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Tung-Hahn E, El-Haddad G, Strosberg J. Cutaneous Neuroendocrine Metastases of Visceral Origin Responsive to Surgical Resection and Targeted Radionuclide Therapy. Case Rep Dermatol Med 2024; 2024:8873822. [PMID: 38352716 PMCID: PMC10864049 DOI: 10.1155/2024/8873822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/22/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024] Open
Abstract
Neuroendocrine neoplasms (NENs) encompass a diverse range of biologically and behaviorally distinct epithelial malignancies that derive from neuroendocrine cells. These neoplasms are able to secrete a variety of bioactive amines or peptide hormones. The majority of NENs are well-differentiated and are defined as neuroendocrine tumors (NETs). While NETs are known to frequently metastasize to lymph nodes, liver, and lungs, spread to the skin is extremely rare and is often a late finding. Because cutaneous metastasis from a visceral site represents distant tumor dissemination, prompt histologic diagnosis is critical in terms of selecting further treatment options and ultimately impacts subsequent prognosis. This report presents a man with painful cutaneous NET metastases initially on the face then scalp. He had a prior history of longstanding and progressive stage IV visceral disease. Multimodal therapy with initial surgical resection of the larger facial lesion and radionuclide infusion therapy was undertaken. Excision fully removed the temple lesion and resolved pain. Peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE, a radiolabeled somatostatin analog that targets somatostatin receptors on NETs, was given along with maintenance lanreotide therapy, which resolved the scalp lesion, prevented recurrence of prior lesions and development of new cutaneous metastases, and controlled his visceral disease. PRRT has not been previously described in the management of cutaneous NET metastases. Due to the rare nature of cutaneous NET metastases, there is no consensus regarding optimal management. As such, we propose novel multimodal therapy involving excision and targeted radionuclide therapy as a possible effective option.
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Affiliation(s)
- Eleanor Tung-Hahn
- Lake Erie College of Osteopathic Medicine (LECOM), 5000 Lakewood Ranch Blvd, Bradenton, FL 34211, USA
| | - Ghassan El-Haddad
- Moffitt Cancer Center, Department of Diagnostic Imaging and Interventional Radiology, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Jonathan Strosberg
- Moffitt Cancer Center, Department of Medical Oncology and Hematology, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- University of South Florida College of Medicine, Department of Oncologic Sciences, 560 Channelside Dr, Tampa, FL 33602, USA
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2
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Kunovsky L, Dite P, Brezinova E, Sedlakova L, Trna J, Jabandziev P. Skin manifestations of pancreatic diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:353-358. [PMID: 35938387 DOI: 10.5507/bp.2022.035] [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: 03/30/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022] Open
Abstract
Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.
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Affiliation(s)
- Lumir Kunovsky
- Department of Surgery, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Czech Republic.,Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Dite
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Czech Republic.,Faculty of Medicine, University of Ostrava, Czech Republic
| | - Eva Brezinova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,1st Department of Dermatovenerology, St. Anne's University Hospital, Brno, Czech Republic
| | - Libuse Sedlakova
- Department of Dermatology, Military Hospital Brno, Czech Republic
| | - Jan Trna
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Jabandziev
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Pediatrics, University Hospital Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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3
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Hobbs MM, Snow JT, Shachner TR, Sokumbi O. Cutaneous Metastases of Non‐cutaneous Neuroendocrine Neoplasms: A Histopathologic Review of 15 Cases. J Cutan Pathol 2022; 49:960-970. [DOI: 10.1111/cup.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Justin T. Snow
- Department of Pathology and Laboratory Medicine Dartmouth Hitchcock Medical Center Lebanon NH
| | - Tracy R. Shachner
- Department of Pathology University of Tennessee Medical Center Knoxville TN
| | - Olayemi Sokumbi
- Department of Dermatology Mayo Clinic Jacksonville FL
- Department of Laboratory Medicine and Pathology Mayo Clinic Jacksonville FL
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4
