1
|
Chen ZY, Chen XL, Yu Q, Fan QB. Giant retroperitoneal lipoma presenting with abdominal distention: A case report and review of the literature. World J Clin Cases 2022; 10:1675-1683. [PMID: 35211608 PMCID: PMC8855279 DOI: 10.12998/wjcc.v10.i5.1675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/08/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retroperitoneal lipomas are extremely rare tumors and tend to be large in size (> 10 cm) when diagnosed, causing various clinical manifestations. Preoperative diagnosis of retroperitoneal lipomas is difficult. There is a lack of relevant information about the management and prognosis of these benign tumors due to limited reports.
CASE SUMMARY A 53-year-old woman who complained about progressive abdominal distention and aggravating satiety was referred to the gynecological outpatient department of Peking Union Medical College Hospital. Computerized tomography (CT) revealed an immense mass with fat density, measuring 28.6 cm× 16.6 cm in size. Adjacent organs, including the intestinal tract and uterus, were squeezed to the right side of the abdomen. An exploratory laparotomy was performed with suspicion of liposarcoma. Intraoperatively, a giant yellowish lobulated mass was found occupying the retroperitoneum and it was removed by tumor debulking. Postoperative histopathological results confirmed the diagnosis of retroperitoneal lipoma.
CONCLUSION Retroperitoneal lipoma is a very rare condition and is difficult to differentiate from well-differentiated liposarcoma. Radiographic investigations, especially CT and magnetic resonance imaging, are important for preoperative diagnosis. Surgical resection is the fundamental treatment, which is difficult due to its size and relation to neighboring structures.
Collapse
Affiliation(s)
- Zhi-Yan Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xian-Long Chen
- Department of Pathology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Qi Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Qing-Bo Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
| |
Collapse
|
2
|
Mejía Granados DM, de Baptista MB, Bonadia LC, Bertuzzo CS, Steiner CE. Clinical and Molecular Investigation of Familial Multiple Lipomatosis: Variants in the HMGA2 Gene. Clin Cosmet Investig Dermatol 2020; 13:1-10. [PMID: 32021365 PMCID: PMC6956394 DOI: 10.2147/ccid.s213139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022]
Abstract
Background Familial multiple lipomatosis (FML) is an autosomal dominant disorder characterized by the slow growth of encapsulated nodules spread across the trunk and limbs. Currently, there is no specific etiology; therefore, its molecular and biological bases need to be better understood. High-throughput sequencing technologies appear to be a cost-effective tool and have a pivotal role in elucidating different genodermatoses. Objective This study aimed to perform a clinical and molecular characterization of constitutional DNA of seven individuals belonging to five unrelated families diagnosed with FML. Patients and methods Clinical aspects were obtained from medical records and physical examination. HMGA2 gene was investigated using Sanger sequencing method. Mutational analysis of other genes associated with syndromic lipomatosis AKT1, APC, PIK3CA, MEN-1, and PTEN was performed through next-generation sequencing. Results In this series, FML was predominant among women who were overweight and reaching the age of thirty and was associated with gastrointestinal comorbidity. Histopathological diagnosis of biopsies revealed typical features of both lipoma and angiolipoma. We identified two identical novel variants with unknown significance in exon 5 of the HMGA2 gene in two participants of different families. There were no additional changes in exons 1 to 4 of the HMGA2 gene. Multi-gene panel was normal in all cases. Conclusion Variants found in exon 5 of the HMGA2 gene have not been described and have an uncertain significance in the genesis of FML. Further studies, including a more significant number of affected individuals and functional analysis of the novel variants of HGMA2 gene, should be undertaken to better understand its biological role in FML.
Collapse
Affiliation(s)
- Diana Marcela Mejía Granados
- Department of Medical Genetics and Genomic Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Marcella Bergamini de Baptista
- Department of Medical Genetics and Genomic Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Luciana Cardoso Bonadia
- Department of Medical Genetics and Genomic Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Carmen Silvia Bertuzzo
- Department of Medical Genetics and Genomic Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Carlos Eduardo Steiner
- Department of Medical Genetics and Genomic Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| |
Collapse
|
3
|
Abstract
Lipoma is a common subcutaneous tumour composed of fat tissue. It may occur as a sporadic solitary lesion or as multiple lesions. They often grow very slowly. They vary between 2 and 10 cm in size. There are rarely any subjective symptoms. Lipomas do not usually require treatment unless they are big enough to be symptomatic. We reported a 75-year-old man with a rapidly enlarging and ulcerated mass on his right upper thigh.
