Immunohistochemically, tumor cells are positive for CD34 (clusters of differentiation 34) antigen (Panel D). The obtained soft tissue mass specimen was consistent with metastatic epithelioid hemangioendothelioma (EHE) on microscopic investigation and immunohistochemical testing. Hepatic EHE is a rare, low-grade malignant vascular tumor LY294002 that occurs exclusively in adults. Clinical manifestation is variable, from asymptomatic patients to patients with hepatic failure, with the most common symptom being pain at the right upper quadrant. Although hepatic EHE is a rapidly progressive disease, prognosis and
extrahepatic involvement are more favorable compared with other hepatic malignancies. The most common sites of extrahepatic metastasis are the lungs, peritoneum, lymph nodes, and bones. A general treatment strategy for hepatic EHE has not yet been established. However, Ibrutinib the most common treatment is liver transplantation due to the multicentricity of hepatic EHE.1 To the best of our knowledge, the extrahepatic metastasis of hepatic EHE to the soft tissue of the cervical neck area has not been reported previously. Because the imaging characteristics of hepatic EHE might mimic metastatic adenocarcinoma, cholangiocarcinoma, and/or hepatocellular carcinoma, the clinician’s awareness of this
tendency and a histopathological examination are essential for the accurate diagnosis and proper treatment of hepatic malignancies.2 “
with great interest the study by Romero-Gómez et al.1 demonstrating that the combination of metformin, peginterferon alfa-2, and ribavirin improved insulin resistance in >50% of patients and increased sustained virological response (SVR) ADAMTS5 rate in 10% of patients with hepatitis C genotype 1 and homeostasis model assessment (HOMA) >2. Intriguingly, in female participants, the addition of metformin to the standard of care for chronic HCV infection doubled the SVR rate.1 Since 1994, the U.S. National Institutes of Health requires that at least half of all clinical trial participants enrolled are females,2 and increasing interest in women’s health and sex-specific outcomes have led to the increase in subgroup analyses stratified by sex. However, improperly conducted sex-based subgroup analysis in clinical trials can yield incorrect conclusions that may result in adverse effects on women’s health. It has been therefore suggested that: (1) sex-based subgroup analysis should be planned a priori to the study commencement; (2) hypothesis or rationale for the analysis should be provided; (3) a statistical tests for interaction with sex should be performed when analyzing the outcomes; and (4) the overall treatment results should be emphasized more than the findings of the sex-based subgroup analysis.3 The study by Romero-Gómez et al.