Ewing's sarcoma/primitive neuroectodermal tumor of the kidney: a case report and literature review

Primary Ewing sarcoma/primitive neuroectodermal tumors of the kidney: Case series of eight cases from a single center with follow-up details

Introduction

We aim to share the experience of a single center in the management of eight cases of renal primitive neuroectodermal tumor (PNET) which are uncommon, aggressive tumors. The objectives were to study the presentation of the disease, the treatment offered and its outcomes, and the comparison of the treatment with published literature.

Methods

The single-center renal PNET data of all patients were retrospectively reviewed from 2011 to 2022. Renal PNET was seen in eight patients. Minimum follow-up period of 1 year was required.

Results

Male-to-female ratio was 7:1. The mean age was 26.5 years. All were locally advanced tumors on presentation. One patient had an inferior vena cava thrombus, one patient had metastases on presentation, and two patients had tumor extending to paranephric space. The diagnosis was made by histopathology supported by immunohistochemistry showing CD99 positivity. All patients were treated with radical nephrectomy, followed by chemotherapy in all and radiotherapy in three patients. Two patients expired at 3½ and 6 years after surgery, the remaining six are alive at a median follow-up period of 34.5 months.

Conclusion

Renal PNET is an uncommon renal tumor which is aggressive and requires multimodal therapy for prolonged survival.

Primary Ewing sarcoma of the kidney mimicking cystic papillary renal cell carcinoma in an older patient: A case report

BACKGROUND

Ewing's sarcoma (ES) is a neuroectodermal tumor that typically occurs in the bones and soft tissues of children and young adults. Primary renal ES is rare; only a few cases and a small case series have been documented, and only four cases involved primary renal ES in older people (> 65 years old).

CASE SUMMARY

Herein, we describe the radiological and pathological features of primary renal ES in an older person. A 76-year-old man complained of poor oral intake and was found to have a large cystic renal mass with indistinct margins on computed tomography. Ultrasound-guided biopsy revealed that the tumor contained small round blue cells. The patient underwent a right radical nephrectomy. The tumor cells showed diffuse membranous CD99, and nuclear friend leukemia integration 1 transcription factor and NK2 Homeobox 2. Fluorescence in situ hybridization revealed EWSR1 translocation. Postoperatively, 18F-fluorodeoxyglucose positron emission tomography revealed no evidence of metastasis. The patient was diagnosed with primary renal ES. Six months following the surgery, local recurrence and distant metastasis were observed. Primary renal ES is rare and often lethal in older individuals. The specific imaging findings are unknown, and treatment protocols have not been standardized.

CONCLUSION

This case report describes the radiological and pathological features of primary renal ES in an older person.

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.

A primary Ewing's sarcoma of the kidney: A case report and review of literature

Primary Ewing's kidney sarcoma is a rare and aggressive cancer with poor treatment outcomes. Furthermore, clinical presentations are nonspecific, such as abdominal pain, abdominal mass, cachexia, or hematuria. Currently, there is no consensus guideline for the treatment of this condition. We report on a 22-year-old man who presented with gross hematuria for 3 weeks. Computed tomography demonstrated a huge right renal mass with a thrombus in the inferior vena cava (IVC) without visceral metastasis. A percutaneous tissue biopsy revealed Ewing's sarcoma (ES) and the patient received neoadjuvant chemotherapy (doxorubicin and ifosfamide) for four cycles. This reduced the tumor's size significantly and made it eligible for surgical intervention. Radical nephrectomy and tumor thrombus removal with wedge IVC wall were performed. The final diagnosis of ES was confirmed by the immunohistochemistry of the kidney specimen. After a 5-year follow-up of the patient, clinical and imaging evidence demonstrated that there was no disease recurrence.

A case report of unusual presentation of a rare renal tumor

There are very few cases of primary renal Ewing sarcomas, which are characterized by a high rate of metastasis. These tumors are often mistaken for other more common kidney tumors due to their rarity and lack of pathognomonic symptoms in the early stages. A 28-year-old male patient presented to our clinic with a 2-month history of nonproductive progressive cough and left flank pain. The chest was scanned with contrast-enhanced computed tomography, which showed a heterogeneously enhancing mass with central vascularity on the left retroperitoneal. An abdominal dynamic multiphasic magnetic resonance imaging with contrast revealed a large mass that was highly suggestive of neoplastic pathology and multiple metastatic nodules. The pathology report indicated a renal Ewing sarcoma as the result of a core needle biopsy. In order to initiate chemotherapy promptly, early detection is crucial, and radiology plays an important role in diagnosing.

