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Lloyd N, Kopel J, Awasthi S, Cordero J. Case report of recurrent fibromatosis with laryngeal involvement: Treatment based on network analyses of NGS data. Mol Clin Oncol 2022; 16:73. [PMID: 35251624 PMCID: PMC8848739 DOI: 10.3892/mco.2022.2506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Abstract
Aggressive fibromatosis (AF) is a rare, benign neoplasm originating from musculoaponeurotic stromal structures characterized by aggressive growth and infiltration of local tissues. To date, only six previous cases of AF involving the larynx have been reported. The present case was that of a 70-year-old female patient with a 5-year history of hoarseness and an enlarging neck mass consistent with aggressive recurrent fibromatosis. MRI displayed a large, solid mass arising from the left anterior cervical space displacing the trachea and upper airway to the right. At one year after the initial radical resection, the patient presented with recurrence. A second radical excision was performed not including a laryngectomy. Radiation therapy was considered for possible local treatment to prevent subsequent tumor recurrence. According to the literature, AF has recurrence rates of up to 40-70% within 18 months. There is only sparse literature to guide treatment. Using the mutations detected in the patient's AF tissue, an Ingenuity Pathway Analysis (IPA) was used to guide treatment of the recurrence. In the present case, the IPA analysis indicated the use of pazopanib to treat the patient's cancer. In general, surgery appears to be the treatment of choice for head and neck AF, but the management of recurrence is controversial.
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Affiliation(s)
- Nathan Lloyd
- Department of Surgery, Division of Heme/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Division of Heme/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Sanjay Awasthi
- Department of Internal Medicine, Division of Heme/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Joehassin Cordero
- Department of Surgery, Division of Heme/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Zhao CX, Dombrowski ND, Perez-Atayde AR, Robson CD, Afshar S, Janeway KA, Rahbar R. Desmoid tumors of the head and neck in the pediatric population: Has anything changed? Int J Pediatr Otorhinolaryngol 2021; 140:110511. [PMID: 33271436 DOI: 10.1016/j.ijporl.2020.110511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pediatric head and neck desmoid tumors are rare neoplasms that can cause significant morbidity due to infiltration of vital anatomic structures. The goal of this study is to review presentation, evaluation, and management of these tumors. METHODS Retrospective study of children with head and neck desmoid tumors treated from 1999 to 2018 and literature review. RESULTS 11 patients (5 boys, 6 girls) were included. Presentation included firm neck mass (n = 8), trismus (n = 2) and tongue lesion (n = 1). All patients had preoperative imaging with CT (n = 2), MRI (n = 1) or both (n = 8). Five patients underwent needle biopsy, five had open biopsy and one was diagnosed on pathology from primary excision. Seven patients were treated by primary surgical resection, with positive surgical margins in six cases due to proximity to vital neurovascular structures. None needed chemotherapy, had disease recurrence or progression. Three patients with unresectable disease were treated with chemotherapy. One patient was monitored with imaging without any treatment and did not have disease progression. Follow-up ranged from 6 months to 6 years (median 21 months). Ten patients (7 surgical, 2 chemotherapy, 1 observation) were either disease-free or had stable disease at last follow-up. CONCLUSION Pediatric head and neck desmoid tumors, though rare and histologically benign, are locally infiltrative and aggressive. When feasible, surgical treatment results in good disease control despite positive margins. A balance between achieving negative margins and minimizing functional deficits should be considered. Chemotherapy can be successfully utilized in patients where surgery entails a high risk of morbidity and mortality.
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Affiliation(s)
- Cher X Zhao
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - Antonio R Perez-Atayde
- Department of Pathology, Boston Children's Hospital, Boston, MA, United States; Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Caroline D Robson
- Department of Radiology, Boston Children's Hospital, MA, United States; Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Salim Afshar
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA, United States; Department of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, MA, United States
| | - Katherine A Janeway
- Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States; Department of Otolaryngology, Harvard Medical School, Boston, MA, United States.