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Molasy B, Zemła P, Kuśnierz K. Skin Metastases of Gastrointestinal Neuroendocrine Tumors - Literature Review. POLISH JOURNAL OF SURGERY 2022; 94:60-65. [PMID: 36169582 DOI: 10.5604/01.3001.0015.7958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
<b> Introduction:</b> Gastrointestinal neuroendocrine neoplasms arise from cells of the diffuse endocrine system (DES) located in the digestive tract. They are often diagnosed in an advanced stage, when distant metastases appear. Skin metastases of neuroendocrine tumors are extremely rare. </br></br> <b>Aim:</b> The aim of the study was to collect and analyze cases of skin metastases of gastrointestinal neuroendocrine neoplasms. </br></br> <b>Materials and methods:</b> A literature search across PubMed and Medline databases from 1969 up to 2021 was performed. We reviewed English literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following keywords were used: "neuroendocrine tumor", "neuroendocrine neoplasm", "neuroendocrine carcinoma", "NET", "NEN", "skin and cutaneous metastases", "lymph nodes". The characteristics of patients, grading, tumor localization and other data that was found in publications were assessed. Case reports and case series were included. </br></br> <b>Results:</b> The initial search strategy yielded 14 results in PubMed and 3 in the Medline database. We removed duplicates after we imported the citations with a citation manager. We found 17 publications concerning skin metastases of neuroendocrine neoplasms. The analysis of 18 cases concerned 13 NECs and 5 NETs. In most cases, the metastases are small, painless and located on the scalp or lower extremities. Skin metastases may be the first symptom of the disease. The pancreas is the most common primary tumor site.</br></br> <b>Conclusions:</b> NEN metastases to the skin are often diagnosed with disseminated neoplastic process, which is associated with poor prognosis and high mortality. NET metastases to the skin may occur with an unknown primary site. Skin metastases of neuroendocrine tumors should be considered during the diagnosis of skin tumors.
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Affiliation(s)
- Bartosz Molasy
- Students' Scientific Society of the Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland Department of General Surgery, St Alexander Hospital, Kielce, Poland
| | - Patryk Zemła
- Students' Scientific Society of the Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Kuśnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
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5
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Goto K, Kukita Y, Honma K, Ohike N, Komori T, Ishida Y, Ishikawa M, Nakatsuka T, Fumita S, Nakagawa K, Okabayashi A, Iwahashi Y, Tanino T, Kikuchi K, Kawahara Y, Hishima T, Uehara J, Oishi T, Isei T. Sweat-gland carcinoma with neuroendocrine differentiation (SCAND): a clinicopathologic study of 13 cases with genetic analysis. Mod Pathol 2022; 35:33-43. [PMID: 34518631 DOI: 10.1038/s41379-021-00921-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022]
Abstract
Low-grade neuroendocrine carcinoma of the skin (LGNECS) was proposed in 2017 as a new primary cutaneous neoplasm with neuroendocrine differentiation; however, it is not yet well known due to its rarity. Herein, we perform a detailed clinicopathologic analysis of 13 cases as well as panel DNA sequencing in three cases. The study included 12 males and 1 female with a median age of 71 (43-85) years. All lesions occurred on the ventral trunk. The mean tumor size was 2.2 (0.8-11.0) cm. The histopathology resembled that of well-differentiated neuroendocrine tumors (NETs) in other organs, but intraepidermal pagetoid spreading was seen in 8 (61.5%) cases and stromal mucin deposits in 4 (30.8%). Immunoreactivity for CK7, CK19, EMA, BerEP4, CEA, chromogranin A, synaptophysin, INSM1, GCDFP15, GATA3, ER, and bcl-2 were present in varying degrees in all tested cases. PTEN c.165-1G>A splice site mutation was detected by panel sequencing in one case, and GATA3 P409fs*99 and SETD2 R1708fs*4 in another case. Lymph node metastasis was seen significantly in cases with tumor size >2.0 cm [8/8 (100%) vs. 1/5 (20%)]. All three cases with size >3.0 cm were in unresectable advanced-stage [3/3 (100%) vs. 1/10 (10%)], and two of the three patients succumbed to the disease. The two cases of death revealed mild nuclear atypia (mitosis: 1/10 HPFs) and moderate nuclear atypia (2/10 HPFs). Thus, tumor size would be a better prognostic factor than nuclear atypia, mitotic count, and Ki67 index, unlike in NETs. These clinicopathologic and immunohistochemical features would represent the characteristics as skin adnexal tumors with apocrine/eccrine differentiation rather than NETs; therefore, we rename it as sweat-gland carcinoma with neuroendocrine differentiation (SCAND).
