Clinical Case Summary

57 year old male with a history of diabetes mellitus and heart ischemic disease that is referred to our department due to an incidental ultrasound finding of liver nodule of 3.8 cm in segment VIII and posterior CT with contrast compatible with hepatocellular carcinoma. Radiologically no data for advanced liver disease and normal fibroscan.
Given these findings, we decided to perform contrast-enhanced ultrasound, appreciating a subcapsular lesion in segment VIII that after contrast administration presents homogeneous early enhancement in the arterial phase, with homogeneous washout at the end of the same, maintaining the enhancement peripherally and later with progressive washing throughout the portal and late phase. This data suggests the diagnosis of intrahepatic cholangiocarcinoma. Hence, we perfomed a liver biopsy twice, as in the first occasion we found material compatible with normality and suspected malignant patology was high. After the histological analysis of the second biopsy ,we established the diagnosis of hepatic PEComa.
The pathogenesis of PEComas is uncertain, the main hypothesis s that it originates from undifferentiated neural crest cells capable of expressing phenotype of melanocytic and smooth muscle cells (1).
Despite their rarity, they should be included in the differential diagnosis of hepatic tumors as they present malignant potential even if it is low (2). Diagnosis may be easy through a histopathological study that proves the presence of marked immunohistochemical melanocytic (melan-A) and muscular (SMA) (2). However, they show a wide spectrum of findings in imaging tests (3), for what its suspected diagnosis and differential diagnosis with hepatocellular carcinoma and cholangiocarcinoma is complex. We have not found a description in the literature of its behavior with ultrasound contrast, hence the relevance of our case.

References

1. Arribas Jurado, Martina; Revollo, Ivia; Rubio Fernández, Alejandro; Galeano Díaz, Francisco; Blanco Fernández, Gerardo (2015). PEComa hepático. Cirugía Española, 93(9), 600–601.
2. Abhirup, Banerjee; Kaushal, Kundalia; Sanket, Mehta; Ganesh, Nagarajan (2015). Malignant hepatic perivascular epithelioid cell tumor (PEComa) – Case report and a brief review. Journal of the Egyptian National Cancer Institute.
3. Yan Tan, En-hua Xiao (2012). Hepatic perivascular epithelioid cell tumor (PEComa): dynamic CT, MRI, ultrasonography, and pathologic features—analysis of 7 cases and review of the literatura. 37(5), 781–787.

Introduction

Gender diversity in scientific authorship is a progress indicator in various medical fields, including gastrointestinal (GI) endoscopy. The representation of women in academia reflects broader changes in professional roles and leadership. This study aims at analyzing trends in gender representation among authors of randomised controlled trials (RCTs) in GI endoscopy from the 1960s to the present, providing insights into the progression of gender equity in academic gastroenterology.

Aims & Methods

A PubMed search using the terms "digestive endoscopy" and "gastrointestinal endoscopy" was conducted on April 1st, 2024, yielding 5,944 studies filtered for RCTs. After excluding non-English articles, those unrelated to endoscopy, and studies without identifiable first authors, 4,357 RCTs were included. First and last authors' genders were identified using Genderize.io with ≥90% certainty. Descriptive and inferential statistics, including chi-squared tests, were used to analyze trends in gender representation over time.

Results

In total, there were 967 female first authors (21.7%), 3,415 male first authors (77.0%), and 57 unclassified first authors (1.3%). Out of 4173 last authors, 637 were female (15.3%), 3,203 were male (76.7%), and 333 were unclassified (8.0%) (p < 0.001). Female representation among last authors increased from 0% to approximately 20%, while first authors rose from 0% in the 1970s to about 30% by 2024 (p<0.05 for both trends). Multivariate regression confirmed that the increase in female first authorship was more significant compared to last authorship (p<0.001, R-square 0.90).Regarding specific topics, “non-IBD-related diagnostic lower GI endoscopy” showed the highest representation for female first authors at 25.5%, while “Obesity” and “Artificial Intelligence” had the lowest at 1.4% and 1.7%, respectively. For the last authorship, “non-IBD-related diagnostic lower GI endoscopy” led at 22.1%, followed by “Diagnostic upper GI endoscopy” at 14.0%. The lowest percentages among the last authors were “Obesity” at 1.4% and “Artificial Intelligence” at 0.6%. Statistical analysis revealed significant differences in gender representation across topics (p < 0.0001).Regional differences were noted, with female first authors more prevalent in Europe (36.2%) and Asia (31.0%), while female last authors were more common in Europe (34.2%) and North America (30.8%, p = 0.032), highlighting variations in gender dynamics within endoscopy research.

Conclusion

This study demonstrates a progressive increase in female representation in digestive endoscopy RCTs, particularly among first authors. However, gender disparities persist in senior roles, underscoring the need for continued efforts to support gender equity, especially in leadership positions within academic gastroenterology.

References

Liu CS et al. Am J Gastroenterol. 2024 Oct 1;119(10):2103-2106.
Genderize Data Roskilde, Denmark. Genderize.io (last access Nov 1st, 2024