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Journal of Bone and Soft Tissue Tumors (JBST) is the official Journal of The Indian Musculo Skeletal Oncology Society
Primary Intraosseous Schwannoma
Vol 3 | Issue 2 | Sep-Dec 2017 | Page 14-15| Asawari Ambekar, Chitralekha Soman.
Authors: Asawari Ambekar [1], Chitralekha Soman [1].
[1] Department of Histopathology, Mumbai Reference Laboratory, SRL Limited, Mumbai, Maharashtra, India
Address of Correspondence
Dr. Asawari Ambekar,
Reserve Bank of India Soc number 2 B 5 Gavand Path Thane West 400602
E-mail: asawariaa61@gmail.com
Abstract
Schwannomas are benign tumors arising from the peripheral nerve sheath. Neurogenic tumors of bone are extremely uncommon and they compose less than 1% of all benign tumors [1]. We present a case of intraosseous schwannoma in a 15 year old girl who presented with pain and pathological fracture of tibia. The radiology revealed an expansile and lytic lesion in the diaphysis. Histopathology confirmed the diagnosis of intraosseous schwannoma. The tumor cells were immunoreactive for S100protein. We present this case as tibial schwannoma is extremely rare and its diaphyseal location in the bone is virtually unknown.
Keywords: Schwannoma, tibia, diaphysis
References
1. Mark JM, Natalie C., Donald K.Schwannoma: A case report.The Foot and Ankle Online Journal 2009
2. Rosai, J., Ackerman, L. V. 1. &Rosai, J. (2004). Rosai and Ackerman’s surgical pathology (9th ed.). St. Louis, Mo. : London: Mosby
3. Fletcher, CDM. Bridge, JA. Hogendoorn, P., Mertens, F.WHO Classification of Tumours of Soft Tissue and Bone. Fourth Edition.2002
4. Ryan MI, Kevin BJ, Nathan L, Joseph AB.Intraosseous neurilemmoma involving the distal tibia and fibula: A case report.The Iowa Orthopaedic Journal.
5. K. Krishnan Unni Carrie Y. Inwards.Dahlin’s Bone Tumors, 6e.GENERAL ASPECTS AND DATA ON 10,165 CASES.
6. Chelsea P,Hamad G, Shweta B. Vikram Dogra.Schwannoma of the Tibial Nerve.Journal of Diagnostic Medical Sonography.2010
7. Manasa AM. Intraosseous Schwannoma of the Maxilla Mimicking a Periapical Lesion: A Diagnostic Challenge. Journal of Clinical and Diagnostic Research. 2015.
8. Kaihu Li et al.Giant intraosseous Schwannoma of the calcaneusInt J ClinExp Med 2016.
9. S.A. Lacerda et al.Intraosseous Schwannoma of Mandibular Symphysis: Case Report.Braz Dent J 2006.
10. Suzuki et al.Association between intraosseous schwannoma occurrence and the position of the intraosseous nutrient vessel: A case report.ONCOLOGY LETTERS.2016
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Adamantinoma; An update
Vol 3 | Issue 2 | Sep-Dec 2017 | Page 16-19 | Ashish Gulia, Pankaj Kumar Panda.
Authors: Ashish Gulia [1], Pankaj Kumar Panda [1].
[1] Surgical Oncology (Orthopedic Oncology), 93, Ground Floor, Main Building, Bone & Soft tissue Services (Disease Management Group), Tata Memorial Hospital, Mumbai – 400012, India.
Address of Correspondence
Dr. Ashish Gulia,
Surgical Oncology (Orthopedic Oncology), 93, Ground Floor, Main Building, Bone & Soft tissue Services (Disease Management Group), Tata Memorial Hospital, Mumbai – 400012, India.
Email: aashishgulia@gmail.com
Abstract
Adamantinoma is a rare, malignant biphasic tumor with varied morphological patterns.Adamantinoma mostly occurs in the second to fifth decade and is slightly more common in men than women.The onset is insidious, and its course shows a slow, progressive character.Radiography is the initial and most reliable imaging modality for adamantinoma of bones because of the tumor’s classic location and appearance on a plain radiograph.Present management modalitieswhich includeen blocresection (mostly intercalary resection) with limb salvage and limb reconstruction. Chemotherapy and radiotherapy have no established role. Amputation does not improve survival but may be advisable in cases with local recurrence and in cases with few large, recurrent lesions where en bloc resection is not possible.