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Khaladj-Ghom A, Isaiah A, Caccamese JF, Pereira KD. Facial Desmoid Tumor in a 2-Year-Old. EAR, NOSE & THROAT JOURNAL 2019; 99:NP3-NP5. [PMID: 31536374 DOI: 10.1177/0145561318823647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ariana Khaladj-Ghom
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John F Caccamese
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Oral Maxillofacial Surgery, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
RATIONALE Desmoid fibromatosis is a rare benign neoplasm arising from musculoaponeurotic structures with the potential to infiltrate local tissues and recur locally. While the commonly affected regions are the shoulder, chest wall and back, thigh, head and neck, localization in the foot is rare and only a few cases have been reported. Deep-seated lesions of foot tend to spread along the fascia and nerve or tendon sheaths. PATIENT CONCERNS We present a case of a 41-year-old female with a 3 years history of a slowly enlarging painful mass in the right foot. DIAGNOSES Desmoid fibromatosis was diagnosed based on clinical manifestations, imaging findings and pathological examinations. INTERVENTIONS The patient was treated by local incomplete resection. OUTCOMES The patient recovered well postoperatively and was well followed up at our outpatient department with no evidence of recurrence during 16 months of follow-up after local excision. LESSONS Surgical excision is recommended for symptomatic lesions located in the foot. However, it is difficult to excise thoroughly and periodic follow-up is needed to monitor for recurrence. Further study is warranted to determine whether patients benefit more from function preservation instead of complete resection.
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Affiliation(s)
| | - Lu Fang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Li
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Lee JW, Bewley AF, Senders CW. Marginal versus segmental mandibulectomy for pediatric desmoid fibromatosis of the mandible - Two case reports and review of the literature. Int J Pediatr Otorhinolaryngol 2018; 109:21-26. [PMID: 29728178 DOI: 10.1016/j.ijporl.2018.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/11/2022]
Abstract
Desmoid fibromatosis (DF) is a rare, benign soft tissue neoplasm with high rate of local recurrence. Surgical management of DF in the head and neck can be challenging given the desire to balance the preservation of form and function with the need to minimize local recurrence by achieving complete resection. We present two contrasting cases which highlight the advantages of marginal mandibulectomy over segmental mandibulectomy in children with DF. We favor marginal mandibulectomy even with limited bone stock given the remarkable ability of children to generate new bone.
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Affiliation(s)
- Janet W Lee
- University of California Davis, Department of Otolaryngology, United States.
| | - Arnaud F Bewley
- University of California Davis, Department of Otolaryngology, United States
| | - Craig W Senders
- University of California Davis, Department of Otolaryngology, United States
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Orbital Desmoid-Type Fibromatosis: A Case Report and Literature Review. Case Rep Oncol Med 2018; 2018:1684763. [PMID: 29707396 PMCID: PMC5863316 DOI: 10.1155/2018/1684763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/28/2017] [Accepted: 12/27/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Desmoid-type fibromatosis is a benign fibrous neoplasia originating from connective tissue, fascial planes, and musculoaponeurotic structures of the muscles. Currently, there is no evidence-based treatment approach available for desmoid fibromatosis. In this article, a case of a patient in the pediatric age affected by desmoid fibromatosis localized in the orbit is presented. The aim of the article is to describe this unusual and rare location for the desmoid fibromatosis and outline the principle phases in the decision-making process and the therapeutic alternatives for a patient affected by desmoid fibromatosis. Methods The protocol of this review included study objectives, search strategy, and selection criteria. The primary end point of this study was to analyze the head and neck desmoid fibromatosis. The secondary end point was to identify the available therapies and assess their specific indications. Results The mean age of patients was 18.9 years ranging from 0 to 66, and 52% were female. A bimodal age distribution was observed, and two age peaks were identified: 0–14 years (57%) and 28–42 years (18%). The most common involved areas were the mandible (25%) followed by the neck (21%). In 86% of the cases, the treatment was the surgical resection of the disease, and only in 5% of the cases, the surgical resection was followed by adjuvant radiotherapy. Conclusion The orbital location is extremely rare, especially in the pediatric population. The management of desmoid fibromatosis is based on the function preservation and the maintenance of a good quality of life, but in case of symptomatic patients or aggressive course of the disease or risk of functional damages, the surgical approach may be considered. Therapeutic alternatives to surgical resection are radiotherapy and systemic therapy.
