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Long E, You D, Wang S, Lu S, Xu P, Zhou J, Li L, Wu J, Zhang B, Zhu G, Lang J. Outcome of primary intraosseous carcinoma: cases review of a single institution. Oral Dis 2022. [PMID: 35500146 DOI: 10.1111/odi.14233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/17/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the prognostic factors and treatment of primary intraosseous carcinoma. METHODS Patients diagnosed with primary intraosseous carcinoma and received treatment in Sichuan cancer hospital from 2000 to 2019 were followed up and retrospectively reviewed. RESULTS A total of 28 patients were included in the study, with a mean age of 60 years (60±10.11). The 2-year and 5-year overall survival were 60.7% and 38.5% respectively. In the univariate analysis, surgery combined with adjuvant therapy improved the overall survival compared with surgery or radiotherapy alone (P=0.035), and patients received postoperative adjuvant radiotherapy had a higher overall survival than those who received radical radiotherapy (P = 0.01). In addition, patients with well differentiated tumors have increased progression free survival (P=0.01). Multivariate analyses showed that radiotherapy was an independent indicator for overall survival (P = 0.007). CONCLUSIONS surgery combined with adjuvant therapy is the superior treatment strategy for primary intraosseous carcinoma at present. This study is the first to confirm the positive role of radiotherapy in treating primary intraosseous carcinoma with data to back it up.
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Affiliation(s)
- En Long
- Department of Oncology, Southwest Medical University, 646000, Luzhou, China
| | - Dongling You
- Department of Oncology, Southwest Medical University, 646000, Luzhou, China
| | - Shubin Wang
- School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China
| | - Shun Lu
- Department of radiation oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China.,Department of Radiological Protection, Radiation Oncology Key Laboratory of Sichuan Province, 610041, Chengdu, China
| | - Peng Xu
- Department of radiation oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China
| | - Jie Zhou
- Department of radiation oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China
| | - Lu Li
- Department of radiation oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China
| | - Jian Wu
- Department of Oncology, Southwest Medical University, 646000, Luzhou, China
| | - Biqin Zhang
- School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China
| | - Guiquan Zhu
- Department of Head and Neck Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Jinyi Lang
- Department of Oncology, Southwest Medical University, 646000, Luzhou, China.,Department of radiation oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, 610041, Chengdu, China.,Department of Radiological Protection, Radiation Oncology Key Laboratory of Sichuan Province, 610041, Chengdu, China
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Oh HJ, Shin DW, Yoon HJ, Myoung H, Kim SM. Primary intraosseous carcinoma in the pediatric and adolescent mandible. World J Surg Oncol 2022; 20:25. [PMID: 35086533 PMCID: PMC8793206 DOI: 10.1186/s12957-021-02465-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary intraosseous carcinoma (PIOC) is a rare malignant odontogenic tumor that predominantly occurs in males older than 50 years. PIOC can be misdiagnosed as odontogenic cyst because it occasionally shows a well-defined border on radiography. In this study, related literatures of pediatric and adolescent PIOC cases were analyzed under strict PRISMA guidelines along with an adolescent case who was provisionally misdiagnosed as an odontogenic cyst. METHODS All case reports for PIOC published in English from 1966 to 2021 were collected. Cases under the age of 20 were classified as pediatric and adolescent populations in this study. A total of 12 pediatric and adolescent cases including 11 PIOCs from the literature and one new case of a 14-year-old female were analyzed. Clinical and radiographic features, diagnosis and treatment approaches, and prognosis were investigated. RESULTS Ages ranged from 4 to 18 years. The female to male ratio was 1.4:1. Seven cases occurred in the mandible. Swelling was observed in 11 patients. The radiologic borders were well-defined in six cases and corticated in four cases. Tooth displacement and root resorption were observed in four and six cases, respectively. The provisional diagnosis for seven patients was odontogenic cyst and enucleation was performed in six cases including the new case. During the follow-up period, local recurrence occurred in three patients. The pediatric and adolescent PIOC cases with local recurrence showed poor prognosis. The locally recurred lesion in the new case did not decrease in size despite concurrent chemo-radiation therapy. CONCLUSIONS Three-dimensional imaging modalities and incisional biopsy with multiple specimens are necessary to rule out PIOC in the lesions with atypical radiographic findings. PIOC should be diagnosed differentially from odontogenic cyst even in pediatric and adolescent populations to properly manage the disease with poor prognosis.
