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case_images: (A) Enhanced computed tomography (CT) image demonstrating a large mass replacing the lower part of the right kidney (star); the mass had invaded the perirenal space and Gerota's fascia (arrow). (B) Enhanced CT image of the upper abdomen reveals a thrombus in the renal vein and inferior vena cava (arrow).
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case_images: Enhanced CT scans identified extension of the tumor into the perirenal space and Gerota's fascia (Fig. 1).
case_images: (A) Histological examination of the kidney demonstrates that the tumor mass had infiltrated the cortex and medulla (original magnification, x40). (B) Small, round tumor cells with scanty cytoplasm and round nuclei (original magnification, x400). (C) Neoplastic cells infiltrating blood vessels (original magnification, x400). (D) Similar neoplastic cells in the tumor thrombus (original magnification x400). Staining, hematoxylin and eosin.
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case_images: Furthermore, vague rosette-like patterns or perivascular concentrations of tumor cells were observed (Fig. 2).
case_images: Immunohistochemical staining reveals that the tumor cells were positive for (A) cluster of differentiation 99, (B) friend leukemia integration 1 and (C) integrase interactor-1 (original magnification, x400).
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case_images: An immunohistochemical panel demonstrated strong, diffuse membranous positivity for CD99 and nuclear staining for friend leukemia integration 1 (FLI1) in the tumor sections (Fig. 3A and B, respectively). No loss of integrase interactor-1 (INI-1) protein expression levels were observed, as determined by the nuclear positivity for INI-1 (Fig. 3C), and the Ki-67 nuclear labeling index was ~10%.
case_images: Fluorescence in situ hybridization analysis using a Vysis LSI EWSR1 Dual Color, Break Apart Rearrangement probe for 22q12 demonstrates the green and red probe breaking apart, confirming the Ewing's sarcoma breakpoint region 1 translocation.
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