病人,男,95 岁,2021 年3 月因"血尿半月余"入我院.病人入院前半月出现无痛性血尿,为全程肉眼血尿,伴有左腰部胀痛,于外院就诊,CT提示:左侧输尿管盆段软组织密度影,左肾积水.病人为进一步治疗转入我院.既往史:"高血压"病史 10 年,无吸烟、饮酒嗜好,无家族遗传病史.入院体格检查:左侧腰部压痛,无其他阳性体征.血肌酐:211 .46μmol/L.尿常规:红细胞3 +,尿蛋白1 +,白细胞433.9/μl.胸部CT:双肺条片状高密度影,炎性病变可能,心脏增大,心包积液,双侧胸腔积液.泌尿系彩超:左肾积水,肾盂宽约2.1 cm,左输尿管近端扩张并中上端约2.5 cm ×1 cm高回声占位,占位可见血流信号.我院泌尿系CT:左肾饱满,右肾体积小,肾实质内未见明显异常密度影.左肾窦区见小结节状高密度影,左侧肾盂扩张,左侧输尿管中段见结节状软组织密度影,CT值约35 HU,近端输尿管扩张.肾周筋膜未见增厚.腹膜后及盆腔内未见明显肿大淋巴结.见图1.术前诊断:左侧输尿管肿瘤可能.

This article reported 2 cases primary renal Ewing sarcoma (PRES)/primitive neuroectodermal tumor (PNET). By reviewing literature, renal PRES/PNET has a high degree of malignancy, and early symptoms are not typical. It needs to be combined with clinical manifestations, imaging examinations and pathological examination results. At present, surgical treatment is the main treatment, combined with radiotherapy and chemotherapy or targeted treatment might help.