CEUS-Guided Microwave Ablation for Post-Biopsy Liver Rupture: Case Report

In this study, two patients with papillary thyroid carcinoma and lymph node metastasis were treated by Dr. Shurong Wang’s team and are reported. The two patients refused surgery and underwent microwave ablation (MWA) of the thyroid and lymph node lesions. Ultrasound review 2 days after MWA revealed internal jugular vein thrombosis. Patient #1 received low molecular weight heparin calcium injection, Xueshuantong injection, Xiangdan injection, and rivaroxaban. Patient #2 was treated with enoxaparin sodium injection, Xueshuantong injection, urokinase, and warfarin sodium tablet. The thrombus was successfully managed in each patient using anticoagulant treatment. Such complication of MWA has not been reported in many cases before. According to the relevant literature, thrombosis after thyroid cancer ablation might be related to subclinical hypothyroidism, increased heme oxidase 1 (HO-1) levels in the blood of patients with papillary thyroid cancer, and increased platelet content and mean platelet volume in patients with thyroid cancer. No specific cause of thrombosis was identified in the two cases reported here. No recurrence was observed after 1 (patient #1) and 4 (#2) years of follow-up. In conclusion, patients with papillary thyroid carcinoma and lymph node metastasis should undergo color Doppler ultrasound of the neck after MWA of thyroid lesions and neck metastasis.

Introduction: We report the case of a patient with antepartum HELLP syndrome and simultaneous rupture of the right liver lobe. An emergency caesarean section was performed and the liver rupture was managed surgically via perihepatic packing. The mother and her child recovered well and were discharged 19 days after admission. Case Report: We describe a case report and review the literature. Based on our own experience and the most common clinical presentations of such patients, we were able to establish an algorithm for managing such cases. Conclusion: An association between liver rupture and HELLP syndrome is rare but was previously described in several case reports. In pregnant women with HELLP syndrome and acute onset abdominal pain, a potential spontaneous hepatic rupture should be taken into consideration.

Horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. While the incidence of renal cell carcinoma (RCC) in HSK is not higher than in anatomically normal kidneys, altered renal anatomy makes surgical management technically challenging. Minimally invasive, image-guided therapies such as microwave ablation (MWA) have emerged as promising alternatives. We present the case of a 65-year-old male with HSK and a 2.0 cm RCC in the right renal moiety who underwent CT-guided MWA with no complications. Hydrodissection was used to protect the psoas muscle and lumbosacral nerves. Follow-up imaging confirmed local tumor control with no signs of remnant or recurrence. Only a limited number of similar cases have been reported. This case highlights the feasibility and safety of percutaneous MWA for RCC in HSK. It adds to the growing evidence supporting MWA as a minimally invasive option in anatomically complex renal tumors.

RationaleBreast leiomyoma is the rarest non-epithelial tumor of the breast. As a benign tumor, its main treatment is regular follow-up. Surgical treatment is often used in clinical practice when patients have symptoms or strongly require treatment. However, if the tumor is large or located around the nipple or areola, the cosmetic effect of surgery is not good, so it is urgent to find new treatment methods. We pioneered the use of microwave ablation in the treatment of giant breast leiomyoma and achieved good results.Patient concernsA 37-year-old female was admitted to hospital because she found a breast mass of approximately 8 cm. She had no obvious clinical symptoms, but had great psychological pressure.DiagnosisPathological biopsy showed leiomyoma followingly the surgical operation of giant breast leiomyoma was planned. However, the breast mass was large, and the postoperative scar would affect the breast appearance.InterventionsThe consent was obtained from the patient and her family. The Ultrasound-guided microwave ablation was successfully performed.OutcomesThe patient was followed up for 10 months, and the tumor volume ablation rate was 69.8%. The cosmetic effect of breast was excellent.LessonsTo our knowledge, this is the first case to using microwave ablation (MWA) for the treatment of breast leiomyoma. Ultrasound-guided MWA can be used for the treatment of breast leiomyoma, especially when the mass is large and requires traditional surgical resection. It can effectively improve the breast aesthetics and further improve the quality of life of patients. However, it is only a case report, and needs more research to verify MWA in breast leiomyoma.

