Microwave ablation for hyperparathyroidism in an older adult unsuitable for parathyroidectomy: a 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.

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.

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.

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.

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.

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.

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.

The aim of the study was to describe laparoscopic ultrasound (LUS) to guide microwave ablation (MWA) of hepatocellular carcinoma (HCC) in a dog. A 13-year-old female spayed Husky. Case report. The dog was referred for laparoscopic MWA of a caudate lobe HCC measuring 2.7 cm × 1.9 cm× 2.3 cm. Laparoscopic ultrasound was used to guide percutaneous placement of a MWA probe within the caudate lobe mass. LUS was used to determine the tumor margins for placement of the probe within the medial and lateral aspects as well as the center of the mass. Additionally, LUS allowed visualization of vessels within the tumor so they could be avoided during probe placement. Safe ablation was accomplished, and the dog recovered uneventfully with no complications. Follow-up computed tomography (CT) 3- and 12-months postoperatively revealed complete ablation of the caudate lobe mass. However, progressive increase in size of the right medial lobe mass occurred. Right medial liver lobectomy was performed 13 months after MWA, with a histopathologic diagnosis of HCC. The dog was euthanized 777 days post MWA and 1445 days post initial left lateral lobectomy for HCC. Laparoscopic ultrasound was useful in guiding complete and safe MWA of an HCC in this dog. Laparoscopic ultrasound should be considered when performing laparoscopic MWA of liver lesions in dogs.

Introduction: Microwave ablation (MWA) utilizes electromagnetic methods to destroy tumors, employing devices operating at 900 MHz or above frequencies. MWA has emerged as a recent alternative for treating osteoid osteoma (OO), providing similar accessibility, safety, and technical effectiveness as radiofrequency ablation. This systematic review aims to evaluate the safety and efficacy of MWA in treating OO. Methods: A systematic review of published studies on the use of MWA in managing OO was conducted. Studies were excluded if they were 1) not written in English, 2) case reports, 3) lacked adequate peer review, or 4) consisted solely of abstracts. Before full-text assessment, titles, and abstracts were screened. Extracted data included author, year, study design, patient count, age, gender, OO site, ablation power (watts), duration, complications, outcome, and recurrence. The data were analyzed and presented as means, frequencies, and percentages. Results: Eight studies, including 143 cases, met the inclusion criteria; among these cases, 59.44% were male, and the mean age was 19.03 ± 7.09. Most of the OOs were in the femur, 54.54%. MWA at 60 W was the prevailing power setting, utilized in 37 cases (25.87%), with an ablation time of 90 s for 95 cases (66.43%). Clinical success was achieved in 137 (95.80%) cases, with recurrence observed in 4 cases (2.80%). However, 16 minor and major complications were observed despite the overall success. Conclusion: Percutaneous MWA may represent an efficient choice for the minimally invasive management of OO, demonstrating a minimal risk of complications and recurrence.

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.

Hepatocellular carcinoma (HCC) stands as one of the most prevalent malignant tumors [1], and is the cause of over one million deaths annually worldwide [2]. While surgical resection remains the preferred treatment for early-stage hepatocellular carcinoma (HCC) in well-compensated cirrhosis patients, thermal ablation techniques offer a credible non-surgical option. Their minimal invasiveness, high tolerability, safety, established efficacy in local disease control, virtually unlimited repeatability, and cost-effectiveness render them valuable alternatives. Microwave ablation (MWA) of HCC appears to be a safe and effective treatment. Here we report a case of 53-year-old male, followed for hepatitis C complicated by compensated cirrhosis, During the follow up, Laboratory tests found liver function tests were eleveted, α-fetoprotein (AFP) was normal. Abdominal ultrasound showed a focal hepatic mass straddling segments VI and VIII, rounded, well-limited, with heterogeneous hyperechoic echostructure, and splenomegaly. Contrast-enhanced abdominal computed tomography showed a chronic liver desease with a focal lesion straddling segments VI and VIII, oval, tissue-like, hypodense in the center, measuring 50x41mm, with signs of early arterial enhancement consistent with HCC characteristics and signs of portal hypertension and a multicystic kidney. Hepatic MRI revealed a chronic liver disease straddling segments VII and VIII of a hepatic lesion measuring 23x 22mm classified as Li-RADS 4 with signs of portal hypertension and splenomegaly. Based on these results, the patient was diagnosed as HCC with well compensated cirrhosis, and in view of the fact that he had only a single lesion and was in functional grade A of Child-Pugh classification and staged as BCLC-A in the Barcelona Clinic Liver Cancer (BCLC) staging system, the patient benefited from microwave ablation for his HCC, with good clinical, biological and radiological evolution. Microwave Ablation (MWA) emerges ..........

Pyogenic liver abscess (PLA) could be fatal even after standard treatment with antibiotics and percutaneous drainage. Immune checkpoint inhibitors, bevacizumab or microwave ablation may cause PLA, respectively. This paper presents the first case of PLA secondary to the concomitant use of microwave ablation with atezolizumab and bevacizumab in the treatment of liver cancer. A 54-year-old Chinese man with Barcelona Clinic Liver Cancer (BCLC) C-stage liver cancer complained of fever and chills twenty-nine days after concurrent microwave ablation plus atezolizumab and bevacizumab. Post-hospitalization, a computed tomography revealed a rim-enhancing hypodensity within the right lobe of the liver, approximately 8.8 cm in diameter containing foci of gas. Laboratory examination revealed elevated white blood cell count, C-reactive protein and procalcitonin, and blood culture indicated the presence of Escherichia coli bacteremia. The patient was diagnosed with PLA complicated by septic shock, and due to recurrent fever, multiple courses of antibiotics (imipenem/cilastatin sodium, cefoperazone/sulbactam, meropenem, respectively) were administered in combination with five percutaneous drainages over the next 90 days. The patient's fever eventually resolved, and the patient was discharged. The patient was re-treated with two cycles of atezolizumab and bevacizumab initiated in March 2024. An imaging evaluation in May 2023 demonstrated tumor progression. Subsequently, the patient underwent one transarterial chemoembolization procedure and two cycles of atezolizumab and bevacizumab over the subsequent 2 months. Notably, the patient achieved a complete response at the July 2024 imaging evaluation. In patients undergoing atezolizumab and bevacizumab, the potential risk of PLA versus the antitumor benefit of microwave ablation requires to be assessed. The use of multiple courses of antibiotics over a prolonged period did not appear to influence the effectiveness of atezolizumab and bevacizumab. Further studies are, however, needed to substantiate this finding.