Home Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
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Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review

  • Chen Li , Jing-Yong Xu EMAIL logo and Yuan Liu
Published/Copyright: May 11, 2021
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Open Medicine
From the journal Open Medicine Volume 16 Issue 1

Abstract

Perivascular epithelioid cell tumor (PEComa) is a mesenchymal tumor rarely described in the liver. Sonazoid is a new ultrasound contrast with both vascular and post-vascular phases due to the uptake of Kupffer cell. CD68 is a defined immunohistorical staining marker for macrophage including Kupffer cell. No previous cases have been reported to reveal Kupffer images in the post-vascular phase by using Sonazoid and pathologic characters of CD68 positive cell in PEComa. Herein, we describe the first case to present Sonazoid contrast-enhanced ultrasonography (CEUS) findings in Kupffer images and CD68 positive cell in hepatic PEComa which may lead to rethink of the phagocytic properties of macrophages.

Keywords: Sonazoid; CD68; perivascular epithelioid cell tumor; enhanced ultrasonography; Kupffer cell

1 Introduction

Perivascular epithelioid cell tumors (PEComas) are mesenchymal tumors with unique perivascular cells found on the histopathology and immunohistochemistry of liver tissue sections [1]. The PEComa family is comprised of angiomyolipomas, lymphangioleiomyomas, and a group of immunohistochemically similar rare tumors arising at various soft tissues and visceral sites often termed as “PEComas-NOS (not otherwise specified)” [2,3,4]. Hepatic PEComas are rare and challenging to diagnose preoperatively because of nonspecific radiologic features.

Contrast-enhanced ultrasonography (CEUS) using Sonazoid, a new-generation ultrasound contrast agent, can provide the “hemodynamic phase” (or “vascular phase”) like other conventional contrast agents. It detected liver masses by the generation of functional images that allow the radiologist to visualize Kupffer cell distributions, defined as “Kupffer-phase” or “post-vascular phase” [5,6]. Only one patient with PEComa, evaluated with Sonazoid CEUS, has been published [7]; however, the Kupffer-phase was not evaluated in that study. Therefore, in this report, we present the novel imaging characteristics of hepatic PEComa using Sonozoid CEUS, including Kupffer-phase characteristics. This imaging was compared with histopathologic examinations and CD68 immunohistochemical staining characteristics of macrophages and Kupffer cells in liver and tumor tissue sections.

2 Case report

We have received informed consent from the patient. A 36-year-old female patient diagnosed with a liver tumor was admitted. The patient was asymptomatic and had no medical history of heavy drinking, oral contraceptives use, hepatitis, or autoimmune disorders. No abnormalities were found on the physical examination or hepatic laboratory functional tests. Serum alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 (CA19-9) levels were all within normal intervals.

Abdominal ultrasonography revealed a heterogeneous hypoechoic mass in the right lobe of the liver, with well-circumscribed margins (Figure 1a). Color Doppler flow images showed blood flow at the margin of the mass (Figure 1b). Sonazoid CEUS (Figure 1c–f) revealed homogeneous hyper-enhancement in the arterial phase, iso-enhancement in the portal phase, and mild hypo-enhancement in the equilibrium phase. Heterogeneous hypo-enhancement was seen in the post-vascular phase. Transverse abdominal contrast-enhanced computed tomography imaging (Figure 2) demonstrated heterogeneous enhancement during the arterial phase and slightly washout during the portal and equilibrium phases. Traverse abdominal magnetic resonance imaging (MRI) of the mass showed low signal intensities on T1-weighted (T1w, Figure 3a) imaging and high signal intensities on T2-weighted (T2w, Figure 3b) imaging. Dynamic contrast-enhanced MRI showed tumor hyper-intensities in arterial phase images (Figure 3c) and hypo-intensities in the portal phase (Figure 3d).