Keywords: Adamantinoma, malignant biphasic tumor, management.
References
1. Dahlin DC. Bone Tumors: General Aspects and Data on 6221 Cases. 3rded. Springfield, IL: Charles C Thomas; 1978. p. 296.
2. Kahn LB. Adamantinoma, osteofibrous dysplasia and differentiated adamantinoma. Skeletal Radiol 2003;32(5):245-258.
3. Fisher B. Primary adamantinoma of the tibia. Z Pathol 1913;12:422-441.
4. Van Rijn R, Bras J, Schaap G, van den Berg H, Maas M. Adamantinoma in childhood: Report of six cases and review of the literature. PediatrRadiol 2006;36(10):1068-1074.
5. Czerniak B, Rojas-Corona RR, Dorfman HD. Morphologic diversity of long bone adamantinoma. The concept of differentiated (regressing) adamantinoma and its relationship to osteofibrous dysplasia. Cancer 1989;64(11):2319-2334.
6. Mirra JM. Adamantinoma and fibrous dysplasia. InBone tumors 1sted. Mirra JM, editor. Philadelphia,PA: Lea &Febiger; 1989. p. 1203-1231.
7. Springfield DS, Rosenberg AE, Mankin HJ, Mindell ER. Relationship between osteofibrous dysplasia and adamantinoma. ClinOrthopRelat Res 1994;309:234-244.
8. Moon NF, Mori H. Adamantinoma of the appendicular skeleton-updated. ClinOrthopRelat Res 1986;204:215-237.
9. Lederer H, Sinclair AJ. Malignant synovioma simulating “adamantinoma of the tibia”. J PatholBacteriol 1954;67(1):163-168.
10. Van der Woude HJ, Hazelbag HM, Bloem JL, Taminiau AH, Hogendoorn PC. MRI of adamantinoma of long bones in correlation with histopathology. AJR Am J Roentgenol 2004;183(6):1737-1744.
11. Unni KK. Dahlin’s Bone Tumors: General Aspects and Data on 11,087 Cases. 5thed. Philadelphia, Pa: Lippincott-Raven; 1996. p. 333-342.
12. Hazelbag HM, Taminiau AHM, Fleuren GJ, Hogendoorn PC. Adamantinoma of the long bones. A clinicopathological study of thirty-two patients with emphasis on histologic subtype, precursor lesion, and biological behavior. J Bone Joint Surg Am 1994;76:1482-1499.
13. Weiss SW, Dorfman HD. Adamantinoma of long bone. An analysis of nine new cases with emphasis on metastasizing lesions and fibrous dysplasia-like changes. Hum Pathol 1977;8(2):141-153.
14. Bridge JA, Dembinski A, DeBoer J, Travis J, Neff JR. Clonal chromosomal abnormalities in osteofibrous dysplasia. Implications for histopathogenesis and its relationship with adamantinoma. Cancer 1994;73(6):1746-1752.
15. Ueda Y, Blasius S, Edel G, Wuisman P, Böcker W, Roessner A. Osteofibrous dysplasia of long bones-A reactive process to adamantinomatous tissue. J Cancer Res ClinOncol 1992;118(2):152-156.
16. Hazelbag HM, Fleuren GJ, vdBroek LJ, Taminiau AH, Hogendoorn PC. Adamantinoma of the long bones: Keratin subclass immunoreactivity pattern with reference to its histogenesis. Am J SurgPathol 1993;17(12):1225-1233.
17. Kanamori M, Antonescu CR, Scott M, Bridge RS Jr, Neff JR, Spanier SS, et al. Extra copies of chromosomes 7, 8, 12, 19, and 21 are recurrent in adamantinoma. J MolDiagn 2001;3(1):16-21.
