BACKGROUND Hepatic perivascular epithelioid cell neoplasms (PEComas) are rare. Diagnostic and treatment experience with hepatic PEComa remains insufficient. CASE SUMMARY Three hepatic PEComa cases are reported in this paper: One case of primary malignant hepatic PEComa, one case of benign hepatic PEComa, and one case of hepatic PEComa with an ovarian mature cystic teratoma. During preoperative imaging and pathological assessment of intraoperative frozen samples, patients were diagnosed with hepatocellular carcinoma (HCC), while postoperative pathology and immunohistochemistry subsequently revealed hepatic PEComa. Patients with hepatic PEComa which is misdiagnosed as HCC often require a wider surgical resection. It is easy to mistake them for distant metastases of hepatic PEComa and misdiagnosed as HCC, especially when it's combined with tumors in other organs. Three patients eventually underwent partial hepatectomy. After 1-4 years of follow-up, none of the patients experienced recurrence or metastases. CONCLUSION A clear preoperative diagnosis of hepatic PEComa can reduce the scope of resection and prevent unnecessary injuries during surgery.

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San Miao Wan (SMW) is a traditional Chinese medicine (composed of Cortex phellodendri, Rhizoma atractylodes, and Radix cyathulae) widely used in China to treat arthritis; however, its underlying mechanism remains unknown. We established the target gene library of SMW and performed gene ontology enrichment analysis of related target genes. The component-target protein-protein interaction (PPI) network of SMW and the disease-target PPI network of arthritis were merged to form a core PPI network. Finally, the anti-oxidative effect of SMW for treating arthritis was evaluated in a rat arthritis model induced by sodium urate. The results showed that R. atractylodes contained four active components with 68 target proteins, R. cyathulae contained two active components and 139 target proteins, and C. phellodendri contained eight active components and 275 target proteins. The target genes of R. cyathulae were highly related to the synthesis and metabolism of reactive oxygen species, while target genes of R. atractylodes and C. phellodendri were highly related to the circulatory system. The component-target PPI network of SMW and the disease-target PPI network of arthritis predominantly overlapped. In vivo, SMW effectively reduced knee swelling induced by sodium urate, decreased serum malondialdehyde levels, and increased serum superoxide dismutase levels. In conclusion, the therapeutic effects of SMW in arthritis are associated with its anti-oxidative properties.