wall, paraspinal location, and retroperitoneum among soft tissues (39.4%); and kidney, ovary, and cervix among visceral tumours (11.3%). Fluorescence in situ hybridisation for EWSR1 gene rearrangement was positive in 54 patients and reverse-transcriptase polymerase chain reaction in 19 patients. Predominance of male sex, younger age and location in extremities among skeletal tumours and lack of gender predilection, higher age and axial location in extra-skeletal tumours were noted, which were statistically significant. Molecular tests were performed more frequently in extra-skeletal tumours, especially in visceral tumours to establish the diagnosis.

CONCLUSIONS

The study showed statistically significant differences in the age, sex, and location between skeletal and extra-skeletal ESFT. The increased percentage of extra-skeletal tumours especially in viscera was attributed to the increased awareness and availability of ancillary techniques.

Primary Renal Ewing Sarcoma: A Case Report and Review of the Literature

Primary Ewing sarcoma of the kidney is an extremely rare and aggressive tumor affecting young adults. We present the case of a 22-year-old male with primary Ewing sarcoma/primitive neuroectodermal tumor (EWS/PNET) of the kidney who underwent right radical nephrectomy and adjuvant chemo-radiation.

A case of Ewing sarcoma family tumor of the kidney treated with robotic-assisted partial nephrectomy

Ewing sarcoma family tumors (ESFTs) of the kidney represents less than 1% of all renal tumors. A 45-year-old Japanese woman presented with right abdominal pain. Contrast-enhanced computed tomography showed a 12 × 8-cm right cystic renal mass. The mass was diagnosed as cystic renal cell carcinoma (RCC) and right partial nephrectomy was performed. Immunohistochemical studies showed that the tumor was positive for CD99 (membranous staining in tumoral cells), indicating ESFT. The patient is doing well without further therapy after 1 year of follow-up. To our knowledge, this is the first report of renal ESFT mimicking cystic RCC on diagnostic imaging.

Metachronous renal Ewing sarcoma/primitive neuroectodermal tumour in a survivor of Burkitt lymphoma

We present a case of a 14-year-old girl who was diagnosed with Burkitt lymphoma in 2014. She was managed with chemotherapy and remained in remission for 3 years. On her surveillance imaging in 2017, a left-sided renal neoplastic mass was incidentally discovered. She underwent nephrectomy and pathology of the resected specimen revealed small cell tumour of the kidney with features favouring renal Ewing sarcoma/primitive neuroectodermal tumour. Molecular genetic analysis by fluorescence in situ hybridisation was performed which showed translocation of 22q12, thereby confirming the diagnosis. This is a rare secondary malignancy and an unusual association. This case highlights the importance and diagnostic dilemmas of rare secondary tumours in patients with such haematological malignancies and discusses its possible pathogenetic aspects.

CT Features and Pathological Correlation of Primitive Neuroectodermal Tumor of the Kidney

The purpose of the study was to analyze the computed tomography (CT) findings of primitive neuroectodermal tumor (PNET) of the kidney and correlate them pathologically. Ten cases of pathologically confirmed renal PNET were collected and retrospectively reviewed. The CT features that were analyzed include tumor size, shape, margins, density, nature of enhancement, presence of thrombosis, and metastasis, etc. These parameters were correlated with pathological findings and combined with literature review. The median age of the patients was 30 years. CT images showed solitary, large, ill-defined, irregular, or lobulated heterogeneous mass. Invasive growth toward the renal cortex and pelvis with renal cortical interruptions were seen in eight cases with one case exhibiting invasion that extended beyond the renal capsule with soft tissue seen in the perirenal fat pace. The tumors were confined to the kidney contour with enlargement of kidney in six of the cases. Cystic changes with mural nodules were detected in three cases. Eight cases showed persistent moderate enhancement during the nephrographic phase. Irregular septum-like structures were seen in four cases. Thrombosis was detected in eight cases. Lymph node metastasis was detected in eight cases with bilateral lung metastasis in two and bone metastasis in one. Renal PNET is a rare highly aggressive disease affecting younger people. It should be considered as a strong differential when well confined, yet large tumors that cause enlargement of the kidney are seen and also when tumors expressing cystic changes along with mural nodules are seen. Although renal PNET has certain other characteristic CT features, pathological and immunohistochemistry report must also be sought for definitive diagnosis.

CT and MRI Findings in a Rare Case of Renal Primitive Neuroectodermal Tumor

BACKGROUND

Primary renal primitive neuroectodermal tumor/extraskeletal Ewing's sarcoma (PNET/EES) is a very rare renal tumor.

CASE REPORT

We report a case of primary renal PNET/EES of the kidney in an adult patient and describe its computed tomography and magnetic resonance imaging findings, including diffusion weighted images along with a review of the current medical literature.

CONCLUSIONS

Although very rare, a relatively large renal mass which shows very infiltrative growth pattern on CT and MR imaging and striking diffusion restriction should raise the suspicion of a renal primitive neuroectodermal tumor, in a young adult.

Extraosseous Ewing sarcoma in the mesentery: the first report of cases in children

Extraosseous ewing sarcoma (EES) is a rare soft-tissue tumor usually found in the extremities or paraspinal region. We describe the case of a 4-year-old boy with a large cystic mass in the mesentery diagnosed as mesenteric lymphangioma preoperatively and as EES after partial resection and histopathological examination. EES in the mesentery is extremely rare, with only 2 reports described in the English literature. This represents the first report of EES in a child.

Ewing's Sarcoma of the Kidney Complicated by a Wunderlich Syndrome

The Wunderlich syndrome found after the rupture of primitive renal Ewing's sarcoma is not a situation that we find often in everyday practice. The clinical findings are not specific, which is why the differential diagnosis must be made with a multitude of benign and malignant renal masses until the correct diagnosis can be made by the pathologist. The CT and MRI images are not characteristic. One treatment option is the multidisciplinary approach; however, the prognosis remains poor for patients with metastatic disease.

Primary Ewing's Sarcoma/Primitive Neuroectodermal Tumor of of Kidney - a Diagnostic Dilemma

Among the group of small round cell tumors of kidney Ewing's sarcoma/PNET is a very rare entity which has aggressive clinical course. We report a case of renal mass in 24 years old male which was histologically diagnosed as small round cell tumor of kidney. Arrangement of the malignant cell along with vascular network in a filigree pattern was suspicious for a diagnosis of Ewing's sarcoma/PNET which was confirmed by positivity of CD 99 immunohistochemically. Thus careful histological observation and immunohistochemical stains can give the proper diagnosis of primary Ewing's sarcoma/PNET thus removing the diagnostic dilemma in the group of small round cell tumors.