18. Keeney GL, Unni KK, Beabout JW, Pritchard DJ. Adamantinoma of long bones. A clinicopathologic study of 85 cases. Cancer 1989;64(3):730-7.
19. Qureshi AA, Shott S, Mallin BA, Gitelis S. Current trends in the management of adamantinoma of long bones. An international study. J Bone Joint Surg Am 2000;82-A(8):1122-1131.
20. Bovée JV, van den Broek LJ, de Boer WI, Hogendoorn PC. Expression of growth factors and their receptors in adamantinoma of long bones and the implication for its histogenesis. J Pathol 1998;184(1):24-30.
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Giant Cell Tumor Symposium Part 2
Vol 3 | Issue 2 | Sep-Dec 2017 | page:1 | Dr. Mandip Shah.
Author: Mandip Shah [1].
[1] Sparsh Orthopedic Oncology Clinic. Medicare Building 9th Floor, , B/H Town Hall, Ashram Road, 380006 – Ahmedabad., India.
Address of Correspondence
Dr. Mandip Shah
Sparsh Orthopedic Oncology Clinic. Medicare Building 9th Floor, , B/H Town Hall, Ashram Road, 380006 – Ahmedabad., India
Email: mandipshah@gmail.com
Giant Cell Tumor Symposium Part 2
We are back with the second part of the Giant Cell Tumor Symposium for Journal of Bone and Soft Tissue Tumors.
Two very important aspects are covered in this part. First is the histopathological concepts regarding GCT. There is lot of new knowledge that is available in recent years and that has significantly impacted the diagnosis, management and prognosis of GCT. Histopathological assessment play a major role in terms of determining the behaviour of GCT. Current understanding of molecular pathogenesis of GCTB particularly RANK on osteoclast-like GCs and RANKL on stromal cells and development of newer agents such as denosumab and INF-α has tremendously impacted management of patients with GCTB. This aspect is elaborated in the first article. The second article builds on these concepts and describes how this is used for adjuvent therapy for GCTB. Authors of both the authors have taken tremendous effort to make both these articles good and current. Also these two now conclude the GCT Symposium and cover all aspect of GCTB
Please write to us regarding your suggestions and opinions
Regards
Dr. Mandip Shah
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Histopathology of Giant-cell Tumor of Bone – Current Concept
Vol 3 | Issue 2 | Sep-Dec 2017 | Page 2-5| Sanjeev Shah.
Authors: Sanjeev Shah [1].
[1] Department of Pathology, Unipath Laboratory Specialty Ltd, Beside JMC House, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Sanjeev Shah,
102, First floor, Sanoma Plaza, Opp. Parimal Garden, Beside JMC House, Ellisbridge, Ahmedabad – 380006, Gujarat, India.
E-mail: dcp72002@yahoo.com
Abstract
GCTB is a primary osteolytic bone tumor which can recurrence, undergo metastasis, and malignant transformation. Current understanding of molecular pathogenesis of GCTB particularly RANK on osteoclast-like GCs and RANKL on stromal cells and development of newer agents such as denosumab and INF-α has tremendously impacted management of patients with GCTB.
Keywords: Giant-cell tumor of bone histopathology, current concept.
References
1. Turcotte RE. Giant cell tumor of bone. OrthopClin North Am 2006;37:35-51.
2. Georgi PG, Svetoslav S, Iva ND, Boycho L. Giant cell tumor of bone: Current review of morphological, clinical, radiological, and therapeutic characteristics. J Clin Exp Investig 2014;5:475-85.
3. Nielsen GP, Andrew ER, Vikram D, Francis JH, Susan VK, Daniel IR. Diagnostic Pathology Bone: Amirsys; 2013. p. 371-95.
4. Fletcher CD, Bridge JA, Hogendoorn P, Mertens F. WHO Classification of Tumours of Soft Tissue and Bone. 4th ed. Lyon: France IARC Press; 2013. p. 321-4.
5. Dominkus M, Ruggieri P, Bertoni F, Briccoli A, Picci P, Rocca M, et al. Histologically verified lung metastases in benign giant cell tumours–14 cases from a single institution. Int Orthop 2006;30:499-504.
6. Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ. Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res 1994;302:219-30.
7. Gamberi G, Benassi MS, Böhling T, Ragazzini P, Molendini L, Sollazzo MR, et al. Prognostic relevance of C-myc gene expression in giant-cell tumor of bone. J Orthop Res 1998;16:1-7.
8. Schoedel KE, Greco MA, Stetler-Stevenson WG, Ohori NP, Goswami S, Present D, et al. Expression of metalloproteinases and tissue inhibitors of metalloproteinases in giant cell tumor of bone: An immunohistochemical study with clinical correlation. Hum Pathol 1996;27:1144-8.
9. Hoch B, Inwards C, Sundaram M, Rosenberg AE. Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am 2006;88:1998-2008.
10. Dhillon MS, Prasad P. Multicentric giant cell tumour of bone. ActaOrthopBelg 2007;73:289-99.
11. Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer 2003;97:2520-9.
12. Nascimento AG, Huvos AG, Marcove RC. Primary malignant giant cell tumor of bone: A study of eight cases and review of the literature. Cancer 1979;44:1393-402.
13. Anract P, De Pinieux G, Cottias P, Pouillart P, Forest M, Tomeno B, et al. Malignant giant-cell tumours of bone. Clinico-pathological types and prognosis: A review of 29 cases. Int Orthop 1998;22:19-26.
14. Dickson BC, Li SQ, Wunder JS, Ferguson PC, Eslami B, Werier JA, et al. Giant cell tumor of bone express p63. Mod Pathol 2008;21:369-75.
15. Behjati S, Tarpey PS, Presneau N, Scheipl S, Pillay N, Van Loo P, et al. Distinct H3F3A and H3F3B driver mutations define chondroblastoma and giant cell tumor of bone. Nat Genet 2013;45:1479-82.
16. Akpalo H, Lange C, Zustin J. Discovered on gastrointestinal stromal tumour 1 (DOG1): A useful immunohistochemical marker for diagnosing chondroblastoma. Histopathology 2012;60:1099-106.
17. Cleven AG, Briaire-de Bruijn I, Szuhai K, Bovee JV. DOG1 expression in giant-cell-containing bone tumours. Histopathology 2016;68:938-45.
18. Althof PA, Ohmori K, Zhou M, Bailey JM, Bridge RS, Nelson M, et al. Cytogenetic and molecular cytogenetic findings in 43 aneurysmal bone cysts: Aberrations of 17p mapped to 17p13.2 by fluorescence in situhybridization. Mod Pathol 2004;17:518-25.
19. Oliveira AM, Perez-Atayde AR, Dal Cin P, Gebhardt MC, Chen CJ, Neff JR, et al. Aneurysmal bone cyst variant translocations upregulate USP6 transcription by promoter swapping with the ZNF9, COL1A1, TRAP150, and OMD genes. Oncogene 2005;24:3419-26.
20. Kim Y, Nizami S, Goto H, Lee FY. Modern interpretation of giant cell tumor of bone: Predominantly osteoclastogenic stromal tumor. Clin Orthop Surg 2012;4:107-16.
21. López-Pousa A, Martín Broto J, Garrido T, Vázquez J. Giant cell tumour of bone: New treatments in development. Clin Transl Oncol 2015;17:419-30.
22. Xu SF, Adams B, Yu XC, Xu M. Denosumab and giant cell tumour of bone-a review and future management considerations. Curr Oncol 2013;20:e442-7.
23. Branstetter DG, Nelson SD, Manivel JC, Blay JY, Chawla S, Thomas DM, et al. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. Clin Cancer Res 2012;18:4415-24.
24. Heymann D. Anti-RANKL therapy for bone tumours: Basic, pre-clinical and clinical evidences. J Bone Oncol 2012;1:2-11.
25. Roux S, Amazit L, Meduri G, Guiochon-Mantel A, Milgrom E, Mariette X, et al. RANK (receptor activator of nuclear factor kappa B) and RANK ligand are expressed in giant cell tumors of bone. Am J ClinPathol 2002;117:210-6.
