Background:The SARS-CoV-2 pandemic is an ongoing global health emergency. The aim of our study was to investigate the changes of liver function and its clinical significance in COVID-19 patients.

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Glomus tumors are exceedingly rare tumors arising from the normal glomus body. Only a very few cases located in the small intestine were reported to date. Here, we present a case of glomus tumor of the jejunum in a 30-year-old female patient, and discuss its clinical, imaging, and pathologic features.

This is an author response to the letter by Dr Benhong Zhou.We chose the community-acquired pneumonia (CAP) patients hospitalized in our hospital last year as the control because there was no suitable healthy control group available now. And considering the diverse aetiology of CAP, the liver impairment appeared in CAP patients maybe result from ischaemia/hypoxia-reperfusion injury, systemic inflammatory response or drug use before hospitalization, besides the pathogen itself. 1 In addition, we have excluded patients with confirmed chronic liver disease from both groups of COVID-19 and CAP patients, which ruled out its influence on the analysis of our present study.Due to focusing on the liver impairment in COVID-19 patients, we have not included more laboratory indexes. And several studies have shown that the value of NLR was much more significant than lymphocytes in prediction of the COVID-19 progression. 2 Furthermore, our research has also shown that the liver impairment was related to inflammatory reaction, which was consistent with Lu L's finding. 3 Since our data were mainly collected at the time of admission, these patients had not been treated with ventilators and drugs such as ridxivir and glucocorticoids. Therefore, the influence from all above factors could be excluded. During the novel coronavirus outbreak, it is difficult to confirm whether the involved patients have taken oral antibiotics or non-steroidal drugs before admission. It should be noted that we have discussed the influence from those factors in the discussion part.Generally, it is believed that the liver biochemical abnormalities in mild and common COVID-19 patients are not significantly related to the prognosis and mortality, and the main causes of liver impairment in severe and critical cases may be ischaemia/hypoxiareperfusion injury and systemic inflammatory response, rather than the SARS-Cov-2 infection. Most COVID-19 patients recover from liver impairment soon after their respiratory and circulation functions get improved. 4

BackgroundGlomus tumors are exceedingly rare tumors arising from the normal glomus body. Only a very few cases of glomus tumors located in the small intestine were reported to date. Here, we present a case of glomus tumor of the jejunum in a 30-year-old female patient, and discuss its clinical, imaging, and pathologic features.Case presentationA 30-year-old female referred to our hospital with the chief complain of melena and fatigue for 3 weeks. Oral single-balloon enteroscopy discovered a 2.0*2.0cm tumor without epithelial lining in the jejunum. The patient then underwent partial enterectomy. HE stain illustrated that the tumor was interspersed with congestive capillaries of various size, and admixed with smooth muscle bundles. Immunohistochemical study showed that the tumor cells were strongly positive for SMA and collagen type Ⅳ. The Ki-67 proliferation index was less than 1% and mitotic activity is very low (about 1/50 HPF). The case was finally diagnosed as benign glomus tumor.ConclusionsGlomus tumors arising from the small intestine are extremely rare. The final diagnosis is made by histological and immunohistochemical examination. Although there is no standardized management pathway for these patients, early diagnosis and treatment are important for a good prognosis.

Background: Glomus tumors are exceedingly rare tumors arising from the normal glomus body. Only a very few cases of glomus tumors located in the small intestine were reported to date. Here, we present a case of glomus tumor of the jejunum in a 30-year-old female patient, and discuss its clinical, imaging, and pathologic features.Case presentation: A 30-year-old female referred to our hospital with the chief complain of melena and fatigue for 3 weeks. Oral single-balloon enteroscopy discovered a 2.0*2.0cm tumor without epithelial lining in the jejunum. The patient then underwent partial enterectomy. HE stain illustrated that the tumor was interspersed with congestive capillaries of various size, and admixed with smooth muscle bundles. Immunohistochemical study showed that the tumor cells were strongly positive for SMA and collagen type Ⅳ. The Ki-67 proliferation index was less than 1% and mitotic activity is very low (about 1/50 HPF). The case was finally diagnosed as benign glomus tumor. Conclusion: Glomus tumors arising from the small intestine are extremely rare. The final diagnosis is made by histological and immunohistochemical examination. Although there is no standardized management pathway for these patients, early diagnosis and treatment are important for a good prognosis.

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