Clinical Case Report: Renal Ewing Sarcoma in Pregnant Patient: Magnetic Resonance Imaging Approach and Bibliographical Review

Abstract

The case report presents the clinical case of a pregnant patient with renal Ewing’s sarcoma, an extremely rare tumor. Renal tumors during pregnancy are uncommon, with renal cell carcinoma being the most frequent. The diagnosis of cancer during pregnancy has increased due to the use of non-invasive prenatal testing (NIPT) and advanced maternal age. Renal tumors, such as Ewing’s sarcoma, present a diagnostic and therapeutic challenge due to the physiological changes during pregnancy. Renal Ewing’s sarcoma is aggressive and tends to manifest with abdominal pain, a palpable mass, and severe hematuria. However, its symptoms often go unnoticed, leading to late diagnosis with distant metastasis and poor prognosis. This type of tumor is diagnosed through histopathological studies, as imaging alone is insufficient for its characterization. In the presented case, multiparametric magnetic resonance imaging (MP-MRI) was used to assess the renal mass due to the limitations of using computed tomography in pregnant women. MRI provides both morphological and behavioral information about the tumor and is particularly useful in patients where radiation exposure is contraindicated. In this case, the MRI revealed a large tumor in the left kidney, with extension to adjacent structures, thrombosis in the vena cava, and hepatic and bone metastases. The article concludes that this is the largest renal Ewing’s sarcoma tumor described in a pregnant patient in the literature. It highlights the importance of early diagnosis and appropriate intervention to improve the prognosis in these rare but aggressive cases.