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Xia C, Zhu Q, Yue C, Hu M, Li P, Li Z. Sonography used in the infantile desmoid fibromatosis of postcricoid area: A case report. Medicine (Baltimore) 2017; 96:e8500. [PMID: 29095310 PMCID: PMC5682829 DOI: 10.1097/md.0000000000008500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Infantile desmoid fibromatosis of the postcricoid area is a rare disease and is characterized by a proliferation of fibrous tissue with non-metastasis, local infiltration, and a high rate of recurrence after surgical resection. Currently, ultrasound is scarcely used in the hypopharynx and larynx area. PATIENT CONCERNS A 4-year-old boy presented with hoarseness, deep voice and snoring for 2∼4 years without any surgical history. On sonography, the lesion was found in the postcricoid area, and the left larynx showed impaired mobility in real time observation. Complete excision with a negative margin in this pivotal anatomic area is impossible, and necessitates a long-time surveillance. DIAGNOSES Infantile desmoid fibromatosis of the postcricoid area was diagnosed according to surgery and histopathology. INTERVENTIONS Local excision was carried out to relieve the upper airway narrowing. OUTCOMES Relieved hoarseness and snoring were reported on the latest follow-up. A residual lesion was seen in the surgical bed and maintained a stable extent on ultrasound and MR imaging after a year. LESSONS Considering the non-radiation merit and diagnostic ability, ultrasonography is advocated as a valuable supplementary imaging method to CT, MR and laryngoscopy in the juvenile larynx and hypopharynx.
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Affiliation(s)
- Chunxia Xia
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University
| | - Qiang Zhu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University
| | - Changli Yue
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University
| | - Minxia Hu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University
| | - Pingdong Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
| | - Zheng Li
- Department of Diagnostic Ultrasound, Beijing Aerospace General Hospital, Beijing, China
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Nair KK, Chaudhuri K, Lingappa A, Shetty R, Vittobarao PG. Aggressive fibromatosis of the oral cavity in a 5 year old boy: a rare case report. Pan Afr Med J 2017; 27:47. [PMID: 28819469 PMCID: PMC5554660 DOI: 10.11604/pamj.2017.27.47.11739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/06/2017] [Indexed: 11/14/2022] Open
Abstract
Fibrous tissue proliferations express a wide spectrum of histologic and morphologic variation in both infants and adults. This ranges from hypertrophic scar formation at one end to malignant fibrosarcoma at the other end of the spectrum. Aggressive fibromatosis is an intermediate tumor which is in proximity to fibrosarcomas. These are locally invasive and often recur after excision, but do not metastasize. Histologically, they are characterized by proliferating fibroblasts with little mitotic activity. Aggressive fibromatosis in the head and neck region is not common, and very sporadically occurs in the oral cavity or jaw bones. Here we report a rare case of aggressive fibromatosis occurring in a 5 year old boy.