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Affiliation(s)
- Keisuke Goto
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan. .,Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan. .,Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan. .,Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan. .,Department of Diagnostic Pathology, Osaka National Hospital, Osaka, Japan. .,Department of Dermatology, Hyogo Cancer Center, Akashi, Japan.
| | - Yoji Kukita
- Laboratory of Genomic Pathology, Research Center, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Nobuyuki Ohike
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Takaya Komori
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihiro Ishida
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Misawo Ishikawa
- Department of Diagnostic Pathology, Kainan Hospital, Yatomi, Japan
| | - Takashi Nakatsuka
- Department of Plastic Surgery, JR Tokyo General Hospital, Tokyo, Japan
| | - Soichi Fumita
- Department of Medical Oncology, Kindai University, Osakasayama, Japan
| | - Koichi Nakagawa
- Department of Dermatology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan
| | - Aya Okabayashi
- Department of Dermatology, Izumi City General Hospital, Izumi, Japan
| | - Yoshifumi Iwahashi
- Department of Human Pathology and Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Tomoyuki Tanino
- Department of Diagnostic Pathology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Keisuke Kikuchi
- Department of Diagnostic Pathology, Obihiro Kosei Hospital, Obihiro, Japan
| | | | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Jiro Uehara
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Takuma Oishi
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Taiki Isei
- Department of Dermatologic Oncology, Osaka International Cancer Institute, Osaka, Japan
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6
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Shakerdi LA, Al Ghafri A, Swan N, O' Shea D, McGuigan C, Hutchinson M, FitzGerald O. Update: Atypical presentation of a midgut neuroendocrine tumor originally diagnosed as eosinophilic fasciitis. Neurology 2020; 95:695-697. [PMID: 32913012 DOI: 10.1212/wnl.0000000000010715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Loai A Shakerdi
- From the Department of Rheumatology (L.A.S., A.A.G., O.F.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Pathology (N.S.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Endocrinology (D.O.S.); and Department of Neurology (C.M., M.H.), St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Aadil Al Ghafri
- From the Department of Rheumatology (L.A.S., A.A.G., O.F.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Pathology (N.S.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Endocrinology (D.O.S.); and Department of Neurology (C.M., M.H.), St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Niall Swan
- From the Department of Rheumatology (L.A.S., A.A.G., O.F.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Pathology (N.S.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Endocrinology (D.O.S.); and Department of Neurology (C.M., M.H.), St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Donal O' Shea
- From the Department of Rheumatology (L.A.S., A.A.G., O.F.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Pathology (N.S.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Endocrinology (D.O.S.); and Department of Neurology (C.M., M.H.), St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Christopher McGuigan
- From the Department of Rheumatology (L.A.S., A.A.G., O.F.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Pathology (N.S.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Endocrinology (D.O.S.); and Department of Neurology (C.M., M.H.), St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Michael Hutchinson
- From the Department of Rheumatology (L.A.S., A.A.G., O.F.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Pathology (N.S.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Endocrinology (D.O.S.); and Department of Neurology (C.M., M.H.), St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Oliver FitzGerald
- From the Department of Rheumatology (L.A.S., A.A.G., O.F.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Pathology (N.S.), St Vincent's University Hospital, Elm Park, Dublin, Ireland; Department of Endocrinology (D.O.S.); and Department of Neurology (C.M., M.H.), St Vincent's University Hospital, Elm Park, Dublin, Ireland.
