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Yazıcı C, Gündoğdu E. Very Rare Liver Tumor: PEComa Case Report with and a Review of Literature. Indian J Radiol Imaging 2024; 34:172-176. [PMID: 38106859 PMCID: PMC10723948 DOI: 10.1055/s-0043-1774392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are very rare mesenchymal tumors. In addition to being rare in general, they are even rarer in the liver. There are various subtypes and there is only one case of liver PEComa reported in the clear cell type in the literature to date. We present the second clear cell type liver PEComa in this case by reviewing the literature data. The hypodense, smooth-edged, ovoid lesion was detected on computed tomography (CT) for performing abdominal pain in a 41-year-old female patient. Magnetic resonance imaging (MRI) was then performed for lesion characterization. The lesion was hypointense on T1-weighted imaging (T1WI), hyperintense on T2-weighted imaging (T2WI). In dynamic phases, it showed marked enhancement on the arterial phase and capsular enhancement with central washout on the portal and late venous phases. The posterior branch of the right portal vein extended into the mass. The lesion was excised and the pathological result was epithelioid clear cell subtype of PEComa. Although the imaging findings are generally nonspecific and certain diagnosis is made histopathologically, radiologists should consider PEComa in the differential diagnosis in the presence of intensely enhanced lesion on the right lobe in female patients. Also, the "large vessel sign" may help in the diagnosis.
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Affiliation(s)
- Celal Yazıcı
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
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Matrood S, Görg C, Safai Zadeh E, Alhyari A. Hepatic perivascular epithelioid cell tumor (PEComa): contrast-enhanced ultrasound (CEUS) characteristics-a case report and literature review. Clin J Gastroenterol 2023; 16:444-449. [PMID: 36964879 DOI: 10.1007/s12328-023-01779-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/23/2023] [Indexed: 03/26/2023]
Abstract
Perivascular epithelioid cell tumors (PEComa) are rare mesenchymal neoplasms that arise from soft tissue of various organs such as the stomach, intestines, and lungs. We report a rare case of a primary PEComa of the liver and its characteristics on contrast-enhanced ultrasound (CEUS) in a 51-year-old female patient with an incidental finding of a hypoechoic liver lesion with peripheral hypervascularization on Doppler ultrasound. CEUS showed homogenous hypervascularity in the arterial phase that was consistent in the portal phase. In the late phase, a central washout phenomenon was evident. Histopathologic findings on sonographic biopsy of the lesion revealed a mesenchymal tumor with positivity for melanocytic markers Human Melanin Black-45 (HMB45) and Melan-A consistent with a PEComa. Despite the absence of high-risk features for malignancy, surgical resection was recommended due to the uncertain malignant potential of PEComas. The patient refused the operation and preferred sonographic follow-up; the lesion was stable over a period of 2 years. CEUS can provide valuable information regarding PEComa. After histological confirmation, the choice between resection and a watchful waiting must be made on individual basis.
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Affiliation(s)
- Sami Matrood
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Christian Görg
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Marburg, Philipps-University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35042, Marburg, Germany
| | - Ehsan Safai Zadeh
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Marburg, Philipps-University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35042, Marburg, Germany
| | - Amjad Alhyari
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany.
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Marburg, Philipps-University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35042, Marburg, Germany.
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Cai X, Sun S, Deng Y, Liu J, Pan S. Hepatic epithelioid angiomyolipoma is scattered and unsuitable for surgery: a case report. J Int Med Res 2023; 51:3000605231154657. [PMID: 36794565 PMCID: PMC9936533 DOI: 10.1177/03000605231154657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Hepatic epithelioid angiomyolipoma (HEAML) is a rare tumour of mesenchymal tissue with a malignant tendency. Occurring most frequently in women, the relative incidence in men and women, according to incomplete statistics, is approximately 1:5. In rare cases, disease occurrence and development is hidden. Lesions are generally discovered as chance findings by patients; abdominal pain is the first symptom, and imaging has no specificity in diagnosing the disease. Therefore, great difficulties exist in the diagnosis and treatment of HEAML. Here, the case of a 51-year-old female patient with a history of hepatitis B, and abdominal pain over 8 months as the initial symptom, is described. The patient was found to have multiple intrahepatic angiomyolipoma. Due to the small and scattered foci, complete resection was impossible, and because of her history of hepatitis B, conservative treatment was undertaken, with the patient undergoing regular follow-up. When hepatic cell carcinoma could not be excluded, the patient was treated with transcatheter arterial chemoembolization. No tumour neogenesis or metastasis was detected at the 1-year follow-up.
