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Tsakos E, Xydias EM, Ziogas AC, Bimpa K, Sioutas A, Zarampouka K, Tampakoudis G. Uterine malignant leiomyosarcoma associated with high levels of serum beta‐human chorionic gonadotropin: A case report. Clin Case Rep 2022; 10:e6322. [PMID: 36188042 PMCID: PMC9483817 DOI: 10.1002/ccr3.6322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
We present the case of a 54‐year‐old woman diagnosed with uterine leiomyosarcoma that produced beta‐human chorionic gonadotropin (β‐hCG), evident by both serum and immunohistologic examination. Based on this and similar cases from the available literature, β‐hCG‐producing sarcomas tend to have poorer prognosis, indicating that β‐hCG could potentially be used as a marker of disease status and response to the therapy; however, this association is inconsistent and should be further investigated.
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Affiliation(s)
| | - Emmanouil M. Xydias
- Embryoclinic Thessaloniki Greece
- School of Health Sciences, Faculty of Medicine University of Thessaly Larissa Greece
| | - Apostolos C. Ziogas
- School of Health Sciences, Faculty of Medicine University of Thessaly Larissa Greece
| | | | | | | | - Georgios Tampakoudis
- Maternal‐Fetal Medicine and Obstetrics Saint Luke's Hospital Thessaloniki Greece
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Pokharel K, Gilbar PJ, Mansfield SK, Nair LM, So A. Elevated beta human chorionic gonadotropin in a non-pregnant female diagnosed with anal squamous cell carcinoma. J Oncol Pharm Pract 2019; 26:1266-1269. [PMID: 31840564 DOI: 10.1177/1078155219893428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Elevated serum beta human chorionic gonadotrophin (β-hCG) in a female normally indicates pregnancy or possibly, gestational trophoblastic disease or ovarian germ cell tumours. Expression of β-hCG has been demonstrated in cervical and endometrial carcinoma and other non-germ cell tumours of the ovary, vulva, breast, prostate, lung, colon, oral/facial tissue and stomach. CASE REPORT We report a 43-year-old premenopausal woman with p16 positive squamous cell anal cancer. Pre-treatment urinary screening was positive for β-hCG (218 IU/L), which was confirmed on serum and expressed in the tumour. Pelvic ultrasound ruled out pregnancy. Cervical cytology detected human papilloma virus p16 infection and a potential squamous intraepithelial lesion. Management and outcome: She received definitive chemoradiation (Mitomycin/5-fluorouracil) for six weeks. β-hCG, taken four weeks post completion, had returned to normal levels (<2 IU/L). DISCUSSION Cases of elevated serum β-hCG are documented in different cancers including breast, gastric, lung, ovarian and renal cell. In our case, the elevated β-hCG is probably ectopic excretion by the squamous cell carcinoma tumour in the anus. While this has never been reported previously in the anus, it is likely due to the documented risk of development of precancerous as well as cancerous anal and cervical lesions through human papilloma virus infection. Raised levels of β-hCG have been reported in cervical cancers. Other possible causes of β-hCG elevation were excluded. Following treatment, her β-hCG level returned to normal strengthening the hypothesis that β-hCG elevation was due to the anal carcinoma. In conclusion, unexplained ectopic secretion of β-hCG may be the first sign of a primary malignancy.
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Affiliation(s)
- Khageshwor Pokharel
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia.,Private Practice Clinics, St Andrew's Hospital, Toowoomba, Australia
| | - Peter J Gilbar
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Scott K Mansfield
- Private Practice Clinics, St Andrew's Hospital, Toowoomba, Australia.,Department of Surgery, Toowoomba Hospital, Toowoomba, Australia
| | - Lekshmi M Nair
- ICON Cancer Centre, St Andrew's Hospital, Toowoomba, Australia
| | - Albertina So
- Sullivan and Nicolaides Pathology, Toowoomba Laboratory, Toowoomba, Australia
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Blank AT, Khalighi M, Randall RL, Jones KB. Don't cancel the surgery just yet! A case report of positive preoperative pregnancy test due to a soft tissue sarcoma production of ectopic beta human chorionic gonadotropin. Rare Tumors 2018; 10:2036361318789727. [PMID: 30093984 PMCID: PMC6081757 DOI: 10.1177/2036361318789727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
Soft tissue sarcomas are a rare group of mesenchymal malignancies which can range from low to high grade. These tumors have different clinical, radiographic, and histopathological characteristics. Beta human chorionic gonadotropin is a naturally secreted hormone by placental syncytiotrophoblast cells during pregnancy. On very rare occasions, sarcomas can develop the ability to ectopically produce human chorionic gonadotropin. Very few cases exist in the literature of soft tissue sarcomas expressing this hormone. We report the case of a 55-year-old female who presented with a posterior thigh soft tissue sarcoma who on the day of surgical resection was found to have an unusually elevated serum human chorionic gonadotropin. Positive immunohistochemical staining of the resected mass confirmed the sarcoma as the source of the beta human chorionic gonadotropin.