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7
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Adnan A, Basu S. Rare-Site Primary Soft-Tissue Neuroendocrine Tumor with Metastases and Near-Complete Resolution with 177Lu-DOTATATE: Documenting a Promising Clinical Application of Peptide Receptor Radionuclide Therapy. J Nucl Med Technol 2019; 48:36-39. [PMID: 31401619 DOI: 10.2967/jnmt.119.227058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
Neuroendocrine tumors (NETs) of the skin or soft tissue are rare (mostly described as sites of metastasis), whereas primary soft-tissue NETs are extremely rare; they are usually diagnosed at advanced stages with distant metastases because of their indolent nature. We herein describe our experience with 2 such cases. In the first case, the NET originated in the retroperitoneal soft tissue, and in the second case, the patient was a middle-aged lady with NET arising from soft tissue in the pelvis. Both patients were treated with 177Lu-DOTATATE in view of their somatostatin receptor-expressing metastatic lesions, demonstrating an excellent outcome as reflected by a complete metabolic response and near-complete anatomic response to the administered peptide receptor radionuclide therapy. The noteworthy factors of the reported cases were, first, unusual sites of primary tumor and, second, near-complete to complete symptomatic, anatomic, and metabolic resolution of the recurrent primary tumor and metastatic lesions with peptide receptor radionuclide therapy alone. NETs arising from rare anatomic locations are usually nonfunctioning, with good clinical outcomes, and 177Lu-DOTATATE peptide receptor radionuclide therapy can be considered promising in patients with metastatic or advanced disease.
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Affiliation(s)
- Aadil Adnan
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, and Homi Bhabha National Institute, Mumbai, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, and Homi Bhabha National Institute, Mumbai, India
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8
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Incidental Finding of Benign Trichilemmal Cysts on 99mTc-Octreotide Scan. Clin Nucl Med 2019; 44:834-835. [PMID: 31306209 DOI: 10.1097/rlu.0000000000002737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 63-year-old woman with neuroendocrine carcinoma of the colon was referred to our department for staging with Tc-octreotide scan. Two focal, highly intense, superficial lesions were detected in patient's scalp and paralumbar region, medial to the right kidney. Pathology correlation was recommended, revealing them both to be benign trichilemmal cysts. This unexpected finding strengthens the hypothesis of Merkel cell carcinoma and trichilemmal cysts originating from pluripotent stem cells of adnexal epithelium, making a neuroendocrine differentiation for the latter plausible.
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9
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Bosco D, Perrotti S, Spatola C, Vecchio GM, Latino R, Di Cataldo A. Rare breast and subcutaneous metastases from pancreatic neuroendocrine tumor: a case report. World J Surg Oncol 2019; 17:121. [PMID: 31296241 PMCID: PMC6624935 DOI: 10.1186/s12957-019-1662-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Neuroendocrine tumors are a group of rare neoplasms, and the pancreatic neuroendocrine tumors (PNETs) represent only 1–2% of all pancreatic malignant tumors. The most common sites of these tumors include the gastrointestinal tract, lung, adrenal gland, and thyroid gland. Moreover, the most common sites of PNET metastases are the lymph nodes, liver, spleen, and bone. Case summary A 40-year-old woman with pT3N1 PNET underwent surgical excision of the lesion (12 cm, at the level of the pancreatic body and tail). Postsurgical treatment included chemotherapy and radiation, both of which the patient showed a good tolerance for. After a 12-month disease-free interval, however, the patient reported the development of a lesion in her left breast and a small lesion in the left posterior region of her neck. The lesions were surgically excised, and the histological findings characterized both as pancreatic neuroendocrine metastatic poorly differentiated neoplasms (G3). A re-staging CT scan showed multiple metastases in the left axillary, clavicular, and latero-cervical lymph nodes, as well as diffuse osteolytic-osteoblastic bone metastases, almost mimicking the behavior of a primitive breast tumor. Conclusion This case of breast and subcutaneous metastases from PNET should prompt awareness of potential metastatic lesions in unusual locations.