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Affiliation(s)
- Keerthi Krishnankutty Nair
- Department of Oral Medicine and Radiology SJM Dental College and Hospital, Chitradurga, Karnataka, India
| | - Kanad Chaudhuri
- Dental Surgeon, Lifeline Polyclinic Kalyani, Nadia, West Bengal, India
| | - Ashok Lingappa
- Department of Oral Medicine and Radiology Bapuji Dental College and Hospital MCC B Block, Davangere, Karnataka, India
| | - Ranjani Shetty
- Department of Oral Medicine and Radiology Bapuji Dental College and Hospital MCC B Block, Davangere, Karnataka, India
| | - Pramod Gujjar Vittobarao
- Department of Oral Medicine and Radiology Bapuji Dental College and Hospital MCC B Block, Davangere, Karnataka, India
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Zheng Z, Jordan AC, Hackett AM, Chai RL. Pediatric desmoid fibromatosis of the parapharyngeal space: A case report and review of literature. Am J Otolaryngol 2016; 37:372-5. [PMID: 27040413 DOI: 10.1016/j.amjoto.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
Desmoid fibromatosis, or aggressive fibromatosis, is a benign but locally infiltrative fibroblastic neoplasm arising from fascial or musculoaponeurotic tissues. Although lacking metastatic potential, head and neck fibromatosis can have significant functional or cosmetic morbidities. 7%-15% of all desmoid tumors are seen in the head and neck region, 57% of which occur in the pediatric population. The incidence of pediatric desmoid tumor peaks around age 8. Treatment of choice is complete surgical resection; however, local recurrence is common. We present a case of a 14-month-old male with an 8-cm desmoid tumor in the right parapharyngeal space and provide an overview of diagnosis and management of pediatric head and neck fibromatosis. This is the largest desmoid tumor of the parapharyngeal space in the youngest patient described in the literature.
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Affiliation(s)
- Zhong Zheng
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Adrienne C Jordan
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Alyssa M Hackett
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Raymond L Chai
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA; Institute of Head, Neck and Thyroid Cancer, Mount Sinai Beth Israel, New York, NY, USA.
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Miyashita H, Asoda S, Soma T, Munakata K, Yazawa M, Nakagawa T, Kawana H. Desmoid-type fibromatosis of the head and neck in children: a case report and review of the literature. J Med Case Rep 2016; 10:173. [PMID: 27286970 PMCID: PMC4902910 DOI: 10.1186/s13256-016-0949-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/16/2022] Open
Abstract
Background Desmoid-type fibromatosis is defined as an intermediate tumor that rarely occurs in the head and neck of children. There is no doubt as to the value of complete surgical excision for desmoid-type fibromatosis. However, in pediatric patients, surgeons may often be concerned about making a wide excision because of the potential for functional morbidity. Some studies have reported a lack of correlation between margin status and recurrence. Therefore, we discussed our findings with a focus on the state of surgical margins. Case presentation We report an unusual case of a 9-month-old Japanese girl who prior to presenting at our hospital underwent debulking surgery twice with chemotherapy for desmoid-type fibromatosis of the tongue at another hospital. We performed a partial glossectomy and simultaneous reconstruction with local flap and achieved microscopic complete resection. We also reviewed available literature of pediatric desmoid-type fibromatosis in the head and neck. Conclusions We described successful treatment for the refractory case of pediatric desmoid-type fibromatosis. The review results showed that some microscopic incomplete resections of tumors in pediatric patients with desmoid-type fibromatosis tended to be acceptable with surgical treatment.
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Affiliation(s)
- Hidetaka Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Seiji Asoda
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Tomoya Soma
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Kanako Munakata
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Masaki Yazawa
- Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Taneaki Nakagawa
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hiromasa Kawana
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
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De Vloo P, De Vlieger J, Vander Poorten V, Sciot R, van Loon J, Van Calenbergh F. Desmoid tumors in neurosurgery: a review of the literature. Clin Neurol Neurosurg 2014; 129:78-84. [PMID: 25576767 DOI: 10.1016/j.clineuro.2014.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
Desmoid tumors (DTs) are rare myofibroblastic neoplasms, which are mostly sporadic, but sometimes associated with familial adenomatous polyposis syndrome. Neurosurgical cases of DT have been very scarce. We review the literature concerning neurosurgical DTs and describe the first case of a cicatricial DT after the resection of vestibular schwannoma, presenting as a painful swelling in the retrosigmoid scar. Contrary to other localizations in the body, standard-of-care wide margin resection cannot be performed in intracranial and spinal DTs. Therefore, maximally safe resection followed by radiotherapy when tumor margins are not free can be proposed as a treatment strategy in neurosurgical DTs.
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Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - Jan De Vlieger
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Frank Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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