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Pang L, Chen J, Chang X. Large-cell neuroendocrine carcinoma of the gynecologic tract: Prevalence, survival outcomes, and associated factors. Front Oncol 2022; 12:970985. [PMID: 36457506 PMCID: PMC9707296 DOI: 10.3389/fonc.2022.970985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/27/2022] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND We aimed to assess the clinical behavior of gynecologic large-cell neuroendocrine carcinoma (LCNEC) via a retrospective analysis of data from 469 patients. METHODS Patients diagnosed with gynecologic LCNEC from 1988 to 2015 were identified using the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox hazard regression analyses were performed to assess independent predictors of overall survival (OS) and cancer-specific survival (CSS). OS and CSS were also evaluated using the Kaplan-Meier method, and the effects of different treatment regimens on prognosis were compared according to disease stage. RESULTS Cervical, ovarian, and endometrial LCNEC were observed in 169, 219, and 79 patients, respectively. The 5-year OS rates for patients with cervical, ovarian, and endometrial LCNEC were 35.98%, 17.84%, and 23.21%, respectively, and the median duration of overall survival was 26, 11, and 11 months in each group. The 5-year CSS rates for the three groups were 45.23%, 19.23%, and 31.39%, respectively, and the median duration of CSS was 41, 12, and 11 months in each group. Multivariate analysis revealed that American Joint Committee on Cancer stage, lymph node metastasis, and chemotherapy were independent prognostic factors for OS and CSS in patients with cervical LCNEC. Lymph node metastasis, surgery, and chemotherapy were independent prognostic factors for OS and CSS in the ovarian group and for OS in the endometrial group. Lymph node metastasis and surgery were also independent prognostic factors for CSS in the endometrial group. CONCLUSION Surgery alone may help to improve overall survival and CSS in patients with early-stage cervical LCNEC. In contrast, surgery+chemotherapy and surgery+radiotherapy may help to improve survival in those with early-stage ovarian and endometrial LCNEC, respectively. Regardless of subtype, comprehensive treatment involving surgery, CTX, and RT should be considered to improve prognosis in patients with advanced-stage gynecologic LCNEC.
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Affiliation(s)
- Li Pang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jie Chen
- Centre of Journals, China Medical University, Shenyang, Liaoning, China
| | - Xiaohan Chang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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2
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Hirakawa T, Yano M, Nishida H, Sato S, Nasu K. Vulvar neuroendocrine carcinoma that is independent of merkel cell polyomavirus and human papillomavirus suggests endometrial cancer recurrence: a case report. BMC Endocr Disord 2022; 22:81. [PMID: 35351092 PMCID: PMC8962009 DOI: 10.1186/s12902-022-00987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vulvar neuroendocrine carcinomas with small cell morphology need an appropriate differential diagnosis with respect to primary Merkel cell carcinomas, primary small cell neuroendocrine carcinomas, and secondary/metastatic carcinomas. Herein, we report a woman with a history of endometrial carcinoma led to neuroendocrine vulvar carcinoma. CASE PRESENTATION An 82-y-old woman with right vulvar swelling was transferred to our hospital. Computed tomography scan showed a 75 mm irregular mass in her right vulva. Three years ago, she had been diagnosed with endometrial endometrioid carcinoma stage IA and had undergone surgery. Vulvar biopsy revealed neuroendocrine carcinomas with small cell morphology. Immunohistochemical staining showed that the vulvar tumor was positive for CD56 and chromogranin A, but negative for Merkel cell polyomavirus and cytokeratin 20. Incidentally, her endometrial carcinoma was also positive for CD56 and chromogranin A. Human papillomavirus DNA typing analysis of vulvar tumor was negative. Hence, the vulvar tumor seemed to be a recurrence of the endometrial cancer rather than a primary vulvar neuroendocrine carcinoma. The patient died of the disease within a month. CONCLUSION We report a case of vulvar neuroendocrine carcinoma that is independent of Merkel cell polyomavirus and human papillomavirus, thereby suggesting a recurrence of endometrial cancer. Immunohistochemical and virological analyses helped in the differential diagnosis of the neuroendocrine carcinoma.
