Primary Ewing sarcoma of the kidney with inferior vena cava and right atrial tumor thrombi successfully treated with two-stage surgery

摘要

Ewing sarcoma of the kidney was first described in 1975 by See- mayer and colleagues; it represents <1% of all renal tumors, with less than 150 cases reported globally until 2020. 1 Ewing sarcoma with advanced invasion of the inferior vena cava and right atrium is uncommon; less than 20 cases have been reported, the first report being in 2009. 2 It is difficult to distinguish Ewing sarcoma from renal cell carcinoma based on imaging alone. 3 Its diagnosis is based on the histopathological findings. Herein, we present a case of primary Ewing sarcoma of the kidney with inferior vena cava and right atrial tumor thrombus that was successfully treated with a two-stage surgery. A 46-year-old man presented to our nephrology outpatient department with complaints of bilateral lower limb edema, poor appetite, and nausea for 3 weeks. Physical examination revealed grade 4 pitting edema of both limbs, grade 4, without tenderness. Abdominal palpation revealed a large hard mass in the right abdominal region, again, without tenderness. Magnetic resonance imaging (Fig. 1a) revealed a big renal mass (15.2 cm ? 16.7 cm? 20.8 cm) occupying the right abdomen and directly invading the inferior vena cava above the diaphragm. Ne- phrectomy of the right kidney and thrombectomy of the inferior vena cava and hepatic vein were performed.