A man in his 20s presented with a 2-month history of vague, right upper-quadrant abdominal pain, with associated 5-kg weight loss, loss of appetite, and increasing abdominal distension. He reported a small mass in the right scrotum that was evaluated 5 years previously and was reassured to be a nonmalignant lesion. Physical examination was notable for a distended abdomen with a palpable left abdominal mass. Testicular examination revealed an approximately 1-cm firm right spermatic cord nodule. Laboratory tests showed lactate dehydrogenase levels of 818 U/L (to convert to μkat/L, multiply by 0.0167), with no significant β-human chorionic gonadotropin and α-fetoprotein levels. Computed tomography (CT) of the abdomen (Figure, A and B) revealed innumerable masses throughout the abdomen and pelvis, with the largest measuring 17.5 × 14 × 14 cm and a 3.9-cm enhancing lesion in the left hepatic lobe, and a small amount of ascites. Testicular sonogram disclosed a 1.5-cm right epididymal cyst. Percutaneous biopsy and histologic examination of the dominant left abdominal mass revealed neoplastic cells (Figure, C) that were positive for cytokeratin, desmin but negative for S100. Fluorescence in situ hybridization (FISH) was positive for EWS-WT1 rearrangement.

一名20多岁的男子出现了2个月的模糊，右上象限腹痛史，伴有5公斤体重减轻，食欲不振和腹胀增加。他报告说，右阴囊有一小块肿块，该肿块已于5年前进行了评估，并再次确定是非恶性病变。体检发现腹部明显肿胀，左腹部有明显肿块。睾丸检查发现右精索结节约1厘米。实验室测试显示乳酸脱氢酶水平为818 U / L（转换为μkat/ L，乘以0.0167），没有明显的β-人绒毛膜促性腺激素和α-甲胎蛋白水平。腹部计算机断层扫描（CT）（图A和B）显示，整个腹部和骨盆有无数肿物，最大肿块为17.5×14×14 cm，其值为3。左侧肝叶有9厘米的病灶，并伴有少量腹水。睾丸超声图显示1.5厘米右附睾囊肿。经皮穿刺活检和占主导地位的左腹部肿块的组织学检查显示，肿瘤细胞（图C）对细胞角蛋白呈阳性，结节呈阳性，但对S100呈阴性。荧光原位杂交（FISH）对EWS-WT1重排呈阳性。