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Affiliation(s)
- Dorotea Bosco
- Department of General and Oncological Surgery, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Salvatore Perrotti
- Department of General and Oncological Surgery, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Corrado Spatola
- Department of Oncology and Radiotherapy, University of Catania, Catania, Italy
| | | | - Rosalia Latino
- Department of General and Oncological Surgery, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Di Cataldo
- Department of General and Oncological Surgery, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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10
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Davila PJ, Ortiz-Rosario JC, Matinez M, Toro AC, Echegaray JJ, Correa-Rivas M, Oliver AL. Primary hepatic carcinoid tumor metastasizing to eyelid: A case report. Am J Ophthalmol Case Rep 2019; 15:100511. [PMID: 31341995 PMCID: PMC6630012 DOI: 10.1016/j.ajoc.2019.100511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/03/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose We report a rare case of a metastatic carcinoid tumor to the right lower lid masquerading as a chalazion. Observations A 78-year-old Hispanic woman who presented with a 3-month history of a non-resolving chalazion on the right lower lid despite aggressive medical treatment. The patient had a history of noninfectious anterior uveitis and primary hepatic carcinoid tumor that was incidentally diagnosed during the initial uveitis work-up. The right lower eyelid lesion was biopsied and histological and immunopathological analysis revealed a well differentiated neuroendocrine tumor consistent with a carcinoid tumor. Conclusionand Importance Neuroendocrine tumors should be considered as part of the differential diagnosis of focal, vascularized eyelid masses. To the authors best knowledge this is the first reported case of primary hepatic carcinoid tumor with metastasis to the eyelids. We also highlight the importance of pursuing a histopathologic diagnosis, in the setting of a non-resolving or recurrent chalazion.
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Affiliation(s)
- Pedro J Davila
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR, 00921, USA
| | - Jan C Ortiz-Rosario
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR, 00921, USA
| | - Meliza Matinez
- Department of Endocrinology, University of Puerto Rico School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, 00921, USA
| | - Ana C Toro
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR, 00921, USA
| | - Jose J Echegaray
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR, 00921, USA
| | - Maria Correa-Rivas
- Department of Pathology, University of Puerto Rico School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, 00921, USA
| | - Armando L Oliver
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR, 00921, USA
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11
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Rindi G, Klimstra DS, Abedi-Ardekani B, Asa SL, Bosman FT, Brambilla E, Busam KJ, de Krijger RR, Dietel M, El-Naggar AK, Fernandez-Cuesta L, Klöppel G, McCluggage WG, Moch H, Ohgaki H, Rakha EA, Reed NS, Rous BA, Sasano H, Scarpa A, Scoazec JY, Travis WD, Tallini G, Trouillas J, van Krieken JH, Cree IA. A common classification framework for neuroendocrine neoplasms: an International Agency for Research on Cancer (IARC) and World Health Organization (WHO) expert consensus proposal. Mod Pathol 2018; 31:1770-1786. [PMID: 30140036 PMCID: PMC6265262 DOI: 10.1038/s41379-018-0110-y] [Citation(s) in RCA: 622] [Impact Index Per Article: 103.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 02/08/2023]
Abstract
The classification of neuroendocrine neoplasms (NENs) differs between organ systems and currently causes considerable confusion. A uniform classification framework for NENs at any anatomical location may reduce inconsistencies and contradictions among the various systems currently in use. The classification suggested here is intended to allow pathologists and clinicians to manage their patients with NENs consistently, while acknowledging organ-specific differences in classification criteria, tumor biology, and prognostic factors. The classification suggested is based on a consensus conference held at the International Agency for Research on Cancer (IARC) in November 2017 and subsequent discussion with additional experts. The key feature of the new classification is a distinction between differentiated neuroendocrine tumors (NETs), also designated carcinoid tumors in some systems, and poorly differentiated NECs, as they both share common expression of neuroendocrine markers. This dichotomous morphological subdivision into NETs and NECs is supported by genetic evidence at specific anatomic sites as well as clinical, epidemiologic, histologic, and prognostic differences. In many organ systems, NETs are graded as G1, G2, or G3 based on mitotic count and/or Ki-67 labeling index, and/or the presence of necrosis; NECs are considered high grade by definition. We believe this conceptual approach can form the basis for the next generation of NEN classifications and will allow more consistent taxonomy to understand how neoplasms from different organ systems inter-relate clinically and genetically.