Organ perforation secondary to thermal ablation is a rare but severe complication that can occur in certain patients, in whom tissue dissection and preservation cannot be adequately achieved. A 69-year-old man presented with a gastrocutaneous fistula 20 days after a microwave ablation of liver metastases from colorectal cancer. Besides skin rash, local tenderness, and gastric content discharge from a wound where the probe had been placed, no other signs or symptoms were present. The patient was treated surgically, and a wedge-shaped gastric resection was performed. His postoperative course was uneventful. After 8 months, the patient underwent the same procedure for local progression of the same lesion, using a pulsed MW antenna and a dedicated hydrodissection needle, without complications. A gastrocutaneous fistula is a rare complication of microwave ablation. However, adequate hydrodissection can minimize the risk for the development of these complications. Proper treatment of these complications does not preclude repeated usage of microwave ablation in the future.

The use of percutaneous microwave ablation has been established as a treatment for early-stage hepatocellular carcinoma (HCC). HCC can often arise in the setting of cirrhosis and often requires locoregional therapy to ablate the area as a bridge for the ultimate treatment of liver transplantation. The challenge is its use in patients with decompensated cirrhosis and hypercoagulable states, as these high-risk populations can lead to other major complications, requiring anticoagulation, which remains challenging. In this case report, a 60-year-old woman with a history of alpha-1 antitrypsin deficiency-related cirrhosis presented with Child-Pugh class B (score 9) liver disease, thrombocytopenia, portal hypertension with esophageal varices, and factor V Leiden mutation. She underwent successful image-guided microwave ablation of a segment 7/8 Liver Imaging Reporting and Data System (LI-RADS) 5 HCC lesion as a bridge to liver transplantation, performed by interventional radiology. In this ablation, she had significant procedural risk factors, but with multidisciplinary planning, there was only a minor non-distressing hematoma noted, and overall allowed effective tumor treatment without major complications. This case highlights the practicality of microwave ablation in high-risk patients and emphasizes the critical role of interventional radiology in expanding therapeutic options for transplant candidates with limited alternatives.

BACKGROUNDHepatic hemangioma is the most common benign tumor of the liver. However, patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention. It is necessary to explore additional minimally invasive and personalized treatment options for hemangiomas.CASE SUMMARYA 47-year-old woman was diagnosed with a right hepatic hemangioma for more than 10 years. Abdominal contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound revealed that there was a large hemangioma in the right liver, with a size of approximately 95 mm × 97 mm × 117 mm. Due to the patient's refusal of surgical treatment, hepatic artery embolization was performed in the first stage. After 25 d of liver protection treatment, the liver function indexes decreased to normal levels. Then, ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed. Ten days after the treatment, hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size (the volume was reduced by approximately 30%). Then the patient was discharged from the hospital. One year after discharge, CT showed that the hepatic hemangioma had shrunk by about 80%CONCLUSIONTranscatheter arterial embolization combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.

Introduction: Intrahepatic cholangiocarcinoma (ICC) is rare and often diagnosed in an advanced stage. Neoadjuvant therapy is not established and data on its value are in palliative intention. In the case of a recurrence patients often are offered systemic chemotherapy as the only treatment option. We report on a patient with advanced intrahepatic cholangiocarcinoma who underwent multimodal treatment leading to a long-term survival. Case report: A 61-year-old woman presented with an advanced intrahepatic cholangiocarcinoma of the right liver lobe without evidence of metastatic spread. She had already completed two cycles of chemotherapy of Cisplatin and Gemcitabine resulting in stable disease. An extended hemihepatectomy of the right lobe including segments I, IVa and partially IVb was performed. The TNM status (8th edition) was pT2b (3), pN0 (0/6), M0, V1, G2 and R0. Ten months later recurrence was diagnosed and treated with microwave ablation. Recurrence occurred again and the patient underwent repeated resection 22 months after primary resection. After detection of repeated recurrence once more, repeated resection was performed 46 months after initial resection. The patient is still alive and tumor-free 7 years after primary resection. Conclusion: Multimodal treatment including preoperative chemotherapy, complete resection and repeated resection of recurrence as well as microwave ablation led to long-term survival in a case of advanced intrahepatic cholangiocarcinoma. Close follow-ups were crucial to offer the best treatment options.