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Affiliation(s)
| | | | - R Lor Randall
- University of California Davis Medical Center, Sacramento California
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Maryamchik E, Lyapichev KA, Halliday B, Rosenberg AE. Dedifferentiated Liposarcoma With Rhabdomyosarcomatous Differentiation Producing HCG: A Case Report of a Diagnostic Pitfall. Int J Surg Pathol 2018. [PMID: 29532681 DOI: 10.1177/1066896918760192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report a first case of paraneoplastic human chorionic gonadotropin (HCG) production in a dedifferentiated liposarcoma with rhabdosarcomatous differentiation in an 83-year-old man with a retroperitoneal mass, unilateral scrotal enlargement, and a serum HCG level of 843 IU/L. Core biopsy of the retroperitoneal mass revealed rhabdomyosarcoma. Orchiectomy revealed a paratesticular dedifferentiated liposarcoma with rhabdosarcomatous differentiation. Fluorescence in situ hybridization analysis performed on both the retroperitoneal and paratesticular masses revealed amplification of MDM2. The retroperitoneal tumor was interpreted as metastatic dedifferentiated liposarcoma with the dedifferentiated component represented by rhabdomyosarcoma. HCG production is a common feature of testicular germ cell tumors, less common in carcinomas, and extremely rare in sarcomas. Accordingly, sarcomas secreting HCG are a potential diagnostic pitfall, and raise the differential diagnosis of germ cell tumors and a variety of carcinomas. HCG production by carcinomas is a known poor prognostic finding, however the significance of its production in sarcomas is unknown.
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Affiliation(s)
- Elena Maryamchik
- 1 Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kirill A Lyapichev
- 2 University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | | | - Andrew E Rosenberg
- 2 University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
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Inoue N, Watanabe H, Takehara H, Hamazaki M, Kagami S. Refractory pediatric nonrhabdomyosarcoma soft tissue sarcoma associated with ectopic production of beta hCG and hypercalcemia induced by PTHrP. Pediatr Blood Cancer 2011; 57:1244-6. [PMID: 21898783 DOI: 10.1002/pbc.23271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 06/13/2011] [Indexed: 12/11/2022]
Abstract
A 3-month-old male with a mass on the right side of his back was admitted to our hospital. The tumor was a pathologically high-grade nonrhabdomyosarcoma soft tissue sarcoma (NRSTS). Treatment included subtotal tumor resection followed by chemotherapy. Elevation of serum beta hCG and hypercalcemia with detection of PTHrP was associated with tumor progression. The tumor was refractory to multiagent chemotherapy, and the patient died of the disease at 22 months of age. This case is novel in demonstrating a beta hCG secreting refractory NRSTS.
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Affiliation(s)
- Nami Inoue
- Department of Pediatrics, Tokushima University Hospital, Tokushima, Japan
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Dedifferentiated Liposarcoma of the Retroperitoneum with Extensive Leiomyosarcomatous Differentiation and beta-Human Chorionic Gonadotropin Production. Sarcoma 2011; 2008:658090. [PMID: 18382626 PMCID: PMC2276869 DOI: 10.1155/2008/658090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 11/04/2007] [Accepted: 02/12/2008] [Indexed: 11/29/2022] Open
Abstract
Dedifferentiated liposarcomas may display a variety of “heterologous” lines of differentiation, including osseous, vascular, skeletal, and/or smooth muscular. There have been six previously reported examples of leiomyosarcomas associated with high levels of serum human chorionic gonadotropin (hCG) production, comprised of cases originating from the retroperitoneum, spermatic cord, small intestine, and uterus. This report describes the first example of a dedifferentiated liposarcoma that combined both of the aforementioned features: extensive heterologous (leiomyosarcomatous) differentiation and
β-hCG production (maximum serum levels 1046 mIU/ml, reference <5 mIU/ml). The tumor, which originated in the retroperitoneum in the region of the right kidney, was rapidly progressive and ultimately fatal within three months of its diagnosis. In addition to characteristic morphologic features, lipogenic and smooth muscle differentiation were confirmed with immunohistochemical stains for MDM2 and smooth muscle actin, respectively. The tumor also displayed diffuse immunoreactivity for β-hCG in both primary and metastatic sites. This case further expands the clinicopathologic spectrum of lipogenic tumors.
