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case_images: Patient's pre- and post-treatment imaging data. (A) Preoperative hip MRI shows multiple tumors in both femora, with prolonged T1 and T2 signals and high T2-weighted fat-suppressed signals. The arrows indicate the tumor lesions. (B) Dynamic renal imaging shows a large, hypovascular mass in the left kidney. (C, D) PET-CT scans show a left renal malignant tumor with multiple distant metastases. The star indicates the kidney tumor, and the triangles indicate the metastasis to the inferior vena cava and abdominal aorta. (E, F) Preoperative abdominal contrast-enhanced CT scans show the left renal tumor and the metastasis to the inferior vena cava. (G) Abdominal contrast-enhanced CT scans at 6 months after the second-stage surgery show no recurrence of intra-abdominal tumors.
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case_images: Magnetic Resonance Imaging (MRI) of the hip joint revealed multiple bone abnormalities in the pelvis, spine, and bilateral femurs ( Figure 1A ), raising the suspicion of leukemia or other malignant tumors. PET-CT scans subsequently confirmed the presence of a malignant tumor in the left kidney with multiple systemic metastases ( Figures 1C, D ). Hip joint magnetic resonance imaging (MRI) revealed multiple bone abnormalities in the pelvis, spine, and bilateral femurs, indicating a possible diagnosis of leukemia or other malignant tumors ( Figure 1A ). The total GFR was 158.4ml/min, the GFR of left kidney was 57.7ml/min, and the GFR of right kidney was 100.7ml/min. ( Figure 1B ). Additionally, metastases were observed in the left renal hilum, retroperitoneum, and para-aortic lymph nodes as well as multiple bone metastases throughout the body ( Figures 1C, D ). Abdominal contrast-enhanced CT scans show the left renal tumor and the metastasis to the inferior vena cava ( Figures 1E, F ). An abdominal CT scan conducted 11 months after second-stage surgery did not reveal any recurrence of abdominal tumors ( Figure 1G ).
case_images: Pathology findings. (A) Gross appearance of left kidney tumor. (B) HE staining of left kidney tumor shows undifferentiated small round or oval cells with prominent nuclear division. (C) FISH testing with a dual-color probe targeting the EWSR1 locus shows approximately 98% of tumor tissue with a red-green-yellow breakage signal, and the percentage of cells with breakage signal is greater than 10%. This suggests the presence of a breakage gene in the affected tissue. (D) Desmin is positive on immunohistochemistry staining. (E) Vimentin is positive on immunohistochemistry staining. (F) Ki67 is positive on immunohistochemistry staining. (G) CD56 is positive on immunohistochemistry staining. (H) CyclinD1 is positive on immunohistochemistry staining. (I) WT-1 is negative on immunohistochemistry staining.
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case_images: Figures 2A, B ). Fluorescence in situ hybridization (FISH) analysis demonstrated the presence of EWSR1 breakpoint gene ( Figure 2C ). Immunohistochemistry (IHC) staining showed positive expression for Desmin ( Figure 2D ), Vimentin ( Figure 2E ), Ki67 ( Figure 2F ), CD56 ( Figure 2G ), CyclinD1 ( Figure 2H ), and negative expression for WT-1 ( Figure 2I ).