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Affiliation(s)
- Guido Rindi
- Istituto di Anatomia Patologica, Università Cattolica-Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Behnoush Abedi-Ardekani
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Sylvia L Asa
- University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Elisabeth Brambilla
- CHUGA, UniversitéUGA, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald R de Krijger
- Department of Pathology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | | | - Günter Klöppel
- Department of Pathology, Technical University of München, München, Germany
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Holger Moch
- University Hospital Zurich, Zurich, Switzerland
| | - Hiroko Ohgaki
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | | | | | - Brian A Rous
- National Cancer Registration and Analysis Service, Fulbourn, UK
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Aldo Scarpa
- Section of Pathology, ARC-Net Research Center and Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Jean-Yves Scoazec
- Departement of Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giovanni Tallini
- University Medical Center, University of Bologna, Bologna, Italy
| | | | - J Han van Krieken
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Ian A Cree
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France.
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12
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Cojocari N, David L. Soft Tissue Primary Neuroendocrine Tumor: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:778-782. [PMID: 29967317 PMCID: PMC6061446 DOI: 10.12659/ajcr.909240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neuroendocrine tumors found in skin or soft tissues usually represent metastasis from other organs and are considered late manifestations of disease. Therefore, primary cutaneous and soft tissue neuroendocrine tumors are extremely rare. CASE REPORT We report a case of a 48-year-old male with a neuroendocrine tumor occurring in the subcutaneous abdominal fat, which had an echographic appearance of a vascular malformation. The finding was diagnosed as compatible with neuroendocrine tumor based on histopathological and immunohistochemical studies. No other sites of possible internal origin were detected on supplementary investigations. CONCLUSIONS Soft tissue neuroendocrine tumors may have an appearance on imaging studies that challenge physicians to make a correct diagnosis. Despite the rarity of these tumors, they should be included in the differential diagnosis of other soft tissue masses.
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Affiliation(s)
- Nadejda Cojocari
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Leonard David
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
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13
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Panse G, Cowper SE, Leffell DJ, Pulitzer M, Ko CJ. Well-differentiated neuroendocrine tumors in skin: Terminology and diagnostic utility of cytokeratin 5/6 and p63. J Cutan Pathol 2018; 44:557-562. [PMID: 28417484 DOI: 10.1111/cup.12952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Well-differentiated neuroendocrine tumors (WDNETs) in skin include metastases from visceral primary sites and very uncommonly, primary cutaneous carcinoid tumors. Cutaneous WDNET may present a diagnostic challenge and in particular can be mistaken for a benign skin adnexal tumor. In contrast to cutaneous adnexal tumors, metastatic adenocarcinomas to the skin are cytokeratin 5/6 (CK5/6) and p63 negative in the majority of cases. It is unclear if failure to stain with CK5/6 and p63 would be helpful in differentiating WDNETs from cutaneous adnexal neoplasms. METHODS We reviewed 10 cases of cutaneous WDNETs (8 cases of metastatic disease and 2 presumed primary carcinoid tumors of the skin) and performed immunohistochemical stains for CK5/6 and p63 on all cases. RESULTS All 10 cases were negative with both CK5/6 and p63. CONCLUSION Negative staining for CK5/6 and p63 can be helpful to distinguish WDNETs from cutaneous adnexal neoplasms. It is important to consider WDNETs in the differential diagnosis of cutaneous adnexal neoplasms as low-grade tumors may be the first sign of aggressive metastatic disease.