Figure 1 Abdominal ultrasonography and Sonazoid contrast-enhanced ultrasound images (Sonazoid 0.5 mL bolus injection, Toshiba Aplio 500, and 3.75 MHz convex array probe) of a primary hepatic perivascular epithelioid cell tumor. (a) A heterogeneous hypoechoic nodule is demonstrated on B-mode ultrasound (arrows). (b) Color Doppler flow images reveal abundant blood flow at the tumor margins. (c–f) Sonazoid contrast-enhanced ultrasound in the arterial (c, 23 s), portal (d, 100 s), equilibrium (e, 5 min), and post-vascular (f, 10 min) phases. Hyper-enhancement is observed in the arterial phase, with iso-enhancement in the portal phase and mild hypo-enhancement in the equilibrium and post-vascular phases.
Figure 1

Abdominal ultrasonography and Sonazoid contrast-enhanced ultrasound images (Sonazoid 0.5 mL bolus injection, Toshiba Aplio 500, and 3.75 MHz convex array probe) of a primary hepatic perivascular epithelioid cell tumor. (a) A heterogeneous hypoechoic nodule is demonstrated on B-mode ultrasound (arrows). (b) Color Doppler flow images reveal abundant blood flow at the tumor margins. (c–f) Sonazoid contrast-enhanced ultrasound in the arterial (c, 23 s), portal (d, 100 s), equilibrium (e, 5 min), and post-vascular (f, 10 min) phases. Hyper-enhancement is observed in the arterial phase, with iso-enhancement in the portal phase and mild hypo-enhancement in the equilibrium and post-vascular phases.

Figure 2 Contrast-enhanced computed tomographic (CT) imaging of a primary hepatic perivascular epithelioid cell tumor in the arterial (a, 25–30 s), portal (b, 60 s), and equilibrium (c, 180 s) phases. A heterogeneous enhancement can be seen during the arterial phase, while the contrast agent was washed out during the portal and equilibrium phases (arrows).
Figure 2

Contrast-enhanced computed tomographic (CT) imaging of a primary hepatic perivascular epithelioid cell tumor in the arterial (a, 25–30 s), portal (b, 60 s), and equilibrium (c, 180 s) phases. A heterogeneous enhancement can be seen during the arterial phase, while the contrast agent was washed out during the portal and equilibrium phases (arrows).

Figure 3 Transverse abdominal MRI using different contrasts, including T1-weighted of a primary hepatic perivascular epithelioid cell tumor (a), T2-weighted (b), and dynamic contrast-enhanced magnetic resonance imaging (c and d). The tumor showed low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging (arrows). Hyper-intensity was seen in the arterial phase (25–30 s), while hypo-intensity was seen in the portal phase (60 s).
Figure 3

Transverse abdominal MRI using different contrasts, including T1-weighted of a primary hepatic perivascular epithelioid cell tumor (a), T2-weighted (b), and dynamic contrast-enhanced magnetic resonance imaging (c and d). The tumor showed low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging (arrows). Hyper-intensity was seen in the arterial phase (25–30 s), while hypo-intensity was seen in the portal phase (60 s).

Based on these imaging findings and the medical history, the primary tumor was diagnosed as a hepatic adenoma or atypical hepatocellular carcinoma (HCC).

Resection of liver segment VII was performed. Grossly, the mass was 4.7 × 4 × 3 cm3, brown to gray, and well demarcated from the surrounding liver tissue. On microscopic examination, epithelioid and spindle-shaped cells with oval nuclei and clear to granular eosinophilic cytoplasm were mostly seen. Necrosis and nuclear atypia were inconspicuous (Figure 4). Immunohistochemical staining revealed the tumor cells to be positive for smooth muscle actin (SMA), FLI-1, and TFE3, partially positive for human melanin black-45 (HMB-45), and negative for AE1/AE3, ALK, CK8, Desmin, ERG (UMAB78), GPC3, HCC, LCA, Myogenin, S100, and SOX10. The Ki67 proliferative index was 10%. CD68 staining showed strongly positive macrophages but not Kupffer cells in the tumor. The final diagnosis was hepatic PEComa-NOS.