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Froehner M, Gaertner HJ, Manseck A, Oehlschlaeger S, Wirth MP. Retroperitoneal Leiomyosarcoma Associated with an Elevated beta-HCG Serum Level Mimicking Extragonadal Germ Cell Tumor. Sarcoma 2011; 4:179-81. [PMID: 18521299 PMCID: PMC2395440 DOI: 10.1080/13577140020025904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patient. A 65-year-old man was admitted with a large primary retroperitoneal
tumor and an increased β-human chorionic gonadotropin (β-HCG) serum level. A germ
cell tumor was suspected; however, a computed tomography-guided biopsy failed to enable
tumor classification. After two courses of chemotherapy, the β-HCG serum level had returned
to the normal level and a diagnostic laparotomy with incisional biopsy was performed.
The immunohistochemical examination of the specimen identified the tumor as a
retroperitoneal pleomorphic leiomyosarcoma. Discussion. Tumor markers play only a marginal role in the work-up
of patients with soft tissue sarcomas. In men with suspected retroperitoneal sarcomas,
however, the determination of germ cell tumor markers occasionally enables a preoperative
distinguishing of primary retroperitoneal germ cell tumors with considerable consequences
for management. In this setting, a retroperitoneal tumor associated with a moderately
elevated β-HCG is a diagnostic dilemma, and surgeons should be aware of the pitfall
of a β-HCG-producing leiomyosarcoma in the differential diagnosis.
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Affiliation(s)
- M Froehner
- Department of Urology University Clinics ‘Carl Gustav Carus’ Technical University of Dresden Fetscherstrasse 74 Dresden D-01307 Germany
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Wu YY, Wei Q, Zeng H, Chen HJ, Li H, Lin H, Li X. An unusual case of aldosterone- and norepinephrine-secreting retroperitoneal leiomyosarcoma. ACTA ACUST UNITED AC 2008; 41:214-8. [PMID: 18504372 DOI: 10.1159/000134921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 01/11/2008] [Indexed: 02/05/2023]
Abstract
A case of retroperitoneal leiomyosarcoma (LMS) in a 38-year-old woman who had a tumor in the retroperitoneum with severe hypertension and hypokalemia is presented. Further investigation revealed an elevated serum aldosterone and norepinephrine level. After tumorectomy, the levels of serum aldosterone and norepinephrine successfully normalized; hypertension and hypokalemia were also cured. The tumor was diagnosed as being a LMS by pathologic examination. We suggested that this was the first case of retroperitoneal LMS shown to be associated with increased levels of serum aldosterone and norepinephrine.
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Affiliation(s)
- Y-Y Wu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, PR China
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Demirtas E, Krishnamurthy S, Tulandi T. Elevated serum beta-human chorionic gonadotropin in nonpregnant conditions. Obstet Gynecol Surv 2007; 62:675-9; quiz 691. [PMID: 17868483 DOI: 10.1097/01.ogx.0000281557.04956.61] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Positive serum beta-human chorionic gonadotropin (beta-hCG) in reproductive-age women generally indicates a pregnancy, and to a lesser extent, gestational trophoblastic disease, ovarian or peripheral germ cell tumor. Besides gynecologic conditions, nongynecologic cancers can be associated with beta-hCG positivity as well. The hormone in these tumors varies from detection by the immunohistochemistry studies of the tumor tissue only to a high serum level. This is illustrated by our case report of a 26-year-old woman who was diagnosed with a spindle cell osteosarcoma of the shoulder. The serum beta-hCG became undetectable after chemotherapy. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians Learning OBJECTIVES After completion of this article, the reader should be able to recall that elevated serum hCG can be related to pregnancy, gestational neoplasias, and ovarian and nongynecologic tumors and explain that it is important to appreciate that the hCG detected in these conditions may differ in type and be a marker of the success of treatment.
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Affiliation(s)
- Ezgi Demirtas
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Liang S, Stone G, Chalas E, Pearl M, Callan F, Zheng W. A High-Grade Uterine Leiomyosarcoma With Human Chorionic Gonadotropin Production. Int J Gynecol Pathol 2006; 25:257-61. [PMID: 16810064 DOI: 10.1097/01.pgp.0000192270.22289.af] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ectopic human chorionic gonadotropin production has been described in a wide variety of non-germ cell tumors, particularly in epithelial tumors, but rarely in sarcomas. In this report, we describe the case of 49-year-old woman with a history of "uterine fibroids," who presented with vaginal bleeding and a positive urine pregnancy test. After pregnancy was ruled out by ultrasound, the patient underwent a laparotomy and hysterectomy for a presumptive diagnosis of "fibroids" and was found to have carcinomatosis at the time of the surgery. Therefore optimal debulking of tumors was performed. Two weeks later, the patient developed a small bowel obstruction, which apparently was due to rapid recurrence of tumors in the abdomen, and soon afterwards she died. Microscopically, the resected pelvic mass was composed of highly atypical and pleomorphic spindle cells admixed with many multinucleated giant cells. The tumor had a high mitotic rate along with areas of hemorrhage and necrosis. Immunohistochemically, the tumor cells were positive for vimentin, desmin, smooth muscle actin, and beta-human chorionic gonadotropin, and were negative for epithelial membrane antigen, keratin AE1/3, S-100, CD31, CD117, Ber-EP4, WT-1, estrogen and progesterone receptors. The majority of cells, including the multinucleated giant cells, were strongly immunoreactive for beta-human chorionic gonadotropin. Only three cases of leiomyosarcomas with beta/human chorionic gonadotropin production have been described in the literature, and all three cases had extrauterine origin. Our case, to the authors' best knowledge, is the first uterine leiomyosarcoma with prominent beta/human chorionic gonadotropin production.