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Affiliation(s)
- Gauri Panse
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut
| | - Shawn E Cowper
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - David J Leffell
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christine J Ko
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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15
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Low-Grade Neuroendocrine Carcinoma of the Skin (Primary Cutaneous Carcinoid Tumor) as a Distinctive Entity of Cutaneous Neuroendocrine Tumors: A Clinicopathologic Study of 3 Cases With Literature Review. Am J Dermatopathol 2017; 39:250-258. [PMID: 28169866 DOI: 10.1097/dad.0000000000000657] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is scarcity of information on primary cutaneous low-grade neoplasms commonly known as carcinoid tumors, owing to their rarity. The authors present 3 cases that were named "low-grade neuroendocrine carcinoma of the skin" (LGNECS). These occurred in the dermis and subcutis of the anterior chest or the inguinal region in the elderly. Histologically, the tumors showed infiltrating proliferation of nests of various sizes, with low-grade neuroendocrine cytologic features but without mucin production. All cases exhibited varying degrees of intraductal tumor components. On immunohistochemical examination, these tumors expressed estrogen receptor alpha, progesterone receptor, androgen receptor, gross cystic disease fluid protein 15, mammaglobin, and GATA3 as well as neuroendocrine markers. Although a literature review revealed 8 additional possible cases with no evidence of other diseases, it was difficult to determine if these were true cases of LGNECS, because of the limited information available. Based on its characteristic histologic features and immunoprofile, it can be proposed designating LGNECS as a distinct entity among cutaneous neuroendocrine tumors. Otherwise, such tumors could be misdiagnosed as mammary carcinomas (particularly when involving the skin of the breast) or as metastatic visceral neuroendocrine tumors of the skin.
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Amorim GM, Quintella D, Cuzzi T, Rodrigues R, Ramos-E-Silva M. Cutaneous Metastasis of Neuroendocrine Carcinoma with Unknown Primary Site: Case Report and Review of the Literature. Case Rep Dermatol 2015; 7:263-74. [PMID: 26557073 PMCID: PMC4637521 DOI: 10.1159/000440661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a new case of neuroendocrine carcinoma for which it was not possible to find the primary site until now. The recent medical literature about skin metastasis of neuroendocrine carcinoma (neuroendocrine tumor) is discussed.
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Affiliation(s)
- Gustavo Moreira Amorim
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danielle Quintella
- Sector of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Sector of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosangela Rodrigues
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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17
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Shin WY, Lee KY, Ahn SI, Park SY, Park KM. Cutaneous metastasis as an initial presentation of a non-functioning pancreatic neuroendocrine tumor. World J Gastroenterol 2015; 21:9822-9826. [PMID: 26361431 PMCID: PMC4562968 DOI: 10.3748/wjg.v21.i33.9822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/26/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023] Open
Abstract
Non-functioning pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors that account for 2% of all pancreatic malignancy. About 60% of NF-PNETs present distant metastases and usually hepatic metastases. However, cutaneous metastases are very rare. Herein, we report our experience with a 60-year-old male who visited our outpatient clinic with a mass on his left hip. An abdominal computerized tomography scan demonstrated not only a left hip mass and an enlarged left inguinal lymph node, but also a huge heterogeneous enhancing mass on the pancreas. Initially, we removed the metastatic lesions, which was a small cell neuroendocrine carcinoma with 50% of the Ki-67 index in the histopathological report. After 3 wk, we performed a total pancreatectomy and a total gastrectomy. Four weeks after the 1st operation, we detected a recurrence at the operative bed on his left hip, and subsequently removed the recurring mass. The patient was receiving chemotherapy based on etoposide and cisplatin treatment.
