Abstract
INTRODUCTION: Renal involvement of Ewing sarcoma in adults is extremely rare and tends to be significantly more aggressive in the kidney compared to other anatomical sites. Most cases are diagnosed at an advanced metastatic stage, as in our case, because these tumors are often asymptomatic during the early stages. CASE PRESENTATION: In our case, the patient presented with sudden, severe right flank pain without any associated urinary symptoms. Imaging revealed a mass in the right kidney, along with metastases to multiple body sites. Surgical intervention was carried out, including radical resection of the tumor and kidney, followed by chemotherapy and radiotherapy. CLINICAL DISCUSSION: Although rare, Ewing sarcoma should be included in the differential diagnosis of renal tumors in adults due to its aggressive nature and rapid metastatic potential, necessitating prompt and comprehensive management. CONCLUSION: This case illustrates the rarity and aggressive nature of primary renal Ewing sarcoma in adults, the feasibility of surgery even in metastatic settings when indicated, and the potential for response to standard chemotherapy. It underscores the importance of an individualized, multidisciplinary approach in managing such rare presentations.