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Systemic Adjuvant Therapies in the Management of Giant Cell Tumor of Bone: Current State of Understanding and Practice
Vol 3 | Issue 2 | Sep-Dec 2017 | Page 6-9 | Shekhar Kumta, Carol Lau, K C Wong.
Authors: Shekhar Kumta [1], Carol Lau [1], K C Wong [2].
[1] Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong,
[2] Department of Orthopaedics& Traumatology, The Prince of Wales Hospital, Hong Kong.
Address of Correspondence
Dr. Shekhar Kumta,
103-E, Learning Resource Centre, Block A, Prince of Wales Hospital, Shatin, Hong Kong.
Email: shekharkumta@gmail.com
Abstract
GCT of bone is a locally aggressive bone-destroying tumor. The primary neoplastic tumor cell is a RANKL over expressing cell that drives osteoclast recruitment and activation, ultimately leading to bone resorption at the site of the lesion. Osteoclast driven destruction in GCT may be ameliorated with the use of drugs such as Bisphophonates, which target Osteoclasts as well as the primary neoplastic stromal cells. Denusomab, is a monoclonal antibody against RANKL and it has a dramatic effect on Osteoclasts. Adjuvant therapies have reduced recurrence rates in GCT of bone, but uncertainties remain as to the optimum dose-intensity of the drugs and the duration of treatment.
Keywords: Tumor, bone destruction, Giant Cell Tumor of Bone.
References
1. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, et al. Giant cell tumor of bone: Treatment and outcome of 214 cases. J Cancer Res ClinOncol2008;134:969-78.
2. Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, et al. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am 2008;90:1060-7.
3. Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y, et al. Cryosurgery in the treatment of giant cell tumor. A long-term followup study. ClinOrthopRelat Res 1999;359:176-88.
4. Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R. Cryosurgery in the treatment of giant cell tumors of bone: A report of 52 consecutive cases. ClinOrthopRelat Res 1978;134:275-89.
5. Gortzak Y, Kandel R, Deheshi B, Werier J, Turcotte RE, Ferguson PC, et al. The efficacy of chemical adjuvants on giant-cell tumour of bone. An in vitro study. J Bone Joint Surg Br 2010;92:1475-9.
6. Lin WH, Lan TY, Chen CY, Wu K, Yang RS. Similar local control between phenol- and ethanol-treated giant cell tumors of bone. ClinOrthopRelat Res 2011;469:3200-8.
7. Theoleyre S, Wittrant Y, Tat SK, Fortun Y, Redini F, Heymann D, et al. The molecular triad OPG/RANK/RANKL: Involvement in the orchestration of pathophysiological bone remodeling. Cytokine Growth Factor Rev 2004;15:457-75.
8. Yasuda H, Shima N, Nakagawa N, Yamaguchi K, Kinosaki M, Mochizuki S, et al. Osteoclast differentiation factor is a ligand for osteoprotegerin/osteoclastogenesis-inhibitory factor and is identical to TRANCE/RANKL. Proc Natl AcadSci U S A 1998;95:3597-602.
9. Yasuda H, Shima N, Nakagawa N, Mochizuki SI, Yano K, Fujise N, et al. Identity of osteoclastogenesis inhibitory factor (OCIF) and osteoprotegerin (OPG): A mechanism by which OPG/OCIF inhibits osteoclastogenesisin vitro. Endocrinology 1998;139:1329-37.
10. Huang L, Xu J, Wood DJ, Zheng MH. Gene expression of osteoprotegerin ligand, osteoprotegerin, and receptor activator of NF-kappaB in giant cell tumor of bone: Possible involvement in tumor cell-induced osteoclast-like cell formation. Am J Pathol2000;156:761-7.
11. Nancollas GH, Tang R, Phipps RJ, Henneman Z, Gulde S, Wu W, et al. Novel insights into actions of bisphosphonates on bone: Differences in interactions with hydroxyapatite. Bone 2006;38:617-27.
12. Rogers MJ, Crockett JC, Coxon FP, Mönkkönen J. Biochemical and molecular mechanisms of action of bisphosphonates. Bone 2011;49:34-41.