BackgroundLiver transplantation (LT) is the best therapeutic strategy in patients with early-stage hepatocellular carcinoma (HCC) and end-stage liver disease. However, cancer recurrence may occur in 15–20% of cases, often configuring a poor prognosis condition. In few cases recurrence arises with a limited pattern, allowing local ablative treatments, including surgical resection, with a potentially curative effect. This is the first report of an extrahepatic nodule resection employing intraoperative ultrasonography through minimally invasive thoracoscopic surgery.Case DescriptionWe here describe the case of a patient with a subdiaphragmatic retrohepatic HCC recurrence following LT treated with percutaneous microwave (MW) ablation and subsequent surgical resection. MW ablation of the nodule resulted in partial response and subsequent computed tomography (CT) demonstrated persistence of the nodule without further metastases development. Surgery was performed through a minimally invasive thoracoscopic approach employing intraoperative ultrasonography with partial success. Follow-up CT scan revealed an additional local recurrence. A further MW ablation procedure led to disease control with no evidence of disease at 2 years follow-up.ConclusionsLocal ablative treatments may play a curative role in HCC oligorecurrence following LT. In this context, minimally invasive treatments should be preferred for their safety and lower impact on patients’ general conditions. Intraoperative transdiaphragmatic ultrasonography may be useful to correctly localize the target lesions during minimally invasive surgery.

BackgroundMicrowave ablation is a new, minimally invasive technique for the treatment of thyroid nodules. Hyperthyroidism due to destructive thyroiditis is a known risk of microwave ablation, though it occurs in only a minority of cases. We report a rare case of a patient diagnosed with Graves’ disease nearly six months after undergoing microwave ablation of a thyroid nodule.Case presentationOn July 31, 2022, a 43-year-old male patient presented to our hospital with symptoms of pyrexia, excessive sweating, and palpitations lasting for 15 days. History inquiry revealed that the patient had undergone microwave ablation of right-sided thyroid nodule nearly five months ago at another hospital. The patient’s thyroid ultrasound suggested bilateral diffuse thyroid lesions, with a moderately echogenic mass observed on the right side of the thyroid gland, potentially indicative of thyroid nodule ablation. The patient had elevated serum thyroid hormone levels, decreased thyroid-stimulating hormone levels and positive associated thyroid antibodies. To control the symptoms of hyperthyroidism, the patient opted for oral antithyroid medication, and thyroid hormonal levels returned to normal after 3 months of treatment. The patient is now under regular follow-up.ConclusionsIn this case, we presented the onset of Graves’ disease following microwave ablation in a patient with subclinical thyroid autoimmunity. While the causal relationship between microwave ablation and Graves’ disease remains unproven, this case suggests that preexisting autoimmune thyroid conditions may increase susceptibility to postoperative thyroid dysfunction. Procedural factors, such as thermal injury to surrounding tissues and potential involvement of the autonomic nervous system, are also potential contributors to the development of Graves’ disease following microwave ablation.

HELLP syndrome is a severe complication of hypertensive disorders in pregnancy, characterized by hemolysis, elevated liver enzymes, and thrombocytopenia. Severe cases can lead to various complications such as DIC and placental abruption, directly endangering the lives of both the mother and the fetus. Among these, intra-abdominal hemorrhage caused by the rupture of a subcapsular hepatic hematoma is particularly dangerous. Traditionally, the rescue of liver rupture relies on emergency laparotomy. In recent years, the development of interventional radiology has provided a minimally invasive option of transcatheter arterial embolization (TAE) for hemodynamically stable patients. TAE has significant advantages in emergency hemostasis of HELLP-related liver rupture and can reduce maternal and fetal mortality. This case report analyzes a case of preeclampsia complicated with inevitable abortion progressing to HELLP syndrome with liver rupture and hemorrhage. After successful hemostasis with TAE, the patient received comprehensive intensive care including plasma exchange, blood transfusion, and continuous renal replacement therapy. The case emphasizes that early identification, multidisciplinary collaboration, accurate imaging evaluation, TAE for minimally invasive hemostasis, close renal support, and long-term follow-up are the keys to reducing the mortality of HELLP syndrome-related liver rupture and preventing recurrence in future pregnancies.

