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Jafroodifar A, Tam J, Khan ZV, Lisi M. Delayed Metastatic Cholangiocarcinoma to the Stomach With Imaging Characteristics Resembling Gastrointestinal Stromal Tumor: A Case Report and Review of the Literature. Cureus 2023; 15:e41785. [PMID: 37575729 PMCID: PMC10421337 DOI: 10.7759/cureus.41785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a relatively rare subtype of cholangiocarcinoma, and there has been an increasing incidence of ICC in Western countries in recent years. Surgical resection is the most effective treatment for ICC. However, overall outcomes are extremely poor given that most patients are diagnosed at an advanced stage, and postoperative ICC recurrence is still very high despite hepatic resection. We report a case of metastatic ICC to the stomach presenting after resection of the original tumor, with imaging characteristics highly resembling gastrointestinal stromal tumor (GIST) on imaging. Reported cases of metastatic ICC to the liver are sparse. Given that there is a significant difference in the survival rate between metastatic cholangiocarcinoma and other tumors arising from the gastrointestinal tract, including GISTs, it is important to delineate the differences via imaging features. We further discuss the imaging characteristics of intrahepatic ICC, comparing and contrasting it to other gastric tumors.
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Affiliation(s)
- Abtin Jafroodifar
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Janet Tam
- Radiology, Touro College of Osteopathic Medicine, New York, USA
| | - Zohaib V Khan
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Michele Lisi
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
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2
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Gastrointestinal malignancies in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1709-1723. [PMID: 36607401 DOI: 10.1007/s00261-022-03788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023]
Abstract
Gastrointestinal malignancies, though uncommon in pregnancy, present several unique challenges with regards to diagnosis, staging, and treatment. Imaging the pregnant patient with a suspected or confirmed GI malignancy requires modifications to the radiologic modality of choice and protocol in order to minimize harm to the fetus, ensure accuracy in diagnosis and staging and guide treatment decisions. In this review article, we discuss the imaging approach to the pregnant patient with GI cancer, including safe radiologic modalities and modifications to imaging protocols. We also review the most common GI cancers encountered in pregnancy, including colorectal, pancreatic, gastric, and small bowel tumors, with emphasis to imaging findings, staging, and treatment considerations.
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Identification of a Five-Gene Panel to Assess Prognosis for Gastric Cancer. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5593619. [PMID: 35187167 PMCID: PMC8850031 DOI: 10.1155/2022/5593619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
Methods Two datasets were used as training and validation cohorts to establish the predictive model. We used three types of screening criteria: background analysis, pathway analysis, and functional analysis provided by the cBioportal website. Fisher's exact test and multivariable logistic regression were performed to screen out related genes. Furthermore, we performed receiver operating characteristic (ROC) and Kaplan–Meier curve analyses to evaluate the correlation between the selected genes and overall survival. Result We screened five genes (KNL1, NRXN1, C6, CCDC169-SOHLH2, and TTN) that were highly related to recurrence of GC. The area under the receiver operating characteristic (ROC) curve was 0.813, which was much higher than that of the baseline model (AUC = 0.699). This result suggested that the mutation of five selected genes had a significant effect on the prediction of recurrence compared with other factors (age, stages, history, etc.). Furthermore, the Kaplan-Meier estimator also revealed that the mutation of five genes positively correlated with patient survival. Conclusions The patients who have mutations in these five genes may experience longer survival than those who do not have mutations. This five-gene panel will likely be a practical tool for prognostic evaluation and will provide another possible way for clinicians to determine therapy.
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Abstract
Kaposi sarcoma (KS) is a form of cancer that primarily appears on the skin but can potentially involve internal organs. There are several types of KS. The purpose of this article is to discuss the manifestations of KS and their appearance on imaging, the differential diagnoses associated with these findings, and molecular markers associated with KS that can aid appropriate diagnosis and therapy.