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Affiliation(s)
- Xiangreng Cai
- Department of Emergency Surgery, Lu'an People's Hospital of Anhui Province, Lu'an, Anhui, China
| | - Shuchuan Sun
- Department of Obstetrics and Gynaecology, Affiliated Hospital of Tongchuan City Maternal and Child Health Care, Tongchuan, Shaanxi, China
| | - Yuxin Deng
- School of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Jiangxin Liu
- Department of Pathology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Siyuan Pan
- Graduate Student Affairs Office, Xi’an Medical University, Xi’an, Shaanxi, China,Siyuan Pan, Hanguang Campus of Xi’an Medical University, 74 Hanguang North Road, Xi’an, Shaanxi Province, 712000, China.
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Hu W, Guo G, Chi Y, Li F. Construction of Traf3 knockout liver cancer cell line using CRISPR/Cas9 system. J Cell Biochem 2019; 120:14908-14915. [PMID: 31016787 DOI: 10.1002/jcb.28753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The gene editing technology in CRISPR/Cas9 system was used to construct the Traf3 knockout HepG2 cell line to explore the role of Traf3 in the development of liver cancer. METHODS Five sgRNA sites were designed for the exons of Traf3. The recombinant plasmid of Lentiviral vector2-Traf3-sgRNA was constructed and transformed into Stbl3 competent cells. The recombinants were screened and sequenced, and the effectiveness of the designed gRNA was verified by sequencing. The constructed vector was transfected into HepG2 cells by lentiviral, and the monoclonal antibody was selected to detect the knockout effect of Traf3 gene in HepG2 cells by Western blot. PCR amplification and gene sequencing were performed to obtain the cell line, which the Traf3 gene was knocked out. MTT and Transwell assays were used to detect the effect of Traf3-knockout on HepG2 cell proliferation and cell invasion, respectively. RESULTS The Lentiviral vector2-sgRNA expression vector was successfully constructed. PCR amplification electrophoresis and gene sequencing showed that the Trep3-knockdown HepG2 cells were successfully constructed. Compared with the wild HepG2 cells group, the proliferation and invasion ability of HepG2 cells were enhanced in the Traf3 knockout group. CONCLUSION Knockout Traf3 gene by CRISPR/Cas9 system enhanced the proliferation, migration, and invasion of HepG2 cells, and provided an effective tool for studying the function and mechanism of Traf3.
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Affiliation(s)
- Wenbo Hu
- Class 12, Grade 2015, Faculty of Clinical Medicine, Jilin University, Changchun, Jilin, China
| | - Guiying Guo
- Department of Library, The People's Hospital of Rizhao City, Rizhao, Shandong, China
| | - Yuhua Chi
- Department of Oncology, The People's Hospital of Rizhao City, Rizhao, Shandong, China
| | - Fei Li
- Department of Respiratory Medicine, The People's Hospital of Rizhao City, Rizhao, Shandong, China
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Dežman R, Mašulović D, Popovič P. Hepatic perivascular epithelioid cell tumor: A case report. Eur J Radiol Open 2018; 5:121-125. [PMID: 30140716 PMCID: PMC6104347 DOI: 10.1016/j.ejro.2018.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 12/27/2022] Open
Abstract
Perivascular epithelioid cell tumor (PEComa) of liver is extremely rare hepatic neoplasm with only 30 cases reported in the literature. These lesions are found mainly in young females and may present a potential pitfall in the characterisation of focal liver lesions. The biological behavior of PEComa varies from generally benign to rarely malignant and metastatic disease. We report a case of a patient with hepatic PEComa with the corresponding imaging findings on the ultrasound, contrast-enhanced ultrasound (CEUS) and hepatospecific MRI. After failed attempt to characterize the lesion by percutaneous biopsy, surgical resection was conducted and the final diagnosis was achieved.