Figure 4 Pathologic and histopathologic findings of a primary hepatic perivascular epithelioid cell tumor. (a) The gross appearance of the tumor on cut dissection shows a well-demarcated brown to gray tumor surrounded by liver tissue. (b) A low power photomicrograph of liver and tumor histopathology using H & E staining (H & E staining ×40). A sharp demarcation between the tumor margin and normal liver parenchyma (star) is observed. (c) A low power photomicrograph of the liver (star) and tumor tissue with CD68 immunohistochemical (IHC) staining (H & E staining ×40); the tumor cells are strongly positive for CD68. (d) and (f) High power photomicrographs of normal liver using H & E and CD68 IHC staining, respectively (H & E staining ×40). (f) Kupffer cells are strongly positive for CD68 and scattered throughout the liver tissue section (arrow). (e) A high power photomicrograph of the tumor with H & E staining (H & E staining ×100). (g) A high power photomicrograph of the tumor using CD68 IHC (H & E staining ×100). CD68 positive cells are densely packed and shaped differently from those of the Kupffer cells in normal liver (arrow).
Figure 4

Pathologic and histopathologic findings of a primary hepatic perivascular epithelioid cell tumor. (a) The gross appearance of the tumor on cut dissection shows a well-demarcated brown to gray tumor surrounded by liver tissue. (b) A low power photomicrograph of liver and tumor histopathology using H & E staining (H & E staining ×40). A sharp demarcation between the tumor margin and normal liver parenchyma (star) is observed. (c) A low power photomicrograph of the liver (star) and tumor tissue with CD68 immunohistochemical (IHC) staining (H & E staining ×40); the tumor cells are strongly positive for CD68. (d) and (f) High power photomicrographs of normal liver using H & E and CD68 IHC staining, respectively (H & E staining ×40). (f) Kupffer cells are strongly positive for CD68 and scattered throughout the liver tissue section (arrow). (e) A high power photomicrograph of the tumor with H & E staining (H & E staining ×100). (g) A high power photomicrograph of the tumor using CD68 IHC (H & E staining ×100). CD68 positive cells are densely packed and shaped differently from those of the Kupffer cells in normal liver (arrow).

The patient recovered with no postoperative complications and was discharged 1 week after surgery. The evidence of recurrence or metastasis was not found during the follow-up period of 16 months.

3 Discussion

In 2013, the World Health Organization (WHO) defined PEComas as mesenchymal tumors composed of distinctive cells showing focal associations with blood vessel walls and usually expressing melanocytic and smooth-muscle markers [8]. Hepatic PEComas are rare and occur primarily in adults with wide age ranges (10–86 years). These tumors are much more frequent in females than males (female-to-male ratio, 2:1 to 5:1) [4]. Most patients are asymptomatic or have no specific clinical symptoms, and the tumors are found incidentally in physical examination. Although the majority of reported PEComas have behaved in a benign fashion, minority have demonstrated malignant behavior with locally destructive recurrence and distant metastasis [9]. However, several other cases can probably exhibit local recurrence or metastasis in long-term follow-up. On histopathology, PEComas are characterized by perivascular locations, and the cells are radially arranged around vascular lumens. Typically, cells around the vessels are epithelioid and spindle-shaped, resembling smooth muscles cells with abundant clear to eosinophilic granular cytoplasm [7,10]. A diagnosis of PEComa usually depends on histopathology and immunohistochemistry [8,11], not on initial diagnostic imaging. PEComas are generally characterized by co-expression of melanocytic markers (HMB-45 and/or Melan-A) and muscle markers (actin and/or desmin) [10]. The tumor, in this case, stained strongly positive for Melan-A, and weakly and partially positive for HMB-45 and SMA, a staining pattern that was key in making a PEComa diagnosis.

