Recommended Citation
Ali R, Vemulapalli N, Paollela G, Kaiser P. Ewing Sarcoma Presenting with Renal Mass and Multifocal Epidural Spinal Cord Compression. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Ewing sarcoma is an aggressive small round blue cell tumor most commonly arising from bone in children and adolescents. Primary renal Ewing sarcoma is exceedingly rare and is frequently misidentified as more common renal neoplasms. Although metastatic disease is present in 20–25% of cases at diagnosis, multifocal noncontiguous epidural spinal metastases causing acute cord compression are uncommon. We present a rare case of Ewing sarcoma presenting with disseminated disease and multifocal thoracic epidural spinal cord compression.
Description:
Patient is a 23-year-old female who presented with one week of bilateral low back pain. She was treated with NSAIDs and muscle relaxants with temporary relief. Two weeks later, she returned with flank pain and fever. Imaging revealed renal mass presumed to be nephroma, and patient was treated with steroids, antibiotics, and outpatient urology follow-up. Patient returned with fever to 104°F. MRI demonstrated a 5.2 cm renal neoplasm with suspected osseous metastases and a possible liver lesion. Labs showed anemia and thrombocytopenia. During hospitalization, she developed progressive lower extremity weakness. Emergent spinal imaging showed diffuse abnormal thoracic marrow signal and epidural masses at T5 and T9 causing severe circumferential cord compression and edema, with an additional lesion at T11. Findings suggested disseminated metastatic or marrow-infiltrative malignancy. She underwent emergent T4–T6 and T8–T10 laminectomies with resection of two separate epidural tumors through distinct incisions. Pathology confirmed Ewing sarcoma with EWSR1 gene rearrangement. She was transferred to a tertiary center and is currently receiving treatment with Cytoxan, Adriamycin, vincristine, alternating with ifosfamide and etopside.
Discussion:
This case highlights a rare presentation of Ewing sarcoma with extensive metastatic disease and multifocal epidural spinal cord compression at diagnosis. Nonspecific back pain, transient steroid exposure, and initial mischaracterization of the renal mass contributed to delayed recognition. Cytopenias and diffuse marrow abnormalities further complicated the differential diagnosis. It is unclear if renal mass was primary Ewing sarcoma due to lack of pathology; however, this was the initial mass identified. Persistent back pain accompanied by systemic symptoms and an atypical renal mass should prompt early imaging and biopsy. Timely recognition is essential to prevent irreversible neurologic injury and to initiate appropriate management.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Ewing Sarcoma Presenting with Renal Mass and Multifocal Epidural Spinal Cord Compression
Introduction/Background:
Ewing sarcoma is an aggressive small round blue cell tumor most commonly arising from bone in children and adolescents. Primary renal Ewing sarcoma is exceedingly rare and is frequently misidentified as more common renal neoplasms. Although metastatic disease is present in 20–25% of cases at diagnosis, multifocal noncontiguous epidural spinal metastases causing acute cord compression are uncommon. We present a rare case of Ewing sarcoma presenting with disseminated disease and multifocal thoracic epidural spinal cord compression.
Description:
Patient is a 23-year-old female who presented with one week of bilateral low back pain. She was treated with NSAIDs and muscle relaxants with temporary relief. Two weeks later, she returned with flank pain and fever. Imaging revealed renal mass presumed to be nephroma, and patient was treated with steroids, antibiotics, and outpatient urology follow-up. Patient returned with fever to 104°F. MRI demonstrated a 5.2 cm renal neoplasm with suspected osseous metastases and a possible liver lesion. Labs showed anemia and thrombocytopenia. During hospitalization, she developed progressive lower extremity weakness. Emergent spinal imaging showed diffuse abnormal thoracic marrow signal and epidural masses at T5 and T9 causing severe circumferential cord compression and edema, with an additional lesion at T11. Findings suggested disseminated metastatic or marrow-infiltrative malignancy. She underwent emergent T4–T6 and T8–T10 laminectomies with resection of two separate epidural tumors through distinct incisions. Pathology confirmed Ewing sarcoma with EWSR1 gene rearrangement. She was transferred to a tertiary center and is currently receiving treatment with Cytoxan, Adriamycin, vincristine, alternating with ifosfamide and etopside.
Discussion:
This case highlights a rare presentation of Ewing sarcoma with extensive metastatic disease and multifocal epidural spinal cord compression at diagnosis. Nonspecific back pain, transient steroid exposure, and initial mischaracterization of the renal mass contributed to delayed recognition. Cytopenias and diffuse marrow abnormalities further complicated the differential diagnosis. It is unclear if renal mass was primary Ewing sarcoma due to lack of pathology; however, this was the initial mass identified. Persistent back pain accompanied by systemic symptoms and an atypical renal mass should prompt early imaging and biopsy. Timely recognition is essential to prevent irreversible neurologic injury and to initiate appropriate management.
Affiliations
Advocate Lutheran General Hospital