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Affiliation(s)
- Tomoko Hirakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593 Japan
| | - Mitsutake Yano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593 Japan
| | - Haruto Nishida
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593 Japan
| | - Shimpei Sato
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593 Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593 Japan
- Division of Obstetrics and Gynecology, Support System for Community Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593 Japan
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3
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Du R, Jiang F, Wang ZY, Kang YQ, Wang XY, Du Y. Pure large cell neuroendocrine carcinoma originating from the endometrium: A case report. World J Clin Cases 2021; 9:3449-3457. [PMID: 34002157 PMCID: PMC8107915 DOI: 10.12998/wjcc.v9.i14.3449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/10/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Large cell neuroendocrine carcinoma (LCNEC) of the endometrium is an uncommon and highly aggressive tumor that has not been comprehensively characterized. We report a case of pure endometrial LCNEC and review the current literature of similar cases to raise awareness of the histological features, treatment, and prognosis of this tumor.
CASE SUMMARY We report the case of a 73-year-old woman who presented with irregular postmenopausal vaginal bleeding. Ultrasonography showed an enlarged uterus and a 5.1 cm × 3.3 cm area of medium and low echogenicity in the uterine cavity. Biopsy by dilatation and curettage suggested poorly differentiated carcinoma. Magnetic resonance imaging revealed a heterogeneously enhanced uterine tumor with diffuse infiltration of the posterior wall of the uterine myometrium and enlarged pelvic lymph nodes. The patient underwent a hysterectomy and bilateral adnexal resection. Gross observation revealed an ill-defined white solid mass of the posterior wall of the uterus infiltrating into the serosa with multiple solid nodules on the serous surface. Microscopically, the tumor cells showed neuroendocrine morphology (organoid nesting). Immunohistochemistry revealed the tumor cells were diffusely positive for the neuroendocrine markers CD56, chromogranin A, and synaptophysin. Thus, the tumor was diagnosed as stage IIIC endometrial LCNEC.
CONCLUSION Pathologic findings and immunohistochemistry are essential in making a diagnosis of endometrial LCNEC.
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Affiliation(s)
- Ran Du
- Department of Pathology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Feng Jiang
- Department of Thoracic Surgery, Liaocheng Tumor Hospital, Liaocheng 252000, Shandong Province, China
| | - Zheng-Yan Wang
- Department of Pathology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Yan-Qing Kang
- Department of Radiology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Xiu-Yu Wang
- Department of Pathology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Ying Du
- Department of Pathology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
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4
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Molecular Characterization of Neuroendocrine Carcinomas of the Endometrium: Representation in All 4 TCGA Groups. Am J Surg Pathol 2020; 44:1541-1548. [PMID: 32773531 DOI: 10.1097/pas.0000000000001560] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
High-grade neuroendocrine carcinomas (NEC) of the endometrium are rare and account for <1% of all endometrial carcinomas. Both small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC) morphologies have been reported. Little is known regarding the molecular features of endometrial NEC including how they compare to pulmonary NEC (the most common site for these neoplasms) and the more common endometrial carcinoma histotypes. In this study, we investigated the molecular alterations in a series of endometrial NEC using a targeted next generation sequencing panel (Oncopanel). Fourteen NEC were sequenced; pure NEC (n=4) and mixed (n=10) with endometrioid adenocarcinoma (n=9) or carcinosarcoma (n=1). The NEC components of mixed tumors comprised LCNEC (n=6) and SCNEC (n=4). The 4 pure NEC comprised LCNEC (n=2) and SCNEC (n=2). Molecular analysis classified tumors into the 4 The Cancer Genome Atlas groups: (1) POLE-mutated/ultramutated (1/14; 7%), (2) microsatellite instability/hypermutated (6/14; 43%), (3) TP53 mutated/copy number high (2/14; 14%), or (4) no specific molecular profile (5/14; 36%). Overall, 50% of cases were ultramutated or hypermutated. In 8 cases of mixed carcinomas, the different histologic components were macrodissected and separately sequenced; molecular alterations were nearly identical among the 2 components, with the non-NEC component harboring slightly increased tumor mutational burden. Only 2 carcinomas (both with pure SCNEC morphology) had a molecular profile that would be expected in typical pulmonary SCNEC (RB1 deletion and TP53 mutations). Our findings, similar to data from NECs of other anatomic sites, suggest that the molecular context may be important when selecting therapies for women with endometrial NEC. Immune checkpoint inhibition may be a reasonable approach to treatment of microsatellite instability-NEC and we thus recommend that all endometrial NEC be tested for mismatch repair abnormalities, either molecularly or by mismatch repair protein immunohistochemistry.