The typical ultrasonographic appearance of hepatic PEComa is a well-defined round lesion that is hyperechoic in up to 90% of the cases with high vascularization [12]. Only three liver PEComa cases using CEUS imaging have been reported in English journals [7,13,14]. Sonazoid has been used as a second-generation ultrasound contrast medium in only one case; however, Kupffer imaging in the post-vascular phase has not been reported [7]. SonoVue has been used as another contrast agent in two cases [13,14]. Using SonoVue and Sonazoid contrast agents, homogeneous hyper-enhancements have been obtained in the arterial phase, and iso-enhancement has been seen in the portal vein phase reflected against the surrounding parenchyma. The enhancement patterns in the equilibrium phases were different in PEComas using these two contrast agents; hypo-enhancement was seen using the Sonazoid agent, and persistent slight hyper-enhancement with a lack of rapid washout was observed using the SonoVue agent [7,13,14]. In non-cirrhotic livers, these features can be found in benign lesions such as focal nodular hyperplasia or adenomas, according to the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines [14,15]. Aside from benign lesions, in our case, a differential diagnosis of atypical HCC could not be excluded because of the hypo-enhancement in the equilibrium and post-vascular phases.

Sonazoid is a second-generation sonographic contrast agent initially used in Japan and then licensed in China in 2019. This contrast agent contains lipid-shelled microbubbles that can be easily phagocytosed by Kupffer cells resulting in persistent and stable enhancement periods in hepatic parenchyma. This enhancement is termed the post-vascular or Kupffer phase and begins 10 min after the agent is injected and can last from 1 to 2 h [16]. In this case, tumor hypo-enhancement was seen in the post-vascular phase, which could indicate that fewer Kupffer cells were present in this tumor.

CD68 is expressed in monocyte, macrophage, and Kupffer cell cytoplasm, and can be used to identify Kupffer cells in normal and diseased liver tissue sections [17,18]. We expected that liver tissues containing Kupffer cells or CD68 positive cells would be hyper-enhanced on the Sonazoid CEUS Kupffer or post-vascular phases. However, we saw strongly positive CD68 immunohistochemical staining on the tumor tissue sections, but hypo-enhancement of the tumor in the post-vascular phase on Sonozoid CEUS. CD68 positive cells have been observed in hepatic and renal angiomyolipomas and are relatively common in PEComa family tumors [19,20,21,22]. In our case, it is unclear why so many macrophages were present in the tumor. On high power microscopic examination, a morphologic difference between Kupffer cells in the liver and CD68-positive cells in the tumor was seen. These CD68-positive cells were likely histiocytes, such as migrating macrophages and not Kupffer cells [22]. We speculate that tumor inflammatory responses cause a marked increase in migrating macrophages with decreased functional abilities to uptake the Sonazoid contrast agent. This hypothesis requires further research using Sonazoid CEUS and looking at Kupffer phase images to diagnose hepatic PEComas. Additional research is also needed to study the physiologic mechanisms of PEComas [23].

In conclusion, the PEComa in this study showed hypo-enhancement in the Kupffer or post-vascular phases of Sonazoid CEUS with strongly positive CD68 cell staining on tissue sections. The CD68 cells likely represented migrating macrophages with decreased functional abilities, as opposed to Kupffer cells that would have shown enhanced echogenicity on Sonazoid CEUS. This study provides the first characterization of a PEComa using Sonazoid CEUS, which could be used for the noninvasive diagnosis of PEComas.

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  1. Conflict of interest: Authors state no conflict of interest.

  2. Data availability statement: All data generated or analyzed during this study are included in this published article.

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Received: 2021-01-19
Revised: 2021-03-23
Accepted: 2021-03-24
Published Online: 2021-05-11

© 2021 Chen Li et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
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  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
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  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
https://doi.org/10.1515/med-2021-0275
Keywords for this article
Sonazoid; CD68; perivascular epithelioid cell tumor; enhanced ultrasonography; Kupffer cell
Creative Commons
BY 4.0

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  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
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  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
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  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
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  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
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  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
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  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
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  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
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  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
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