13. Ebetino FH, Francis MD, Rogers MJ, Russell RG. Mechanisms of actions of etidronate and other bisphosphonates. Rev ContempPharmacother1998;9:233-43.
14. Balke M, Campanacci L, Gebert C, Picci P, Gibbons M, Taylor R, et al. Bisphosphonate treatment of aggressive primary, recurrent and metastatic giant cell tumour of bone. BMC Cancer 2010;10:462.
15. Tse LF, Wong KC, Kumta SM, Huang L, Chow TC, Griffith JF, et al. Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: A case-control study. Bone 2008;42:68-73.
16. Yu X, Xu M, Xu S, Su Q. Clinical outcomes of giant cell tumor of bone treated with bone cement filling and internal fixation, and oral bisphosphonates. Oncol Lett 2013;5:447-51.
17. Cheng YY, Huang L, Lee KM, Xu JK, Zheng MH, Kumta SM, et al. Bisphosphonates induce apoptosis of stromal tumor cells in giant cell tumor of bone. Calcif Tissue Int2004;75:71-7.
18. Coleman RE, Major P, Lipton A, Brown JE, Lee KA, Smith M, et al. Predictive value of bone resorption and formation markers in cancer patients with bone metastases receiving the bisphosphonate zoledronic acid. J ClinOncol2005;23:4925-35.
19. Weitzman R, Sauter N, Eriksen EF, Tarassoff PG, Lacerna LV, Dias R, et al. Critical review: Updated recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in cancer patients-May 2006. Crit Rev OncolHematol2007;62:148-52.
20. Perazella MA, Markowitz GS. Bisphosphonate nephrotoxicity. Kidney Int2008;74:1385-93.
21. Kostenuik PJ, Nguyen HQ, McCabe J, Warmington KS, Kurahara C, Sun N, et al. Denosumab, a fully human monoclonal antibody to RANKL, inhibits bone resorption and increases BMD in knock-in mice that express chimeric (murine/human) RANKL. J Bone Miner Res 2009;24:182-95.
22. Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon A, Blay JY, et al. Denosumab in patients with giant-cell tumour of bone: An open-label, Phase 2 study. Lancet Oncol2010;11:275-80.
23. Lewiecki EM, Miller PD, McClung MR, Cohen SB, Bolognese MA, Liu Y, et al. Two-year treatment with denosumab (AMG 162) in a randomized Phase 2 study of postmenopausal women with low BMD. J Bone Miner Res 2007;22:1832-41.
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Giant Cell Tumor Symposium Part 1
Vol 3 | Issue 1 | May- Aug 2017 | page:2 | Dr. Mandip Shah
Author: Dr. Mandip Shah [1].
[1] Sparsh Orthopedic Oncology Clinic. Medicare Building 9th Floor, ,
B/H Town Hall, Ashram Road, 380006 – Ahmedabad., India
Address of Correspondence
Dr. Mandip Shah
Sparsh Orthopedic Oncology Clinic. Medicare Building 9th Floor, ,
B/H Town Hall, Ashram Road, 380006 – Ahmedabad., India
Email: mandipshah@gmail.com
Giant Cell Tumor Symposium Part 1
Giant cell tumor is one of the commonest bony tumor that is not only encountered by Orthopaedic Oncology surgeons but by general orthopaedic surgeons. This is the reason weneed to keep ourselves updated about what new is happening with this specific bone tumor. We have conceptualise this symposium in Journal of Bone and soft tissue tumors in two parts. This first part has two articles. The first article is by Dr Bhavin Jhankaria and his team on Current concepts of imaging in GCT. This article brings up all the latest updates from a radiologist point of view and also keeps in mind the practical issues faced by the surgeons. The second article is an update on intralesional curettage by Dr Manish Agarwal. Intralesional Curettage is the most important and most commonly used surgical technique for treatment of GCT and Dr Agarwal details the surgical techniques as well as the current updates on the concept and results. With these two articles most impoartant areas of GCT are covered. The aspect of adjuvant therapies and other complex topics will be covered in the next part of the symposium Please write to us regarding your suggestions and opinions.
Tissue Tumors May- Aug 2017; 3(1):2.
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