Collapse
Affiliation(s)
- Timea Kosztyuova
- Department of Dermatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Tang Ngee Shim
- Department of Dermatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
4
|
Dawoud NM, Bakry OA, Seleit I. Homozygous Familial Hypercholesterolemia Associated with Symmetric Subcutaneous Lipomatosis. Indian J Dermatol 2015; 60:420. [PMID: 26288434 PMCID: PMC4533564 DOI: 10.4103/0019-5154.160519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Homozygous familial hypercholesterolemia is an autosomal dominant disorder of lipid metabolism, characterized by reduced clearance of low-density lipoprotein-cholesterol and a high risk of rapid development of cardiovascular diseases. Its incidence is relatively rare and estimated to be one in one million in general populations. Here, we report homozygous familial hypercholesterolemia in two Egyptian young siblings, presented with cutaneous, tendinous xanthomas, and corneal arcus. One of them has symmetric subcutaneous lipomatosis, which has not been reported before in association with familial hypercholesterolemia.
Collapse
Affiliation(s)
| | - Ola Ahmed Bakry
- Department of Dermatology, Andrology and STDs, Menoufiya University, Egypt
| | - Iman Seleit
- Department of Dermatology, Andrology and STDs, Menoufiya University, Egypt
| |
Collapse
|
5
|
Arabadzhieva E, Yonkov A, Bonev S, Bulanov D, Taneva I, Ivanova V, Dimitrova V. A rare combination between familial multiple lipomatosis and extragastrointestinal stromal tumor. Int J Surg Case Rep 2015; 14:117-20. [PMID: 26263450 PMCID: PMC4573610 DOI: 10.1016/j.ijscr.2015.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/20/2015] [Accepted: 07/25/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rarely, GISTs can be located in mesentery, retroperitoneal space, omentum or pancreas. In these cases, the neoplasm is defined as "extra-gastrointestinal stromal tumors" (EGISTs). PRESENTATION OF CASE We reported a case of a 63-year-old male patient diagnosed by computer tomography with large intraabdominal tumor with vague origin, postoperatively determined as an EGIST. The diagnosis was confirmed by immunohistochemical study. The patient had multiple, subcutaneous, painless lipomas localized in the arms, forearms, thighs, abdomen and thorax. Because of the family history and the clinical presentation the disease was determined as familial multiple lipomatosis (FML). We performed radical tumor resection with distal pancreatectomy and splenectomy, and abdominoplasty, removing redundant skin and underlying subcutaneous fat tissue with multiple lipomas. DISCUSSION FML is a rare hereditary benign disease. On the other hand, only few cases with familial GIST have been reported. In cases with extensive abdominal involvement, the primary origin of EGIST may be impossible to determine so the differential diagnosis is very difficult. CONCLUSION Although we could not prove correlation between the observed diseases, they are extremely rare and their combination is unusual which makes the presented case valuable and interesting.
Collapse
Affiliation(s)
- Elena Arabadzhieva
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska"-Sofia, Medical University-Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria.
| | - Atanas Yonkov
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska"-Sofia, Medical University-Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Sasho Bonev
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska"-Sofia, Medical University-Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Dimitar Bulanov
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska"-Sofia, Medical University-Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Ivanka Taneva
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska"-Sofia, Medical University-Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Vesela Ivanova
- Department of General and Clinical Pathology, Medical University-Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
| | - Violeta Dimitrova
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska"-Sofia, Medical University-Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| |
Collapse
|
6
|
Giant lipoma of the back affecting quality of life. Ann Med Surg (Lond) 2015; 4:279-82. [PMID: 26468370 PMCID: PMC4556780 DOI: 10.1016/j.amsu.2015.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/02/2022] Open
Abstract
Lipomas are benign tumours composed of adipose tissue. They may be localized in almost all body parts and may be in a giant form. Some of these giant lipomas may transform malignity and cause problems in daily living and detoriate quality of life. Mass localization also restrict body functions. In the present study, a 72-year-old man who presented with a mass enlarged in a time period of two years and because of this could not lie in the supine position, sit in an erect position and dress easily, go outside because of his physical appearance. With surgical treatment a 38 × 22 × 21 cm mass weighing 3575 g was successfully resected. Postoperative early phase complications did not occur. During 48 months of postoperative period, any recurrence was not detected and the patient was free of all his complaints. Cosmetic and functional results of the surgery and patient satisfaction were excellent. After surgery patient's quality of life was improved and restriction of body function was disappeared. The most common mesenchymal neoplasms in humans are lipomas. Lipomas are typically slow-growing tumours; only a few grow to an exceptionally large size. The effects of giant lipomas on daily living and quality of life should be evaluated as an indication for surgery.