BackgroundLymphoepithelioma-like cholangiocarcinoma (LELCC) is a rare type of intrahepatic tumor that is poorly understood. It is not associated with specific physical findings and is usually diagnosed incidentally, resulting in tumors that are often large-sized at diagnosis. At present, the main treatment approach is surgical resection.Case PresentationHere, we report the case of a patient with LELCC treated with microwave ablation (MWA). Our patient was a Chinese man with chronic hepatitis C and a 51 mm-diameter intrahepatic tumor. Despite blood testing, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, and abdominal ultrasound, the tumor was not well diagnosed. However, the histopathological findings of ultrasound-guided percutaneous tumor biopsy led to a diagnosis of LELCC. The patient was treated with MWA, and no new lesions had occurred at 9 months after treatment.ConclusionTo our knowledge, this is the first patient with LELCC treated using MWA. Our experience suggests that MWA is an effective new therapeutic method for this disease.

Desmoid-type fibromatosis (DF) is a locally aggressive tumor characterized by peripheral infiltration of neoplastic cells and remote metastasis disability. This systematic review examined the efficacy and safety of thermal ablative therapy for DF tumors. A literature search was conducted using PubMed, Web of Science, Cochrane Library, and Embase from January 1, 2000, to November 12, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide literature selection. The inclusion criteria were the following: (I) the patients were diagnosed with aggressive fibromatosis pathologically, (II) the patients were treated by thermal ablations, and (III) a focus on treatment efficacy and safety. Meanwhile, the exclusion criteria were the following: (I) cohorts of patients with hypertrophic scar, Gardner fibroma, or nodular fasciitis; (II) conference abstracts, reviews, case reports, letters to editors, comments, or editorials; (III) number of patients <5; (IV) in vitro or animal experiments; and (V) non-English language articles. The inverse variance method with a random effects model was used to obtain the pooled data. Subgroup analyses were performed to identify treatment factors. Egger test was conducted to assess the risk of publication bias. After literature selection, 694 DF tumors were identified in 23 studies. In terms of modality, 13 studies used cryoablation, 9 studies used high-intensity focused ultrasound (HIFU), and 1 study used microwave ablation (MWA). The pooled symptom relief rate was 90% [95% confidence interval (CI): 80-97%], with that for HIFU being 100% (95% CI: 85-100%), that for cryoablation being 87% (95% CI: 74-97%), and that MWA being 89% (95% CI). The pooled major complication rate was 3% (95% CI: 1-7%), and that for each modality was as follows: HIFU =2% (95% CI: 0-6%), cryoablation =4% (95% CI: 1-8%), MWA =11%, ultrasound =6% (95% CI: 1-13%), computed tomography (CT) =2% (95% CI: 0-7%), and magnetic resonance imaging (MRI) =3% (95% CI: 0-14%). The pooled nonperfused volume rate (NPVR) was 76% (95% CI: 71-81%), and that for each modality was as follows: HIFU =77% (95% CI: 71-85%), cryoablation =74% (95% CI: 69-79%), ultrasound =75% (95% CI: 67-83%), CT =76% (95% CI: 67-87%), and MRI =78% (95% CI: 70-87%). The pooled local control rate was 88% (95% CI: 79-94%) and that for each modality was as follows: HIFU =99% (95% CI: 96-100%), cryoablation =80% (95% CI: 68-90%), and MWA =78%. The differences in major complication rate (P=0.77) and NPVR between imaging-guided modalities (P=0.40) were not significant, nor were the differences in symptom relief rate (P=0.32) and major complication rate (P=0.61) between ablative techniques; however, the differences in local control rate (P=0.01) were significant between ablative techniques. Imaging-guided thermal ablative therapies contribute to symptom relief with a duration of more than 6 months and a low major complication rate of DF tumors.