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Zhou F, Zhang X, Chen H, Zheng W. Dedifferentiated Endometrioid Carcinomas with Neuroendocrine Differentiation: A Clinicopathological and Immunohistochemical Study of Three Cases. Cancer Manag Res 2020; 12:11623-11629. [PMID: 33223851 PMCID: PMC7671506 DOI: 10.2147/cmar.s279888] [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: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the relationship between dedifferentiated endometrioid carcinomas with neuroendocrine differentiation and mismatch repair deficiency. Patients and Methods The clinicopathological records and samples of three patients were retrieved from the Pathology Department of Zhejiang University's School of Medicine Women's Hospital. Results The tumors comprised one dominant poorly differentiated component (60-90% of the neoplasm volume) and one well-differentiated glandular component. The poorly differentiated component showed solid sheets with organoid growth patterns and insular, trabecular and rosette/pseudorosette patterns. Large polygonal cells, vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm were observed in the poorly differentiated area. All three cases were diffusely positive for p16 and for at least two of three neuroendocrine markers (chromogranin, synaptophysin, neural cell adhesion molecule (CD56)) in >10% of cancer cells. Loss of MMR protein expression was found in two patients: MLH1 and PSM2 in patient 2 and MSH2 and MSH 6 in patient 3. Abnormal P53 and SMARCB1 (INI1) expression was noted in patient 3. All three patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, and two received postoperative chemotherapy and/or radiation therapy. The patients survived disease-free for 60, 26 and 15 months, respectively. Conclusion Dedifferentiated endometrioid carcinomas with neuroendocrine differentiation may be associated with mismatch repair deficiency and have an improved prognosis.
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Affiliation(s)
- Feng Zhou
- Department of Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaofei Zhang
- Department of Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hao Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center, Dallas, TX, USA
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6
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Jenny C, Kimball K, Kilgore L, Boone J. Large cell neuroendocrine carcinoma of the endometrium: a report and review of the literature. Gynecol Oncol Rep 2019; 28:96-100. [PMID: 30976646 PMCID: PMC6441730 DOI: 10.1016/j.gore.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/08/2019] [Indexed: 01/22/2023] Open
Abstract
Large-cell neuroendocrine tumor of the endometrium is a rare tumor type which is difficult to diagnose. Our routine tissue sampling is often non-productive and these tumors can be mistaken for other poorly differentiated carcinomas. Sites of metastatic disease sometimes confuse the identification of the primary organ, and histological diagnosis requires a choice of neuroendocrine biomarkers. In addition, there are no published diagnostic criteria for LCNEC of the endometrium and diagnostic criteria must be translated from the WHO classification of tumors of the lung. Once a diagnosis is reached, there are no large series to direct treatment. Consensus opinion appears to favor surgery for early stage disease followed by chemotherapy with etoposide and platinum-based agents. While there are many hurdles to overcome, the proper diagnosis of LCNEC of the endometrium is of utmost importance in a disease characterized by rapid progression and poor prognosis. We examine a case of large cell neuroendocrine tumor of the endometrium with rapid progression over a period of two months which precluded her planned chemotherapy. There are 20 cases of large cell neuroendocrine tumor of the endometrium reported. It is difficult to make the diagnosis with traditional tissue sampling procedures. The prognosis is poor with disease that may progress rapidly. There may be a role for neo-adjuvant chemotherapy but this is poorly studied.