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Affiliation(s)
- Sharon Liang
- Department of Pathology, State University of New York at Stony Brook, Stony Brook, New York 11794, USA.
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Froehner M, Theissig F, Konopke R, Detlev Saeger H, Ockert D. Malignant fibrous histiocytoma masquerading as germ cell tumor by producing beta-human chorionic gonadotropin and neuron-specific enolase. Urology 2003; 62:551. [PMID: 12946774 DOI: 10.1016/s0090-4295(03)00379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuron-specific enolase and beta-human chorionic gonadotropin are serum markers frequently found associated with germ cell tumors. To our knowledge, we report the first case of a malignant fibrous histiocytoma producing both markers and discuss the significance of this unusual condition in the differential diagnosis of retroperitoneal tumors.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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12
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Mansi IA, Ashley I, Glezerov V. Retroperitoneal leiomyosarcoma and enlarged epididymis associated with a positive pregnancy test. Am J Med Sci 2002; 324:104-5. [PMID: 12186103 DOI: 10.1097/00000441-200208000-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 57-year-old man presented with a 1-month history of progressive abdominal pain and weight loss. A palpable, nonpulsatile, firm abdominal mass was felt below the xiphisternum down to the pelvis. A pregnancy test performed on a urine sample was positive. Testicular examination and testicular ultrasound were normal. Computerized tomography of the abdomen revealed a retroperitoneal mass measuring 30 x 21 x 13 cm. Serum beta-human chorionic gonadotropin (beta-HCG) was serially increased (19.71-22.71 mIU/mL). Results of histopathology tests confirmed the diagnosis of leiomyosarcoma. The level of serum beta-HCG decreased to < 0.2 mlU/mL after chemotherapy. Beta-HCG is usually increased in germ-cell tumors but few reports in the literature describe beta-HCG-secreting leiomyosarcomas. The incidence of increased levels of beta-HCG in sarcomas in general, and its potential role as a tumor marker, is not known. A simple urine pregnancy test may be done in the work-up of abdominal masses.
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Affiliation(s)
- Ishak A Mansi
- Department of Medicine, Mount Sinai Services at Queens Hospital Center, Jamaica, New Y ork 11432, USA
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Abstract
The immunoprofiles of 121 germ cell and trophoblastic neoplasms were defined, using a battery of antibodies against cytokeratin (CK), vimentin (VIM), epithelial membrane antigen (EMA), placental alkaline phosphatase (PLAP), S-100 protein, leukocyte common antigen (LCA), UCHL-1, LN-2, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), chromogranin A, Leu-7, alpha-fetoprotein (AFP), alpha-1-antitrypsin (AAT), and the beta subunit of human chorionic gonadotropin (BHCG). In addition to 85 neoplasms of testicular origin, the cases included eight ovarian germ cell tumors and 28 extragonadal neoplasms. All tissues had been subjected to formalin fixation and paraffin embedding. Similar immunoreactivity patterns were seen in gonadal and extragonadal neoplasms, gestational and nongestational choriocarcinomas, components of mixed germ cell tumors and their pure counterparts, and metastatic and primary lesions. Placental alkaline phosphatase was a sensitive marker of germ cell differentiation, and expression of this marker in the absence of EMA appeared to be a staining pattern unique to germ cell tumors. Both LCA and S100 were absent in neoplastic germ cells, and thus were useful in differentiating these tumors from malignant lymphoma and malignant melanoma, respectively. Cytokeratin was helpful in distinguishing seminomas/dysgerminomas from nonseminomatous germ cell tumors, although 10% of seminomas showed focal or diffuse cytokeratin reactivity. Finally, 75% of all germ cell neoplasms displayed NSE, calling the specificity of this determinant into question.
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Affiliation(s)
- G A Niehans
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
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Damjanov I. Cell, tissue and organ specific tumor markers: an overview. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1987; 77:367-84. [PMID: 3322698 DOI: 10.1007/978-3-642-71356-9_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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