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Imaging-guided percutaneous microwave ablation (MWA) with high thermal efficiency comprises rapid, successful management of small renal cell carcinomas (RCCs) in selected patients. Ultrasound Committee of Chinese Medical Association, Interventional Oncology Committee of Chinese Research Hospital Association developed evidence-based guidelines for MWA of RCCs after systematically reviewing the 1969–2019 literature. Systematic reviews, meta-analyses, randomized controlled trials, cohort, and case–control studies reporting MWA of RCCs were included and levels of evidence assessed. Altogether, 146 articles were identified, of which 35 reported percutaneous MWA for T1a RCCs and 5 articles for T1b RCCs. Guidelines were established based on indications, techniques, safety, and effectiveness of MWA for RCCs, with the goal of standardizing imaging-guided percutaneous MWA treatment of RCCs.Key points Microwave ablation is recommended for managing small renal cell carcinoma in selected patients. Imaging protocols are tailored based on the procedural plan, guidance, and evaluation. Patient’s selection evaluation, updated technique information, clinical efficacy, and complications are recommended to standardize management. A joint task force (multidisciplinary team) summarized the key elements of the standardized report.

Abstract Background Vena cava thrombus is one of the main clinical manifestations of locally aggressive renal cell carcinoma (RCC). Inferior vena cava (IVC) wall invasion and presence of bland thrombus could affect the surgical outcome. This study aims to assess the value of contrast-enhanced ultrasound (CEUS) in detecting wall invasion and differentiating bland thrombus from tumor thrombus during robot-assisted IVC thrombectomy for RCC. Methods The intraoperative CEUS findings of 60 patients with RCC accompanied by IVC tumor thrombus were retrospectively analyzed. The CEUS features were compared with the intra- and post-operative pathological findings. CEUS in patients with wall invasion showed that the tumor thrombus was enhanced synchronously with the IVC wall, and the continuity of the IVC wall was lost. In contrast, in patients without wall invasion, CEUS showed that the contrast agent could pass between the tumor thrombus and the IVC wall, and the continuity of IVC wall was good. Typically, contrast-enhanced perfusion was seen in tumor thrombus but not in bland thrombus. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were statistically analyzed. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the typical enhancement mode of CEUS were 93.1, 93.5, 93.3, 93.1, and 93.5% in identifying wall invasion and 100, 96, 96.7, 83.3, and 100% in differentiating bland thrombus from tumor thrombus, respectively. There were excellent inter-observer agreements for identifying IVC wall invasion and differentiating bland thrombus from tumor thrombus with kappa coefficients of 0.90 and 0.97. Conclusions The present study indicates that intraoperative CEUS plays an important role in robot-assisted IVC thrombectomy for RCC. It can detect wall invasion and differentiate bland thrombus from tumor thrombus, thus offering real-time information to the operator during surgery.

Abstract Preoperative renal tumor subtype differentiation is important for radiology and urology in clinical practice. Pharmacokinetic data (K trans & V e, etc.) derived from dynamic contrast-enhanced MRI (DCE-MRI) have been used to investigate tumor vessel permeability. In this prospective study on DCE-MRI pharmacokinetic studies, we enrolled patients with five common renal tumor subtypes: clear cell renal cell carcinoma (ccRCC; n = 65), papillary renal cell carcinoma (pRCC; n = 12), chromophobic renal cell carcinoma (cRCC; n = 9), uroepithelial carcinoma (UEC; n = 14), and fat-poor angiomyolipoma (fpAML; n = 10). The results show that K trans of ccRCC, pRCC, cRCC, UEC and fpAML (0.459 ± 0.190 min−1, 0.206 ± 0.127 min−1, 0.311 ± 0.111 min−1, 0.235 ± 0.116 min−1, 0.511 ± 0.159 min−1, respectively) were different, but V e was not. K trans could distinguish ccRCC from non-ccRCC (pRCC & cRCC) with a sensitivity of 76.9% and a specificity of 71.4%, respectively, as well as to differentiate fpAML from non-ccRCC with a sensitivity of 100% and a specificity of 76.2%, respectively. Our findings suggest that DCE-MRI pharmacokinetics are promising for differential diagnosis of renal tumors, especially for RCC subtype characterization and differentiation between fpAML and non-ccRCC, which may facilitate the treatment of renal tumors.

Objective To explore the prevalence of osteoporosis in adult women in Inner Mongolia Autonomous Region and to analyze the influencing factors. Methods Totally 1 333 adult women from 4 regions of Inner Mongolia were selected by stratified cluster random sampling method from July 2014 to December 2015. Questionnaire survey, physical examination and laboratory testing were conducted. Calcaneal bone mineral density was measured by dry ultrasound bone mineral density analyzer. Univariate and multivariate Logistic regression were used to analyze the influencing factors of osteoporosis in adult women. Results The prevalence of osteoporosis in adult women in Inner Mongolia was 7.88% (standardized rate 8.56%). Logistic regression analysis showed that the protective factors of osteoporosis prevalence included young age, high intensity of physical exercise and high height (P＜0.05), while menopause was an independent risk factor for osteoporosis (P＜0.05). Conclusions The osteoporosis of adult women in Inner Mongolia is closely related to age, physical exercise, menopause and body height.

This study describes the clinical, histologic, and immunohistochemical features of four cases of GI PEComa. The size of the tumors ranged from 3.5 to 6.0cm in diameter, and all were located in wall of the large bowel. Microscopically, the tumors were characterized by an epithelioid arrangement of tumor cells, which had abundant clear to pale eosinophilic granular cytoplasm, vesicular nuclei and prominent nucleoli. The stroma was rich in capillaries, a sinusoidal vasculature and thick-walled blood vessels. Mitotic figures were generally rare. Immunohistochemically, the tumors were positive for Vimentin (4/4), HMB-45 (4/4), Melan-A(4/4),alpha-smooth muscle actin (4/4), and desmin (3/4). The patients have been well with no evidence of disease at 8, 15, 32 and 36 months,respectively, after the surgical operation. GI tract PEComas should be regarded as tumors of an uncertain malignant potential until long-term outcome data for a larger number of patients become available. [ABSTRACT FROM AUTHOR]

Abstract: Perivascular epithelioid cell tumor (PEComa) of the laryngopharynx is extremely rare, and no such descriptions have been reported in the literature. This study describes the clinical, histological, and immunohistochemical features of three cases of laryngopharynx PEComa. The patients (two males and one female) were 38, 42, and 47 years old, respectively. Their tumors were well-demarcated, gray white on the cut surface with focal hemorrhage, and ranged from 3.0 to 5.0cm in diameter. Microscopically, the tumors were characterized by an epithelioid arrangement of tumor cells, which had abundant clear to pale eosinophilic granular cytoplasm, vesicular nuclei, and prominent nucleoli. The stroma was rich in capillaries, sinusoidal vasculature, and thick-walled blood vessels. Mitotic figures were rare. The tumors showed no cellular atypia, with two of them having moderate atypical nuclei focally. Immunohistochemically, the tumor cells were diffusely or focally positive for vimentin (3/3), HMB-45 (3/3), melan-A(3/3), alpha-smooth muscle actin (3/3), and S-100(1/3). They were uniformly negative for CK, Syn, CgA, CD34, CD10, and CD117. Two patients are well, with no evidence of disease at 13 and 30 months after surgery, one patient had recurrence at 15 months after operation. Laryngopharynx PEComas should be regarded as tumors with a malignant potential. [Copyright &y& Elsevier]