Experience of CT diagnosis and management of primary renal Ewing's sarcoma: A retrospective analysis of 6 cases and a literature review

To present the clinical experience of primary renal Ewing's sarcoma/primitive neuroectodermal tumors (rEWs/PNET) admitted to our hospital and systematically review the published literature. A retrospective analysis was performed on patients with pathologically confirmed renal EWs/PNET (rEWs) in our hospital, and the literature on rEWs published in PubMed and Embase databases before March 1, 2022 was searched for analysis. A total of 337 rEWs were included in the statistical analysis, including 6 cases of our patients and 331 cases published in the literature. The common clinical symptoms of rEWs are abdominal pain, hematuria, abdominal mass and so on. computed tomography (CT) plays an important role in the diagnosis of rEWs, and the typical manifestation is a large heterogeneous soft tissue density mass, with a specific "septum-like" enhancement in contrast-enhanced scan. The 2-year overall survival rate of rEWs was 48%, with a median survival time of 18 months. "Septum-like" enhancement on CT can be used as a relatively specific sign for the differential diagnosis of rEWs from Wilms tumor and neuroblastoma. The maximum diameter of the rEWs was usually greater than 10 cm, the clinical symptoms of weight loss, metastasis at diagnosis, tumor thrombogenesis of renal vein or/and inferior vena cava tumor, and the failure to undergo radical nephrectomy were the factors of poor prognosis. The incidence of primary rEWs is low and the prognosis is poor. Early diagnosis and radical nephrectomy combined with chemotherapy is the key to improve the prognosis of patients, and CT plays an important role in early diagnosis.

B BK. Primitive neuroectodermal tumor of the kidney: an experience of three cases

Background

Primitive neuroectodermal tumors (PNET) are highly aggressive tumors belonging to the Ewing’s sarcoma family. Primitive neuroectodermal tumor is a group of bone and soft tissue tumor arising from neuroectodermal tissues. They are characterized by the expression of MIC2 and neural markers like neuron-specific enolase, synaptophysin, S-100, vimentin, Leu-7, and the presence of the EWS-FLI1 translocation. It is a rare malignancy with only about 150 cases being published worldwide. The tumor usually presents with non-specific symptoms such as abdomen pain and hematuria. Inferior vena cava (IVC) involvement by renal PNET is extremely rare with only a handful cases reported in the literature and is a clinically challenging scenario. There is a dearth of data on the management of this disease; further, the management of this disease in current scenarios is not well reported. We report our experience with three cases over 11 years which spans all three spectrums of the disease: localized, locally advance and metastasis.

Case presentation

Case 1: 37-year-old gentleman presenting with hematuria found to have right renal tumor with IVC invasion which was found to be unresectable intraoperatively. Patient was started on chemotherapy but deteriorated and died 3 months later. Case 2: 38-year-old gentleman presenting with abdominal pain found to have locally advanced left renal tumor. Patient developed local recurrence and metastasis 15 months after resection but had stable disease for nearly 4 years before developing acute myeloid leukemia and withdrawing consent for treatment. Case 3: 13-year-old girl who presented with right abdominal mass and subsequently found to have localized disease. After aggressive chemotherapy, patient is now recurrence-free after nearly 11 years.

Conclusions

Our study aims to show the spectrum of renal primitive neuroectodermal tumors with outcomes in all three clinical scenarios, with the aim of reinforcing that high index of suspicion for this disease is required in young patients presenting with aggressive disease, and immunohistochemistry should be used when in doubt, as outcomes are greatly improved with adjuvant chemotherapy.

Extraosseous Ewing's sarcoma/peripheral primitive neuroectodermal tumour of the kidney: a case report and literature review

BACKGROUND

Extraosseous Ewing's sarcoma/peripheral primitive neuroectodermal tumours(EWS/pPNETs) of the kidney are rare. Signs and symptoms are atypical in EWS patients. Presenting symptoms include haematuria, abdominal pain, or a palpable mass. A comprehensive review of the literature shows that it is difficult to make an accurate diagnosis based on physical examination alone. The imaging findings of EWS/pPNETs are nonspecific. We used contrast-enhanced ultrasound (CEUS) to diagnose an EWS/pPNET in our patient, which had never been reported previously to our knowledge.

