PMC9807995_01
US imaging on first presentation for haematuria. Showing 6.1 cm heterogeneous, predominantly echogenic mass with internal vascularity arising from the right renal lower pole.
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US Kidneys, ureter, and bladder (KUB) however revealed a 6.1cm heterogenous, solid, echogenic mass with internal vascularity arising from the lower pole of the right kidney (Fig. 1).
Axial cross-sectional MRI demonstrating a 11.6 cm lesion arising from the mid/inferior aspect of the right kidney. This contains intralesional haemorrhage and fat with associated hydronephrosis.
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An MRI was ordered however on further discussion with the radiology department, MRI in first trimester was not yet proven to be safe and therefore the MRI was completed shortly after 11 weeks gestation which revealed an 11.6 cm lesion arising from the mid/inferior aspect of the right kidney (Fig. 2).
A) High powered histopathology demonstrates round blue non-descript cells with a focal area of necrosis. Most of the cells have fine chromatin with occasional nuclei. Morphological appearance in keeping with Ewing sarcoma. B) Nuclear positive staining with NXK2.2 is highly sensitive and specific for Ewing sarcoma. C) Low powered histopathology slide showing diffuse infiltration of tumour composed of small round blue cells growing in a diffuse pattern forming perivascular pseudo papillary structures and pseudo rosettes. Non-neoplastic kidney shows increased number of acute and chronic inflammatory cells. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Histologically the tumour was consistent with a primary Ewing sarcoma of the kidney (Fig. 3).