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Lim HJ, Kang HS, Lee JE, Min JH, Shin KS, You SK, Kim KH. Sarcomatoid carcinoma of the pancreas — multimodality imaging findings with serial imaging follow-up: A case report and review of literature. World J Clin Cases 2021; 9:3102-3113. [PMID: 33969097 PMCID: PMC8080743 DOI: 10.12998/wjcc.v9.i13.3102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas is extremely rare and has an extremely poor prognosis. Although a few cases of sarcomatoid carcinoma of pancreas have been reported, most are focused on a histopathological review. To the best of our knowledge, there are no reports documenting multimodality imaging characteristics and chronological changes with emphasis on radiologic features.
CASE SUMMARY A 64-year-old woman was admitted to Chungnam National University Hospital with acute appendicitis. Contrast-enhanced computed tomography of the abdomen revealed a 2.6 cm × 2.8 cm multilobular cystic mass in the pancreatic tail. The pancreatic lesion showed suspected mural nodules and thin septa. Hence, mucinous cystic neoplasm of pancreas was considered. After 7 mo, the patient was readmitted for repeated epigastric abdominal pain and nausea. Follow-up contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging revealed a marked enlargement (5.4 cm × 4 cm), with a predominant internal solid component. The mass showed low signal intensity on a T1-weighted image and heterogeneously intermediate high signal intensity on a T2-weighted image. It showed diffusion restriction and peripheral rim enhancement on an arterial phase image, and progressive enhancement on portal venous and delayed phase images. Distal pancreatectomy was performed. Based on the morphology and immunohistochemical staining of the specimen, pancreatic sarcomatoid carcinoma was diagnosed.
CONCLUSION We present the computed tomography, magnetic resonance imaging, and positron emission tomography computed tomography findings, pathologic features, and chronological changes for preoperative diagnosis.
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Affiliation(s)
- Hyun Jae Lim
- Department of Radiology, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Hye Seon Kang
- Department of Radiology, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Kyung Sook Shin
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Kyung-Hee Kim
- Department of Pathology, Cancer Research Institute, College of Medicine, Chungnam National University, Daejeon 35015, South Korea
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El Halabi M, Horanieh R, Tamim H, Mukherji D, Jdiaa S, Temraz S, Shamseddine A, Barada K. The impact of age on prognosis in patients with gastric cancer: experience in a tertiary care centre. J Gastrointest Oncol 2021; 11:1233-1241. [PMID: 33456996 DOI: 10.21037/jgo-20-139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Gastric cancer (GC) is a leading cause of cancer-related death in the world and most patients have advanced disease upon presentation. The effect of age on prognosis in GC is controversial. We aimed to determine the impact of age on survival in patients with GC. Methods This was a retrospective study of the medical records of Lebanese patients diagnosed with GC at the American University of Beirut Medical Center (AUBMC) between 2005 and 2014. Patients were divided into young (<65 years) and older groups (≥65 years). A multivariate analysis was done to determine the independent predictors of survival. Kaplan-Meier method was used for analysis of long-term survival outcomes. Results The sample consisted of 156 patients. The mean age was 62.15 (SD 13.54). Most patients presented with stage 4 disease (62.2%) and poorly differentiated histology (66.4%). The most common symptoms were abdominal pain and weight loss. On bivariate analysis, advanced stage (P=0.02) and higher grade (P=0.04) were associated with increased mortality. Patients <65 years of age were significantly more likely to have poorly differentiated tumours, while patients ≥65 years had more comorbidities (P=0.001). The 5-year DFS were 35% and 37% for patients <65 years of age and ≥65 years of age, respectively (P=0.15). Conclusions Higher grade and advanced stage are associated with worse survival in patients with GC, but age did not seem to have an impact. Screening high risk patients and early diagnosis are necessary to improve survival.