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Affiliation(s)
- Hyun Jun Oh
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Dong Whan Shin
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hye-Jung Yoon
- Department of Oral Pathology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Uddin M, Lim LC, Goodall A, Padaki P, Anjum K. Synchronous mucosal and intraosseous oral cavity carcinomas: a case of rare occult second primary malignancy. Ann R Coll Surg Engl 2021; 104:e150-e152. [PMID: 34841900 DOI: 10.1308/rcsann.2021.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Secondary primary malignancies within the head and neck region are well documented. Within this group, synchronous tumours with an index oral cancer are usually found in the oropharyngeal or laryngeal sites. We present a rare case of an index squamous cell carcinoma in the tongue with a synchronous primary intraosseous squamous cell carcinoma. We discuss the challenges associated with investigation, diagnosis and subsequent management. Treatment aims remain the same; namely, eradicating the disease using surgery, radiotherapy, chemotherapy or a combination of these modalities. It is important to acknowledge the unpredictable pattern of tumour presentation and the need to maintain a high index of suspicion.
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Affiliation(s)
- M Uddin
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - L C Lim
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - A Goodall
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - P Padaki
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - K Anjum
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
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Primary intraosseous malignancies: A 10-year retrospective cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:153-162. [PMID: 34020918 DOI: 10.1016/j.oooo.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/07/2020] [Accepted: 02/02/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to explore the characteristics and prognoses of primary jaw malignancies and identify valuable prognostic factors. STUDY DESIGN Patients who were primarily diagnosed with jaw malignancies at Beijing Stomatological Hospital between 2006 and 2016 were retrospectively reviewed. RESULTS Eighty patients with malignant jaw tumors were enrolled in the study. Squamous cell carcinoma was the most common type (56.2%). The age range of patients varied from 11 to 92 years old (mean age = 51.5 years), and the male-to-female ratio was 2.1:1. Anatomically, the mandible was involved in 82.5% of cases. The estimated disease-free survival and overall survival (OS) rates were 60.6% and 73.2%, respectively. Cox multivariate analysis showed that a smoking history (hazard ratio = 5.015, 95% confidence interval, 1.900-13.235, P = .001) and advanced age (≥60 years; hazard ratio = 2.464, 95% confidence interval, 0.987-6.155, P = .046) were independent prognostic factors for poor OS. CONCLUSION Primary jaw malignancies were more prevalent in the mandible and among males and middle-aged patients. Radical resection of the primary surgery was the basis of a good prognosis, and the choice of postoperative adjuvant therapy may not ultimately affect OS. Patients with a history of smoking and advanced age were at high risk for poor prognosis.
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de Morais EF, Carlan LM, de Farias Morais HG, Pinheiro JC, Martins HDD, Barboza CAG, de Almeida Freitas R. Primary Intraosseous Squamous Cell Carcinoma Involving the Jaw Bones: A Systematic Review and Update. Head Neck Pathol 2020; 15:608-616. [PMID: 33044723 PMCID: PMC8134565 DOI: 10.1007/s12105-020-01234-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/06/2020] [Indexed: 01/15/2023]
Abstract
Primary intraosseous oral squamous cell carcinoma (PIOSCC) is a rare malignant neoplasm that affects the jaws. Despite its aggressive biological behavior, there are no studies that evaluated the clinicopathological features of this tumor and parameters associated with its prognosis. The objective of the present study was to conduct a systematic review of the available data on oral and maxillofacial PIOSCC in order to determine its clinicopathological characteristics and biological behavior. We conducted a systematic review in May 2020 in multiple databases using a specific search strategy. Cases diagnosed as PIOSCC in the oral cavity and maxillofacial complex that had sufficient histopathological data, absence of ulceration in the oral mucosa, a negative result for a distant primary tumor, and radiographic evidence of an osteolytic lesion that was entirely or mostly surrounded by the jaw bones were included. A total of 109 published articles were included in our systematic review, corresponding to 257 cases. PIOSCC showed a male predilection (69.3%) and a preference for the mandible (7:1), with the posterior region being the most commonly affected site. The mean age at diagnosis was 57.3 years. Cortical expansion, pain, and lip/facial paresthesia were the most common clinical features. Regarding histopathological features, most PIOSCC were well-differentiated and the solid subtype was the most common. Statistical analysis showed that PIOSCC located in the mandible (p = 0.03) and recurrence (p < 0.01) were significantly associated with a higher mortality rate. PIOSCC has a poor prognosis, with high rates of mortality.
