Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan.
Department of Urology, School of medicine, Tzu Chi University, Hualien, Taiwan.
BMC Urol. 2023 May 16;23(1):95. doi: 10.1186/s12894-023-01272-z.
Extraskeletal Ewing's sarcoma (EES) is a rare malignant tumor primarily found in children and young adults. Localized disease can present with nonspecific symptoms such as local mass, regional pain, and increased skin temperature. More severe cases may present with systemic symptoms such as malaise, weakness, fever, anemia, and weight loss. Among these lesions, retroperitoneal sarcomas are relatively uncommon and difficult to diagnose. Since they are usually asymptomatic until large enough to compress or invade the surrounding tissues, most are already advanced at first detection. Traditionally, the treatment of choice is complete surgical resection, sometimes combined with postoperative radiotherapy and chemotherapy. We report a case of EES with left renal artery invasion in the left retroperitoneal cavity successfully treated with transarterial embolization and surgery.
A 57-year-old woman with a negative family history of cancer presented at our Urology Department with a large left retroperitoneal tumor found by magnetic resonance imaging during the health exam. Physical examination showed a soft abdomen and no palpable mass or tenderness. Imaging studies showed that the tumor covered the entire left renal pedicle, but the left kidney, left adrenal gland, and pancreas appeared tumor free. Since the tumor tightly covered the entire renal pedicle, tumor excision with radical nephrectomy was advised. The patient underwent transarterial embolization of the left renal artery with 10 mg of Gelfoam pieces daily before surgical excision. Tumor excision and left radical nephrectomy were uneventful the day after embolization. Post-operatively, the patient recovered well and was discharged on day 10. The final histopathological analysis showed a round blue cell tumor consistent with an Ewing sarcoma, and the surgical margins were tumor free.
Retroperitoneal malignancies are rare but usually severe conditions. Our case report showed that retroperitoneal EES with renal artery invasion could be treated safely with transarterial embolization and surgery.
骨外尤文肉瘤（EES）是一种罕见的恶性肿瘤，主要发生在儿童和青少年。局限性疾病可表现为局部肿块、区域性疼痛和皮肤温度升高的非特异性症状。更严重的病例可能表现为全身症状，如不适、乏力、发热、贫血和体重减轻。在这些病变中，腹膜后肉瘤相对较少见，且难以诊断。由于它们通常在足够大到压迫或侵犯周围组织之前没有症状，因此大多数在首次发现时已经处于晚期。传统上，治疗选择是完全手术切除，有时结合术后放疗和化疗。我们报告一例成功接受经动脉栓塞和手术治疗的左腹膜后腔 EES 合并左肾动脉侵犯的病例。
一位 57 岁女性，无癌症家族史，因健康检查时磁共振成像发现左腹膜后巨大肿瘤，到我院泌尿科就诊。体格检查显示腹部柔软，未触及肿块或压痛。影像学检查显示肿瘤覆盖整个左肾蒂，但左肾、左肾上腺和胰腺未见肿瘤。由于肿瘤紧紧覆盖整个肾蒂，建议行肿瘤切除术和根治性肾切除术。栓塞前，患者每日接受左肾动脉 10mg 明胶海绵栓塞。栓塞后一天进行肿瘤切除术和左根治性肾切除术，过程顺利。术后患者恢复良好，第 10 天出院。最终组织病理学分析显示符合尤文肉瘤的圆形蓝色细胞瘤，手术切缘无肿瘤。
腹膜后恶性肿瘤罕见但通常严重。我们的病例报告表明，肾动脉侵犯的腹膜后 EES 可通过经动脉栓塞和手术安全治疗。
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