CASE PRESENTATION

This article reports the case of a 20-year-old female with an abdominal mass and gross haematuria for 1 month. The ultrasound revealed a hypoechoic mass with a clear margin at the lower pole in the left kidney. CEUS demonstrated signs of annular enhancement and heterogeneous enhancement of the tumour, and simultaneous wash-in was predominant. Computed tomography images showed an elliptical low-density tumour. The patient underwent a left kidney resection, and the pathological diagnosis was an EWS/pPNET. Twenty-one days after the kidney operation, the patient underwent 8 cycles of a CAV (vinorelbine, ifosfamide, epirubicin) + IE (isocyclophosphamide, etoposide) chemotherapy regimen. Subsequently, radiotherapy (dose: 45 Gy, radiation field:the tumour bed following surgical resection) was administered for nearly 30 days. The patient had no signs of local recurrence or metastasis within a follow-up of 4 years.

CONCLUSIONS

As a radiation-free, inexpensive, convenient, and repeatable examination method, ultrasound was the primary choice for kidney examination. Early CEUS was helpful to make an accurate diagnosis. Surgery and adjuvant radiation or chemotherapy administered in a timely manner can prevent further deterioration.

Renal Primitive Neuroectodermal Tumor With Inferior Vena Cava Thrombus: Case Series and Literature Review of a Rare but Challenging Entity

OBJECTIVE

To investigate the clinicopathological characteristics, treatments, and prognosis of patients with renal primitive neuroectodermal ectodermal tumors (rPNETs) with inferior vena cava (IVC) tumor thrombus.

PATIENTS AND METHODS

We retrospectively reviewed 6 patients with rPNETs and IVC tumor thrombus between January 2005 and December 2019, and identified 39 published cases through a literature review. The clinicopathological characteristics, treatments, and survival data were analyzed.

RESULTS

The median patient age patients was 26 years, and the male to female ratio was approximately 1:1. The average tumor diameter was 12.5 cm. Seventeen patients (37.8%) showed metastasis at diagnosis. Forty-three cases (95.6%) were managed with surgical resection, and 35 (77.8%) received adjuvant chemotherapy after surgery. Follow-up data were available for 41 patients (median follow-up, 10 months; range, 4.5-13.0). The median overall survival (OS) and median progression-free survival (PFS) were both 30.0 months. Patients who received adjuvant chemotherapy had better PFS than those who underwent surgery only (30.0 months [95% confidence interval [CI], 4.3-55.7] vs 5.0 months [95% CI, 1.0-9.0]; P = .036). In terms of OS, however, the difference between the 2 groups was not significant (30.0 months [95% CI, 8.4-52.6] vs 7.0 months [95% CI, 4.5-9.5]; P = .244).

CONCLUSIONS

rPNET with IVCTT is an extremely rare entity that mostly occurs in young adults. Although multidisciplinary treatment is used, the prognosis of this disease remains unclear. RN with IVC tumor thrombectomy is a challenging procedure requiring vascular management techniques and experience. Adjuvant chemotherapy contributes to improved PFS, but not OS. Thus, early diagnosis and treatment play a key role in improving prognosis.

A rare entity of Primary Ewing sarcoma in kidney

Background

Ewing sarcoma (ES) or primitive neuroectodermal tumors (PNET) represents a spectrum of poorly differentiated and aggressive malignancies. It rarely arises from the kidney and accounts for less than 1% of renal mass. Given the uncharacteristic clinical symptoms and imaging features, renal Ewing sarcoma (RES) is often diagnosed by postoperative pathology.

Case presentation

Herein, we depicted a case of RES, which was administrated in our institution by chief complaints of intermittent left plank pain and palpable abdominal mass. We demonstrated the aggressive behavior of this renal malignancy and summarized its therapeutic modalities and outcomes.

Conclusion

The diagnosis of RES relies on integrated analysis including histomorphology, immunohistochemical staining and confirmation of molecular-genetic testing. Despite the surgery and adjuvant therapy, optimized and potent therapeutic regimes are still urgently needed to improve the poor prognosis of RES.