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Affiliation(s)
- Everton Freitas de Morais
- Department of Oral Pathology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil.
| | - Leonardo Magalhães Carlan
- Department of Oral Pathology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil
| | - Hannah Gil de Farias Morais
- Department of Oral Pathology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil
| | - Juliana Campos Pinheiro
- Department of Oral Pathology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil
| | - Hélder Domiciano Dantas Martins
- Department of Oral Pathology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil
| | - Carlos Augusto Galvão Barboza
- Department of Oral Pathology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil
| | - Roseana de Almeida Freitas
- Department of Oral Pathology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil
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Malignant Lesions Mimicking Endodontic Pathoses Lesion: A Systematic Review. J Endod 2020; 47:178-188. [PMID: 32918962 DOI: 10.1016/j.joen.2020.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Malignant nonendodontic periapical lesions represent a rare diagnosis, in which few case have been reported about this condition. Due to the low occurrence and little exploration of this subject, serious errors of diagnosis are observed in the oral medicine services. In this sense, the purpose of the present review was to integrate the information on the record published on malignant lesions that mimic endodontic pathoses into a comprehensive analysis of their clinical, radiologic, and histopathologic features. METHODS An online search was made in March 2020 in the following databases: Pubmed, Web of Science, and Scopus. Eligibility criteria included publications having enough clinical, radiologic, and histopathologic information to confirm the diagnosis. Data were assessed descriptively. RESULTS Forty-nine publications from 16 countries comprising 60 cases were included. There is a nearly equal occurrence rate between males and females (male/female ratio is 49.15%/50.84%) with a mean age of 46.56 years. The lesions were more prevalent in the posterior mandibles (40.69%), and, radiographically, they were unilocular radiolucent. Histopathologic analysis showed metastasis (26.67%) as the most prevalent lesion followed by salivary gland malignant disease (25%). CONCLUSIONS The present systematic review revealed several histologic types of malignant periapical lesions that could be mimicking endodontic pathoses. Because these lesions usually do not show clinical or radiologic features of malignant alteration, clinicians should consider these hypotheses in their routine.
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Genetic and histopathological analysis of a case of primary intraosseous carcinoma, NOS with features of both ameloblastic carcinoma and squamous cell carcinoma. World J Surg Oncol 2020; 18:45. [PMID: 32113465 PMCID: PMC7049395 DOI: 10.1186/s12957-020-01827-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/21/2020] [Indexed: 02/04/2023] Open
Abstract
Background Primary intraosseous carcinoma (PIOC), NOS is an odontogenic carcinoma with unknown etiology. Its diagnosis may be used when central jaw carcinoma cannot be categorized as any other type of carcinoma. Further information on this extremely rare tumor is needed to improve our understanding and evaluate the classification of odontogenic carcinomas. Case presentation We herein presented two patients with PIOC, NOS with different clinical and histopathological features and analyzed gene mutations in these patients using next-generation sequencing (NGS). The typical PIOC, NOS case had many histopathological similarities to oral squamous cell carcinoma (OSCC), including the missense point mutations of TP53 Glu285Val, KDR Gln472His, and APC Pro1433Leu, which are similar to those in other cancers; however, no mutations were detected in the other patient with an atypical presentation of PIOC, NOS, which was derived from a precursor cystic lesion with similarities to both ameloblastic carcinoma and OSCC. Conclusions Genetic analysis suggested that these two PIOC, NOS cases have different features and can be subcategorized.
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An Unusual Case of Mandibular Squamous Cell Carcinoma in Intimacy with an Impacted Wisdom Tooth. Case Rep Surg 2019; 2019:8360357. [PMID: 31110834 PMCID: PMC6487125 DOI: 10.1155/2019/8360357] [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: 01/16/2019] [Accepted: 04/01/2019] [Indexed: 11/18/2022] Open
Abstract
Squamous cell carcinoma is the most common head and neck malignancy. It can occur in the mandible or maxilla without a preexisting oral mucosal lesion. Often, the clinical and radiographic presentation of SCC directs the clinician to favour malignancy over other pathological conditions. However, SCC may also mimic an infectious condition and therefore can pose a diagnostic challenge even for the most experienced clinicians. Herein, we report a case of mandibular squamous cell carcinoma in a 53-year-old male who presented with symptoms of right facial swelling, trismus, pain, and right-sided lip paresthesia. The patient underwent a surgical removal of the presumed infected third molar of the right mandible, but histopathological analysis of the associated soft tissue unexpectedly yielded squamous cell carcinoma. Given the biopsy-proven diagnosis, the patient received a mandibular resection of the tumor followed by primary reconstruction with a fibular free flap. Patients presenting with symptoms mimicking odontogenic infections should receive vigilant attention by clinicians with regard to the disease history, clinical signs, radiographic evidence, and decision for histopathological analysis. This is especially true in the context of impacted dentition, where malignancy must be considered when formulating a differential diagnosis.