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Affiliation(s)
- Maan El Halabi
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.,Division of Gastroenterology, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Renee Horanieh
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.,Division of Hematology and Oncology, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Sara Jdiaa
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Sally Temraz
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.,Division of Hematology and Oncology, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.,Division of Hematology and Oncology, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Kassem Barada
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.,Division of Gastroenterology, American University of Beirut Medical Centre, Beirut, Lebanon
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Udayakumar H, Indiran V, Mariappan K, Maduraimuthu P. Pancreatic Pseudocyst with Mediastinal Extension Presenting as Pseudo-Kirklin Sign—Multimodality Imaging. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1701350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractA mass lesion of the gastric cardia or fundus causing an alteration in the normal regular, translucent gastric fundal air shadow on a frontal erect chest radiograph is referred to as “the Kirklin sign.” Here we present “Pseudo-Kirklin sign” observed on the frontal radiograph of a 46-year-old male patient due to a soft tissue shadow/contour deformity of the fundal gas shadow caused by pseudocyst of the pancreas. We evaluated the patient using plain radiography, contrast enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasound (EUS) with the cyst drained under EUS guidance. So far only two cases of mediastinal pseudocysts have been drained successfully by EUS-guided aspiration.
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Affiliation(s)
- Harshini Udayakumar
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Kalaichezhian Mariappan
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Prabakaran Maduraimuthu
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
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Duarte I, Outerelo C. Gastric Cancer Presenting as Isolated Ascites: A Diagnostic Challenge. Eur J Case Rep Intern Med 2019; 6:001141. [PMID: 31410353 PMCID: PMC6663044 DOI: 10.12890/2019_001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022] Open
Abstract
Malignant ascites is a rare first manifestation of gastric carcinoma and is usually associated with symptoms which include early satiety, abdominal pain and deteriorating clinical state. The authors describe the case of a male patient presenting with malignant ascites of rapid onset which was the sole presentation of gastric cancer, highlighting the importance of upper gastric endoscopy even in the absence of gastrointestinal symptoms.
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Affiliation(s)
- Inês Duarte
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Cristina Outerelo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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10
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Spychała A, Nowaczyk P, Budnicka A, Antoniewicz E, Murawa D. Intramural gastric hematoma imitating a gastrointestinal stromal tumor - case report and literature review. POLISH JOURNAL OF SURGERY 2017; 89:62-65. [PMID: 28537566 DOI: 10.5604/01.3001.0009.9159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The article presents a case report of a patient with an intramural gastric hematoma. Diagnostic examinations were suggestive of a suspected gastrointestinal stromal tumor Normal image was observed in gastroscopic examination while abdominal CT scan revealed a nodular lesion along the greater curvature of the stomach extending from the posterior wall and adjoining the pancreas and the spleen. The patient was qualified for surgical treatment. Laparotomy was performed followed by total gastric resection and Roux-en-Y reconstruction of the gastrointestinal tract. Post-operative histopathological examination revealed the presence of an extensive hematoma penetrating the perigastric fat tissue along with numerous hemosiderinophages and segmental indicators of formation of inflammatory granulation tissue suggestive of a chronic nature of the lesion. Immunohistochemical GIST assays (CD117, DOG-1, CD34, CD31, SMA, S-100, CKAE1/AE3, Ki-67) were negative. No complications were observed in the post-operative course. Patient is subject to continued follow-up and observation. Follow-up gastroscopy and abdominal CT scan performed 6 months after the surgery revealed an unremarkable image.
