Typically, cells around the vessels are epithelioid and spindle-shaped, resembling smooth muscles cell, and have abundant clear to eosinophilic granular cytoplasm.[20,28] Hemorrhage and necrosis can be seen in the malignant hepatic PEComa.[29] Positive immunostaining for melanocytic markers (HMB-45 and/or melan-A) and smooth muscle (actin and/or desmin) are the most histological findings. This evidence concerns the gene DES and neoplasm with perivascular epithelioid cell differentiation.