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18
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Darre T, Saka B, Landoh DE, Mouhari-Toure A, Amegbor K, Pitché P, Napo-Koura G. [Skin metastases seen at the pathology laboratory in Lome, Togo, between 2005 and 2014]. Pan Afr Med J 2015; 22:388. [PMID: 27047627 PMCID: PMC4796782 DOI: 10.11604/pamj.2015.22.388.7223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 12/06/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction L'objectif de cette étude était de documenter le profil épidémiologique et histologique des métastases cutanées vues au laboratoire d'anatomie pathologique (LAP) de Lomé. Méthodes Il s'agissait d'une étude descriptive et transversale portant sur des cas de métastases cutanées observées au LAP du CHU Sylvanus Olympio entre 2005 et 2014. Résultats Au cours de cette période d’étude, nous avons recensé 32 cas de métastases cutanées représentant 3,2% (1005 cas) de l'ensemble des cas de métastases enregistrées au LAP. L’âge moyen des patients atteints de ces métastases cutanées était de 42,6 ans et le sex-ratio (F/H) de 2,2. Sur le plan macroscopique, ces métastases étaient nodulaires dans 15 cas, bourgeonnantes dans 12 cas, ulcéré dans 3 cas et ulcéro-bourgeonnant dans 2 cas. Les types histologiques étaient représentés par les adénocarcinomes (19 cas, 59,4%), les carcinomes épidermoïdes (8 cas, 25%), la maladie de Paget (3 cas, 9,4%), le carcinome à petites cellules du type neuroendocrine (un cas, 3,1%) et le mélanome (un cas, 3,1%). Selon le degré de différenciation, les métastases cutanées étaient bien différenciées dans 14 cas (56%). Les principales localisations de ces métastases cutanées étaient le thorax (11 cas, 34,4%) suivi de l'abdomen (10 cas, 31,3%). Les cancers primitifs étaient surtout d'origine mammaire (14 cas, 43,7%). Conclusion Cette étude montre que les métastases cutanées sont relativement rares et les tumeurs malignes d'origine mammaire sont les tumeurs primitives prédominantes. Avec un pourcentage élevé des formes peu différenciées et celles indifférenciées, l'amélioration du plateau technique du LAP (immunohistochimie) permettra d'accroitre ses capacités diagnostiques.
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Affiliation(s)
- Tchin Darre
- Laboratoire d'Anatomie et Cytologie Pathologiques, CHU Sylvanus Olympio, Lomé, Togo
| | - Bayaki Saka
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Lomé, Togo
| | | | | | - Koffi Amegbor
- Laboratoire d'Anatomie et Cytologie Pathologiques, CHU Sylvanus Olympio, Lomé, Togo
| | - Palokinam Pitché
- Service de Dermatologie et IST, CHU Sylvanus Olympio, Lomé, Togo
| | - Gado Napo-Koura
- Laboratoire d'Anatomie et Cytologie Pathologiques, CHU Sylvanus Olympio, Lomé, Togo
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Hong S, Li L, Liu X, Tu C. Neuroendocrine carcinoma of the larynx with subcutaneous and intramuscular metastases: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:8217-8222. [PMID: 25550875 PMCID: PMC4270572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
Neuroendocrine carcinomas have become increasingly recognized as more reports are emerging to describe these rare tumors. Primary sites include the lung, liver, throat, and other organs. Laryngeal neuroendocrine carcinomas are relatively rare, and the subtypes as well as the prognoses are quite different in most cases. Metastases to the liver, lungs and other parts are common. However, metastases to subcutaneous tissues or muscles have been rarely reported. We report a case of a neuroendocrine carcinoma of the larynx with subcutaneous and muscle metastases.
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Affiliation(s)
- Song Hong
- Department of Orthopaedic Surgery, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
- Department of Orthopaedic Surgery, The Affiliated Hospital, Zunyi Medical College149 Dalian Road, Zunyi 563003, Guizhou, China
| | - Lin Li
- Department of Pathology, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
| | - Xiwei Liu
- Department of Orthopaedic Surgery, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
| | - Chongqi Tu
- Department of Orthopaedic Surgery, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
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