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Affiliation(s)
- Rok Dežman
- University Medical Centre Ljubljana, Clinical Institute of Radiology, Ljubljana, Slovenia
| | - Dragan Mašulović
- Clinical Centre of Serbia, Centre for Radiology and Magnetic Resonance Imaging, Belgrade, Serbia
| | - Peter Popovič
- University Medical Centre Ljubljana, Clinical Institute of Radiology, Ljubljana, Slovenia
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Kirste S, Kayser G, Zipfel A, Grosu AL, Brunner T. Unresectable hepatic PEComa: a rare malignancy treated with stereotactic body radiation therapy (SBRT) followed by complete resection. Radiat Oncol 2018; 13:28. [PMID: 29463266 PMCID: PMC5819697 DOI: 10.1186/s13014-018-0974-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/11/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors occurring in various anatomic regions. Although diagnostic criteria and treatment management are not established, current treatment options consist of surgery and chemotherapy including mTOR inhibitors. Stereotactic body radiation therapy (SBRT) is a non-invasive ablative treatment which has shown excellent control rates for more common types of unresectable liver tumors and metastases. In this report we present a rare case of PEComa of the liver that was treated by stereotactic radiotherapy followed by resection. Staging and evaluation of treatment response was done by FDG-PET/CT. This case highlights the potential of SBRT as a neoadjuvant treatment even for rare liver malignancies. It is the first case of liver PEComa treated by SBRT and resection. CASE PRESENTATION A 52-year-old woman presented at an external hospital with abdominal pressure and pain in the right upper abdominal quadrant. A CT scan showed a 700 cm3 liver lesion in segment IV. In repeated biopsy in July 2015 histopathological workup showed a pleomorphic epitheloid tumor with small to medium sized cells expressing vimentin and melan-A while being negative for cytokeratin establishing the diagnosis of PEComa of the liver. To achieve high, ablative doses a stereotactic body radiotherapy (SBRT) technique was chosen consisting of 60Gy (biologically effective dose 105Gy) in 8 fractions of 7.5Gy. Radiotherapy planning was based on MRI resulting in a planning target volume (PTV) of 1944 cm3. Treatment toxicity was limited to a slight elevation of transaminases (grade 1 and 3). A complete resection was performed 21 weeks after radiotherapy confirmed by negative surgical margins. At last follow-up 21 months after therapy, MRI showed neither local nor distant tumor recurrence. The patient was in stable condition (ECOG 1) and without late radiation toxicity. CONCLUSIONS This is the first documented case of liver PEComa treated by SBRT and resection. A favorable post-treatment course demonstrates that SBRT is a potential neoadjuvant treatment that is capable of reducing an inoperable rare liver tumor to a resectable lesion.
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Affiliation(s)
- Simon Kirste
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Gian Kayser
- Department of Surgical Pathology, University Medical Center Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Anne Zipfel
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Thomas Brunner
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
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Han X, Sun MY, Liu JH, Zhang XY, Wang MY, Fan R, Qamar S. Computed tomography imaging features of hepatic perivascular epithelioid cell tumor: A case report and literature review. Medicine (Baltimore) 2017; 96:e9046. [PMID: 29245304 PMCID: PMC5728919 DOI: 10.1097/md.0000000000009046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Perivascular epithelioid cell tumor (PEComa) is a rare tumor which is most frequently found in uterus. The tumor arising from liver is extremely uncommon. PATIENT CONCERNS A 36-year-old female with abdominal distention, cramps, and low-grade fever for over 15 days. The patient had a history of gastric adenocarcinoma with ovarian, celiac lymph nodes, and retroperitoneal lymph nodes metastases. DIAGNOSES Computed tomography (CT) imaging demonstrated an ill-defined heterogeneous hypo-dense mass in segment 8 (S8) of the liver. Contrast-enhanced CT imaging showed marked enhancement in arterial phase, mild-to-moderate enhancement in portal and equilibrium phases. Tumor-feeding artery was demonstrated from the right hepatic artery by the three-dimensional reconstruction images. Biopsy was performed, and a diagnosis of PEComa was rendered. INTERVENTIONS No intervention for this tumor before liver biopsy. LESSONS We present a rare case of hepatic PEComa. The information we provided is useful for summarizing the CT features of this kind of tumors. It should be included in differential diagnoses from common hypervascular neoplasms of liver. The final diagnosis is established on histopathological and immunohistochemical studies that are the "gold standard."