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Affiliation(s)
- Courtney Jenny
- The University of Tennessee, Knoxville, Department of Obstetrics and Gynecology and Graduate School of Medicine, United States of America
| | - Kristopher Kimball
- The University of Tennessee, Knoxville, Department of Obstetrics and Gynecology and Graduate School of Medicine, United States of America
| | - Larry Kilgore
- The University of Tennessee, Knoxville, Department of Obstetrics and Gynecology and Graduate School of Medicine, United States of America
| | - Jonathan Boone
- The University of Tennessee, Knoxville, Department of Obstetrics and Gynecology and Graduate School of Medicine, United States of America
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7
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Lee E, Ji YI. Large Cell Neuroendocrine Carcinoma of the Cervix with Sequential Metastasis to Different Sites: A Case Report. Case Rep Oncol 2018; 11:665-670. [PMID: 30483095 PMCID: PMC6243902 DOI: 10.1159/000493912] [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: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Neuroendocrine carcinoma of the cervix is rare, and prognosis is very poor. Because of its rarity, effective treatment of neuroendocrine carcinoma of the cervix has not been established. It has distinct patterns of metastasis, but can be successfully treated with radical surgery and platinum-based chemotherapy. We report a 50-year-old woman who was diagnosed with large cell neuroendocrine carcinoma of the cervix and underwent radical surgery followed by adjuvant chemoradiation therapy. She experienced recurrence several times and to different sites, with sequential metastasis to the lung, breast, and retroperitoneum, but nevertheless survived more than 5 years.
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Affiliation(s)
- Eunhyun Lee
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yong-Il Ji
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
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Ogura J, Adachi Y, Yasumoto K, Okamura A, Nonogaki H, Kakui K, Yamanoi K, Suginami K, Koyama T, Ikehara S. Large-cell neuroendocrine carcinoma arising in the endometrium: A case report. Mol Clin Oncol 2018; 8:571-574. [PMID: 29564132 DOI: 10.3892/mco.2018.1583] [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] [Received: 09/01/2017] [Accepted: 01/17/2018] [Indexed: 12/15/2022] Open
Abstract
Large-cell neuroendocrine carcinoma (LCNEC) of the endometrium is an extremely rare, high-grade malignant tumor. We herein report a case of a rapidly growing LCNEC arising in the endometrium. A 52-year-old woman was referred to Toyooka Hospital (Tooyoka, Japan) due to genital bleeding in February 2016. There had been no abnormalities on a regular gynecological and physical examination 3 months prior to the consultation. Imaging (computed tomography and magnetic resonance imaging) and a pelvic examination revealed a tumor sized 16.9×8.4×7.8 mm occupying the intrauterine cavity and extending into the vaginal cavity. Multiple metastatic pelvic and paraaortic lymph nodes were also identified. Continuous bleeding from the tumor was observed, and a blood examination revealed anemia, which was likely due to that bleeding. Biopsy of the tumor was performed, and large atypical cells were identified. The tumor cells were negative for cytokeratin AE1/AE3 and chromogranin A, but positive for CD56 and synaptophysin. There was also an abundance of Ki-67-positive cells in the tumor, altogether suggesting that the tumor was an LCNEC. The patient succumbed to the disease 36 days after the first consultation. Based on the findings of the present case and previously published cases, LCNECs arising in the endometrium may progress rapidly and are associated with an unfavourable outcome. LCNEC should be included in the differential diagnosis in cases of rapidly growing tumors of the uterine corpus.
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Affiliation(s)
- Jumpei Ogura
- Department of Obstetrics and Gynecology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan.,Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Kyoto 606-8501, Japan
| | - Yasushi Adachi
- Department of Diagnostic Pathology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Koji Yasumoto
- Department of Obstetrics and Gynecology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan.,Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Kyoto 606-8501, Japan
| | - Akiharu Okamura
- Department of Diagnostic Pathology, Kakogawa Central City Hospital, Kakogawa, Hyogo 675-8611, Japan
| | - Hirofumi Nonogaki
- Department of Obstetrics and Gynecology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Kazuyo Kakui
- Department of Obstetrics and Gynecology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan.,Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Kyoto 606-8501, Japan
| | - Koji Yamanoi
- Department of Obstetrics and Gynecology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan.,Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Kyoto 606-8501, Japan
| | - Koh Suginami
- Department of Obstetrics and Gynecology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan.,Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Kyoto 606-8501, Japan
| | - Takashi Koyama
- Department of Radiology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Susumu Ikehara
- Professor Emeritus, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
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Chougule A, Garg R, Jain V. Paranuclear dot-like pancytokeratin positivity and MLH1/PMS2 loss in large cell neuroendocrine carcinoma of the endometrium. Pathology 2016; 48:736-739. [PMID: 27780606 DOI: 10.1016/j.pathol.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Abhijit Chougule
- Departments of Cytology and Gynaecologic Pathology, Chandigarh, India
| | - Rashi Garg
- Departments of Cytology and Gynaecologic Pathology, Chandigarh, India.
| | - Vanita Jain
- Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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