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Affiliation(s)
- Arkadiusz Spychała
- Wielkopolskie Centrum Onkologii, Oddział Chirurgii Onkologicznej i Ogólnej I Ordynator Oddziału: prof. zw. dr hab. n. med. Paweł Murawa
| | - Piotr Nowaczyk
- Wielkopolskie Centrum Onkologii, Oddział Chirurgii Onkologicznej i Ogólnej I Ordynator Oddziału: prof. zw. dr hab. n. med. Paweł Murawa
| | - Aleksandra Budnicka
- Wielkopolskie Centrum Onkologii, Studenckie Koło Naukowe Chirurgii Ogólnej i Onkologicznej przy Oddziale Chirurgii Onkologicznej i Ogólnej I Opiekun Studenckiego Koła Naukowego: dr n. med. Piotr Nowaczyk
| | - Ewa Antoniewicz
- Wielkopolskie Centrum Onkologii, Zakład Patologii Nowotworów Kierownik: prof. dr hab. n. med. Andrzej Marszałek
| | - Dawid Murawa
- Wojewódzki Szpital Specjalistyczny we Wrocławiu, Ośrodek Badawczo-Rozwojowy Kierownik: prof. dr hab. n. med. Wojciech Witkiewicz
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Nagpal P, Prakash A, Pradhan G, Vidholia A, Nagpal N, Saboo SS, Kuehn DM, Khandelwal A. MDCT imaging of the stomach: advances and applications. Br J Radiol 2016; 90:20160412. [PMID: 27785936 DOI: 10.1259/bjr.20160412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The stomach may be involved by a myriad of pathologies ranging from benign aetiologies like inflammation to malignant aetiologies like carcinoma or lymphoma. Multidetector CT (MDCT) of the stomach is the first-line imaging for patients with suspected gastric pathologies. Conventionally, CT imaging had the advantage of simultaneous detection of the mural and extramural disease extent, but advances in MDCT have allowed mucosal assessment by virtual endoscopy (VE). Also, better three-dimensional (3D) post-processing techniques have enabled more robust and accurate pre-operative planning in patients undergoing gastrectomy and even predict the response to surgery for patients undergoing laparoscopic sleeve gastrectomy for weight loss. The ability of CT to obtain stomach volume (for bariatric surgery patients) and 3D VE images depends on various patient and protocol factors that are important for a radiologist to understand. We review the appropriate CT imaging protocol in the patients with suspected gastric pathologies and highlight the imaging pearls of various gastric pathologies on CT and VE.
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Affiliation(s)
- Prashant Nagpal
- 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Anjali Prakash
- 2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Gaurav Pradhan
- 2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Aditi Vidholia
- 3 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nishant Nagpal
- 4 Department of Gastroenterology, Fortis Flt. Lt. Rajan Dhall Hospital, Delhi, India
| | - Sachin S Saboo
- 5 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - David M Kuehn
- 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Nasa M, Choksey A, Phadke A, Sawant P. Gastric lipoma: an unusual cause of dyspeptic symptoms. BMJ Case Rep 2016; 2016:bcr-2016-215297. [PMID: 27335362 DOI: 10.1136/bcr-2016-215297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gastric lipomas are rare tumours accounting for 2-3% of all benign gastric tumours. These are usually submucosal in origin but in rare cases may be subserosal in origin. Although a majority of gastric lipomas are asymptomatic and usually detected incidentally, occasionally these can cause abdominal pain, dyspeptic disorders, obstruction, invagination and haemorrhages. In the literature, only 200 cases of gastric lipomas have been reported so far. We report a case of a 56-year-old female with a submucosal symptomatic gastric lipoma presenting with disabling dyspeptic symptoms.
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Affiliation(s)
- Mukesh Nasa
- Department of Gastroenterology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Ajay Choksey
- Department of Gastroenterology, Vedant Hospital, Ahmedabad, Gujarat, India
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Visceral Kaposi's Sarcoma Presenting as Upper Gastrointestinal Bleeding. Case Rep Gastrointest Med 2015; 2015:438973. [PMID: 26064706 PMCID: PMC4438139 DOI: 10.1155/2015/438973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/22/2015] [Indexed: 12/20/2022] Open
Abstract
Since the advent of highly active antiretroviral therapy (HAART), the incidence of acquired immunodeficiency syndrome- (AIDS-) related Kaposi's sarcoma (KS) has decreased dramatically. While cutaneous KS is the most common and well-known manifestation, knowledge of alternative sites such as the gastrointestinal (GI) tract is important. GI-KS is particularly dangerous because of its potential for serious complications including perforation, obstruction, or bleeding. We report a rare case of GI-KS presenting as upper GI bleeding in a human immunodeficiency virus- (HIV-) infected transgendered individual. Prompt diagnosis and early initiation of therapy are the cornerstones for management of this potentially severe disease.
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