Nonepithelial Tumors of the Larynx: Single-Institution 13-Year Review with Radiologic-Pathologic Correlation.

Nonepithelial tumors of the larynx are rare and represent a minority of all laryngeal neoplasms. Imaging has an important role in the diagnosis, treatment planning, and surveillance of these entities. However, unfamiliarity with these neoplasms can cause diagnostic difficulties for radiologists, especially because many of the imaging findings are nonspecific. By using a systematic approach based on clinical history, patient age and gender, lesion location, endoscopic results, and specific imaging findings, the differential diagnosis can often be narrowed. These tumors typically affect the submucosal layer, so if a tumor has an intact mucosa at endoscopy, a nonepithelial neoplasm is the most likely diagnosis. Nonepithelial tumors of the larynx can arise from the laryngeal cartilage or muscle or from the surrounding lymphoid tissue or blood vessels. Consequently, imaging findings typically correspond to the specific cell type from which it originated. Recognizing specific features (eg, metaplastic bone formation, macroscopic fat, or enhancement pattern) can often help narrow the differential diagnosis. In addition, identification of noncircumscribed borders of the lesion and invasion of the adjacent structures is key to diagnosis of a malignant process rather than a benign neoplasm. Understanding the pathologic correlation is fundamental to understanding the radiologic manifestations and is ultimately crucial for differentiation of nonepithelial laryngeal neoplasms. Online supplemental material is available for this article. ©RSNA, 2020.

Evaluation of a thermoprotective gel for hydrodissection during percutaneous microwave ablation: in vivo results.

PURPOSE: To evaluate whether thermoreversible poloxamer 407 15.4 % in water (P407) can protect non-target tissues adjacent to microwave (MW) ablation zones in a porcine model. MATERIALS AND METHODS: MW ablation antennas were placed percutaneously into peripheral liver, spleen, or kidney (target tissues) under US and CT guidance in five swine such that the expected ablation zones would extend into adjacent diaphragm, body wall, or bowel (non-target tissues). For experimental ablations, P407 (a hydrogel that transitions from liquid at room temperature to semi-solid at body temperature) was injected into the potential space between target and non-target tissues, and the presence of a gel barrier was verified on CT. No barrier was used for controls. MW ablation was performed at 65 W for 5 min. Thermal damage to target and non-target tissues was evaluated at dissection. RESULTS: Antennas were placed 7 ± 3 mm from the organ surface for both control and gel-protected ablations (p = 0.95). The volume of gel deployed was 49 ± 27 mL, resulting in a barrier thickness of 0.8 ± 0.5 cm. Ablations extended into non-target tissues in 12/14 control ablations (mean surface area = 3.8 cm(2)) but only 4/14 gel-protected ablations (mean surface area = 0.2 cm(2); p = 0.0005). The gel barrier remained stable at the injection site throughout power delivery. CONCLUSION: When used as a hydrodissection material, P407 protected non-targeted tissues and was successfully maintained at the injection site for the duration of power application. Continued investigations to aid clinical translation appear warranted.

High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation.

PURPOSE: Percutaneous radiofrequency ablation and cryoablation are accepted alternative treatments for small renal cell carcinomas (RCC) in high-risk patients. The recent development of high-powered microwave (MW) ablation offers theoretical advantages over existing ablation systems, including higher tissue temperatures, more reproducible ablation zones, and shorter procedural times. The purpose of this study is to review the feasibility, safety, and early efficacy of a novel high-powered percutaneous MW ablation system to treat RCC. METHODS: An institutional database identified 53 consecutive patients with biopsy-proven RCC ≤4 cm (55 tumors) who were treated with percutaneous MW ablation using a novel MW ablation system. All patients had percutaneous renal mass biopsy, which identified RCC before ablation. Postprocedure follow-up imaging was performed by contrast-enhanced computed tomography or magnetic resonance imaging. RESULTS: Mean patient age was 66 years and 81% of patients were male. RCC subtypes included clear cell (n=25), papillary (n=12), and unspecified (n=18) and Fuhrman grades 1, 2, 3, and ungraded in 15, 25, 1, and 14 patients, respectively. The mean tumor diameter was 2.6 cm (range 0.8-4.0 cm). Six low-grade complications were recorded during 53 (11.3%) procedures: five Clavien Grade 1 (urine retention, fluid overload, and atrial fibrillation) and one Grade 2 (hemorrhage requiring transfusion). The postprocedure estimated glomerular filtration rate was not significantly changed from preprocedure levels (median: -1.1%, p=0.10). Median follow-up was 8 months (interquartile range [IQR] 5-18.25) with 0/38 (0%) patients demonstrating evidence of local recurrence or metastasis during surveillance imaging. CONCLUSIONS: Use of a high-powered MW ablation system for the treatment of T1a RCC is feasible, safe, and efficacious with short-term follow-up. A longer follow-up is warranted to evaluate oncologic outcomes.

Characterization of killer immunoglobulin-like receptor genetics and comprehensive genotyping by pyrosequencing in rhesus macaques.

BACKGROUND: Human killer immunoglobulin-like receptors (KIRs) play a critical role in governing the immune response to neoplastic and infectious disease. Rhesus macaques serve as important animal models for many human diseases in which KIRs are implicated; however, the study of KIR activity in this model is hindered by incomplete characterization of KIR genetics. RESULTS: Here we present a characterization of KIR genetics in rhesus macaques (Macaca mulatta). We conducted a survey of KIRs in this species, identifying 47 novel full-length KIR sequences. Using this expanded sequence library to build upon previous work, we present evidence supporting the existence of 22 Mamu-KIR genes, providing a framework within which to describe macaque KIRs. We also developed a novel pyrosequencing-based technique for KIR genotyping. This method provides both comprehensive KIR genotype and frequency estimates of transcript level, with implications for the study of KIRs in all species. CONCLUSIONS: The results of this study significantly improve our understanding of macaque KIR genetic organization and diversity, with implications for the study of many human diseases that use macaques as a model. The ability to obtain comprehensive KIR genotypes is of basic importance for the study of KIRs, and can easily be adapted to other species. Together these findings both advance the field of macaque KIRs and facilitate future research into the role of KIRs in human disease.

Complete characterization of killer Ig-like receptor (KIR) haplotypes in Mauritian cynomolgus macaques: novel insights into nonhuman primate KIR gene content and organization.

Killer Ig-like receptors (KIRs) are implicated in protection from multiple pathogens including HIV, human papillomavirus, and malaria. Nonhuman primates such as rhesus and cynomolgus macaques are important models for the study of human pathogens; however, KIR genetics in nonhuman primates are poorly defined. Understanding KIR allelic diversity and genomic organization are essential prerequisites to evaluate NK cell responses in macaques. In this study, we present a complete characterization of KIRs in Mauritian cynomolgus macaques, a geographically isolated population. In this study we demonstrate that only eight KIR haplotypes are present in the entire population and characterize the gene content of each. Using the simplified genetics of this population, we construct a model for macaque KIR genomic organization, defining four putative KIR3DL loci, one KIR3DH, two KIR2DL, and one KIR1D. We further demonstrate that loci defined in Mauritian cynomolgus macaques can be applied to rhesus macaques. The findings from this study fundamentally advance our understanding of KIR genetics in nonhuman primates and establish a foundation from which to study KIR signaling in disease pathogenesis.