Despite significant improvements that have been made in terms of progression-free survival and overall survival rates brought about by targeted therapy in non-small cell lung cancer (NSCLC), the emergence of drug resistance remains a limiting factor. However, a previous study has shown promising results by combining local microwave ablation (MWA) with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy for patients with oligometastatic NSCLC. The current study presented the case of a Chinese female patient who was identified as having lung adenocarcinoma (LADC) with EGFR exon 19 deletions (Del) in January 2014, and who experienced multiple instances of oligoprogression but showed a positive response to a combination of chemotherapy, MWA and a TKI drug. First, the patient was treated with four cycles of chemotherapy (120 mg docetaxel on day 1 and 40 mg cisplatin on days 1, 2 and 3; every three weeks as one cycle) and gefitinib (Iressa; 250 mg/day), maintaining a partial response for 17 months. In August 2015, a new solitary lesion was identified in the right lung and erlotinib (Tarceva; 150 mg/day) was administered for 3 months thereafter. In response, the patient underwent ablation of both the new right lung lesion and the primary left lung lesion in January 2016. Subsequently, a treatment course consisting of six cycles of chemotherapy (0.8 g pemetrexed on day 1 and 70 mg nedaplatin on days 1 and 2; every three weeks as one cycle) resulted in stable disease. In May 2016, the patient began treatment with osimertinib (AZD9291; 80 mg/day), resulting in a rapid shrinkage of the mediastinal lymph node after one month, which has been providing a benefit for the patient for 82 months and counting. Of note, the patient also developed metachronous colon cancer in January 2020, followed by the identification of right posterior liver metastases in February 2020 and lung metastases in May 2021 and in February 2022. To address this, the patient underwent radical resection of colon cancer and liver metastasectomy and received a combination of chemotherapy with bevacizumab, along with MWA for lung metastases. Remarkably, the patient has achieved long-term survival of 110 months. In conclusion, this case highlights the promising potential of combining MWA with systemic therapy for a patient with advanced LADC harboring EGFR exon 19 Del and metachronous lung and liver-metastasized colon adenocarcinoma. MWA effectively controlled both in situ oligoprogression and new oligoprogression, thereby enhancing the efficacy of systematic chemotherapy/TKI therapy. Furthermore, this case report emphasizes the importance of repeated histologic biopsies and genetic testing as reliable indicators for adjusting treatment regimens. Physicians should also remain vigilant regarding the occurrence of secondary primary carcinomas, and timely and accurate adjustments to treatment plans will be of significant benefit to patients in terms of treatment efficacy and overall quality of life.

Twin reversed arterial perfusion (TRAP) sequence is a rare but severe complication of monochorionic twinning, in which retrograde arterial perfusion of an acardiac twin places the pump twin at risk of high-output cardiac failure, polyhydramnios, and preterm birth. While established intrauterine therapies include radiofrequency ablation (RFA), bipolar cord occlusion, and fetoscopic laser, the role of microwave ablation (MWA) remains incompletely defined. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines, complemented by a contemporary case experience, to evaluate the feasibility, outcomes, and challenges of MWA for the TRAP sequence. Searches of PubMed, Scopus, Web of Science, and Cochrane Library to December 2024 identified 249 records, of which 45 met the inclusion criteria and 20 were appraised as high-quality evidence. Across reports, MWA consistently achieved Doppler-confirmed intrafetal flow cessation, with procedural feasibility comparable to RFA. Potential advantages included broader and more uniform ablation zones with shorter application times. However, the evidence base remains limited, dominated by case reports and small series without randomized controlled trials. Procedural heterogeneity, including variation in antenna gauge, wattage, and cycle protocols, complicates comparability. Reporting standards are inconsistent, with frequent omission of maternal safety outcomes, neurodevelopmental follow-up, and long-term results. Accessibility is uneven, as expertise and equipment are concentrated in high-resource centers, and ethical dilemmas regarding the timing of intervention and parental counseling remain underexplored. We also report a 22-week TRAP case treated successfully with ultrasound-guided MWA (15G antenna, 60 W × 3 min, then 40 W × 1 min × 4 cycles), achieving complete vascular occlusion and stable pump twin heart rate (143 bpm). Our findings suggest that MWA is a promising but still experimental frontier in minimally invasive perinatology. Multicenter trials, harmonized procedural frameworks, and ethically informed counseling models are urgently needed to define its role in global practice.