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Affiliation(s)
- Xu Han
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Mei-Yu Sun
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Jing-Hong Liu
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | | | - Meng-Yao Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Rui Fan
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Sahrish Qamar
- The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Hekimoglu K, Haberal M. Liver Perivascular Epithelioid Cell Tumor with an Unusual Location: Diagnostic Characteristics with Multidetector Computed Tomography and Magnetic Resonance Imaging. J Clin Imaging Sci 2017; 7:36. [PMID: 28975043 PMCID: PMC5615861 DOI: 10.4103/jcis.jcis_43_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022] Open
Abstract
Primary perivascular epithelioid cell tumor (PEComa) of the liver is a very rare tumor that originates from mesenchyma. Gastrointestinal tract with perivascular distribution is the most common anatomic sites of these tumors. Only few cases of hepatic PEComa have been described so far. Malignant PEComas exhibit aggressive behavior with poor prognosis, making early diagnosis crucial. Hereby, we report a 79-year-old female with unusually located mass in the liver. A partial curative hepatectomy has been done, and PEComa was diagnosed histopathologically. No evidence of recurrence was observed during the 6-month follow-up.
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Affiliation(s)
- Koray Hekimoglu
- Department of Radiology, School of Medicine, Baskent University, Ankara, Turkey
| | - Murat Haberal
- Department of Radiology, School of Medicine, Baskent University, Ankara, Turkey
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Guan H, Zou Y, Lv Y, Wang C. Hepatic perivascular epithelioid cell tumor treated by transarterial embolization plus radiofrequency ablation: A case report and literature review. Medicine (Baltimore) 2017; 96:e6969. [PMID: 28562547 PMCID: PMC5459712 DOI: 10.1097/md.0000000000006969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) are extremely rare mesenchymal entities with potentially malignant properties; the liver cases are not encountered frequently. Owing to themalignant potential, these tumors are treated by surgical methods to ensure total resection. In the present report, a case of liver PEComa treated by embolization combined with radiofrequency ablation (RFA) has been described. CASE SUMMARY A 40-year-old female was admitted for the detection of a liver mass during an annual physical examination. The patient did not have any liver disease background, enhanced computed tomography (CT), and magnetic resonance revealed a huge mass in the right lobe. Pathology gave the diagnosis of PEComa, for disagreement of open surgery, a combination of transarterial embolization (TAE) and RFA were applied for treatment and the outcomes were acceptable, the patient was under follow-up to observe the long-term effect. CONCLUSION Interventional procedures such as TAE and RFA are feasible and effective for such lesions and may serve as an alternate when resection is not indicated. Prospective studies are warranted to verify the long-term outcomes.
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Tang D, Wang J, Tian Y, Li Q, Yan H, Wang B, Xiong L, Li Q. Hepatic perivascular epithelioid cell tumor: Case report and brief literature review. Medicine (Baltimore) 2016; 95:e5572. [PMID: 28002331 PMCID: PMC5181815 DOI: 10.1097/md.0000000000005572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONAL Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm which expresses both myogenic and melanocytic markers. PEComas are found in a variety locations in the body, but up to now only approximately 30 cases about hepatic perivascular epithelioid cell tumor are reported in English language worldwide. PATIENT CONCERNS A 32-year-old woman was admitted in our hospital with intermittent right upper quadrant pain for 1 month and recent (1 day) progressive deterioration. DIAGNOSES Based on the results of the laboratory examinations and the findings of the computed tomography, the diagnosis of hepatic hamartoma or the hepatocecullar carcinoma with hemorrhage was made. INTERVENTIONS The patient underwent a segmentectomy of the liver, and the finally diagnosis of hepatic PEComa was made with immunohistochemical confirmation with HMB-45 and SMA. OUTCOMES There is no clinical or radiographic evidence of recurrence 9 months after surgery. LESSONS This kind of tumor is extremely rare and the natural history of PEComa is uncertain, as the treatment protocol for hepatic PEComa has not reached a consensus. But the main treatment of the disease may be surgical resection. Only after long term follow-up can we know whether the tumor is benign or malignant. It appears that longer clinical follow-up is necessary in all patients with hepatic PEComas.
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Affiliation(s)
- Da Tang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Jianmin Wang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Yuepeng Tian
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Qiuguo Li
- Department of General Surgery, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Haixiong Yan
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Biao Wang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Li Xiong
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Qinglong Li
- Department of General Surgery, Second Xiangya Hospital, Central South University
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