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Li K, Yang L, Qiao YJ, Liang YJ, Wang X, Liao GQ. Risk factors and prognosis for the primary intraosseous carcinoma of the jaw. Int J Oral Maxillofac Surg 2019; 48:157-162. [DOI: 10.1016/j.ijom.2018.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/15/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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Kimura M, Shiraki Y, Ishibashi K, Umemura M. Remarkable Short-Term Regression of a Posterior Mediastinum Metastasis From Primary Intraosseous Carcinoma Treated With Nivolumab: A Case Report. J Oral Maxillofac Surg 2018; 77:555.e1-555.e6. [PMID: 30576676 DOI: 10.1016/j.joms.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 11/29/2022]
Abstract
Primary intraosseous carcinoma (PIOC; not otherwise specified) is a rare odontogenic malignancy that is believed to arise from the odontogenic epithelium. In addition, some cases arise in odontogenic cysts or other benign precursors. There are no established treatment protocols for PIOC because of its rarity. In particular, no standard therapy has been established for patients with recurrent or metastatic PIOC. This report describes a case in which the use of nivolumab showed a marked treatment response in metastatic PIOC. The patient was a 71-year-old man with PIOC. The patient underwent segmental mandibulectomy with modified radical neck dissection after neoadjuvant chemotherapy, including 2 cycles of paclitaxel, cetuximab, and carboplatin and 1 cycle of docetaxel, cisplatin, and 5-fluorouracil. The lesion rapidly enlarged during neoadjuvant chemotherapy, and surgical specimens showed no histologic therapeutic effects of chemotherapy. Three months after the surgery, contrast-enhanced computed tomograms showed posterior mediastinal lymph node metastasis. Treatment with nivolumab was initiated, and notable clinical improvement was noted after 2 cycles. Although it was a short-term treatment, remarkable effects were observed and no adverse events were noted during and after nivolumab treatment. Nivolumab could be an attractive treatment option for metastatic PIOC that is resistant to traditional chemotherapy and target therapy, including cetuximab. Further investigation of this treatment is warranted.
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Affiliation(s)
- Masashi Kimura
- Chief Surgeon, Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Yukihiro Shiraki
- Assistant Professor, Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichiro Ishibashi
- Chief Surgeon, Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Masahiro Umemura
- Director, Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan
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Pavlin D, Dolenšek T, Švara T, Nemec A. Solid type primary intraosseous squamous cell carcinoma in a cat. BMC Vet Res 2018; 14:23. [PMID: 29357860 PMCID: PMC5778816 DOI: 10.1186/s12917-018-1344-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/11/2018] [Indexed: 11/11/2022] Open
Abstract
Background Squamous cell carcinoma (SCC) is the most common nonodontogenic oral tumor in cats. In the jaw, it usually presents as an ulceroproliferative lesion associated with enlargement of the affected bone. Case presentation This report describes the case of a cat in which clinical and radiographic findings of a mandibular swelling were suggestive of an aggressive process, but the oral mucosa was unaffected. The results of histopathological and immunohistochemical examination of the samples obtained from the intraosseous lesion were consistent with SCC. The animal was euthanized 5 months after initial presentation as a result of the severe progression of the disease, and no other primary tumors were identified at necropsy. Conclusions Based on the clinicopathological, microscopic, and immunohistochemical staining features, as well as the absence of a primary tumor at a distant site, we propose that the term, solid type primary intraosseous SCC (PIOSCC), be used to describe this neoplasia, as it shares similar features with human PIOSCC.
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Affiliation(s)
- Darja Pavlin
- University of Ljubljana, Veterinary faculty, Small Animal Clinic, Gerbičeva, 60, Ljubljana, Slovenia.
| | - Tamara Dolenšek
- University of Ljubljana, Veterinary faculty, Institute of Pathology, Wild Animals, Fish and Bees, Gerbičeva, 60, Ljubljana, Slovenia
| | - Tanja Švara
- University of Ljubljana, Veterinary faculty, Institute of Pathology, Wild Animals, Fish and Bees, Gerbičeva, 60, Ljubljana, Slovenia
| | - Ana Nemec
- University of Ljubljana, Veterinary faculty, Small Animal Clinic, Gerbičeva, 60, Ljubljana, Slovenia
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