Collapse
|
7
|
Weniger M, D'Haese JG, Kunz W, Pratschke S, Guba M, Werner J, Angele MK. En-bloc resection of a giant retroperitoneal lipoma: a case report and review of the literature. BMC Res Notes 2015; 8:75. [PMID: 25890295 PMCID: PMC4365774 DOI: 10.1186/s13104-015-1038-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/27/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Retroperitoneal lipomas are an extremely rare condition with only 17 cases described in the literature since 1980. They can reach enormous size and cause significant abdominal symptoms. The most important differential diagnosis is the well-differentiated liposarcoma, which preoperatively often may not definitely be ruled out. CASE PRESENTATION We present the case of a 73 year-old Caucasian patient with a giant retroperitoneal lipoma of 9 kg measuring 55 cm in diameter. The patient presented with abdominal pain and swelling that had been slowly progressive for the last 15 years. On computerized tomography an immense retroperitoneal tumor was revealed. Intraoperatively, the tumor did not show any signs of infiltrative growth, therefore sole tumor extirpation was performed. CONCLUSION Retroperitoneal lipomas are not clearly distinguishable from well-differentiated liposarcomas on imaging and even biopsies may be misleading. Moreover, abdominal symptoms, i.e. pain, obstipation and dysphagia may occur due to mechanical displacement. Therefore, surgical exploration with complete oncological resection is the therapy of choice if malignity cannot be ruled out.
Collapse
Affiliation(s)
- Maximilian Weniger
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, D-81377, Munich, Germany.
| | - Jan G D'Haese
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, D-81377, Munich, Germany.
| | - Wolfgang Kunz
- Institute for Clinical Radiology, Campus Grosshadern, Ludwig Maximilians-University, Munich, Germany.
| | - Sebastian Pratschke
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, D-81377, Munich, Germany.
| | - Markus Guba
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, D-81377, Munich, Germany.
| | - Jens Werner
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, D-81377, Munich, Germany.
| | - Martin K Angele
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig Maximilians-University, Marchioninistraße 15, D-81377, Munich, Germany.
| |
Collapse
|
8
|
Rosmaninho A, Pinto-Almeida T, Fernandes IC, Machado S, Selores M. Do you know this syndrome? An Bras Dermatol 2012; 87:324-5. [DOI: 10.1590/s0365-05962012000200027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/22/2011] [Indexed: 11/22/2022] Open
Abstract
Lipomas are among the most common tumors seen in the soft body parts and usually are solitary lesions. The authors report a case of a male patient that presented for evaluation of multiple subcutaneous nodules that caused important functional and cosmetic impairment. The diagnosis of familial multiple lipomatosis was made. Physicians should be able to recognize and characterize this rare disease.
Collapse
|
9
|
Krilis M, Miyakis S. Cytophagic histiocytic panniculitis with haemophagocytosis in a patient with familial multiple lipomatosis and review of the literature. Mod Rheumatol 2012. [DOI: 10.3109/s10165-011-0487-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
10
|
Krilis M, Miyakis S. Cytophagic histiocytic panniculitis with haemophagocytosis in a patient with familial multiple lipomatosis and review of the literature. Mod Rheumatol 2011; 22:158-62. [PMID: 21732050 DOI: 10.1007/s10165-011-0487-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/02/2011] [Indexed: 11/25/2022]
Abstract
We report a patient with the extremely rare familial multiple lipomatosis syndrome, who developed the uncommon autoimmune disease cytophagic histiocytic panniculitis, manifested as inflammation of preexisting lipomas. Despite his initial critical condition and unsuccessful treatment with steroids, he responded to cyclosporin and remains well 15 years after diagnosis. In contrast with most previous reports, our patient stays dependent on cyclosporin; repeated attempts of discontinuing or substituting treatment were quickly followed by relapse. Haemophagocytic panniculitis is considered as a T-cell disorder, but its exact pathophysiological mechanism has not been clarified. Differential diagnosis of cytophagic histiocytic panniculitis mainly includes malignant histiocytosis, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and lupus erythematosus panniculitis (lupus profundus). We discuss the main clinical features, diagnostic challenges and treatment issues of this usually benign, but at times life-threatening autoimmune condition.
Collapse
MESH Headings
- Cyclosporine/therapeutic use
- Diagnosis, Differential
- Family Health
- Female
- Genetic Predisposition to Disease
- Histiocytic Sarcoma/diagnosis
- Histiocytosis, Non-Langerhans-Cell/complications
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/drug therapy
- Humans
- Lipomatosis, Multiple Symmetrical/diagnosis
- Lipomatosis, Multiple Symmetrical/drug therapy
- Lipomatosis, Multiple Symmetrical/genetics
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphoma, T-Cell/diagnosis
- Male
- Panniculitis/complications
- Panniculitis/diagnosis
- Panniculitis/drug therapy
- Pedigree
- Treatment Outcome
Collapse
Affiliation(s)
- Matthew Krilis
- Department of Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
| | | |
Collapse
|
11
|
Musaad S, Robertson K, Clarke MW, Hooper AJ, French G, Chiu W, Burnett JR. Extreme hyperalphalipoproteinaemia in a patient with a solitary paraspinal lipoma. Ann Clin Biochem 2009; 47:90-3. [PMID: 19940205 DOI: 10.1258/acb.2009.009168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increased high-density lipoprotein (HDL)-cholesterol (hyperalphalipoproteinaemia; HALP) is commonly genetic, but may have secondary causes. An association between multiple lipomatosis and HALP has been reported; however, the mechanism for this is unclear. We report the case of a 69-year-old Cook Island woman with extreme HALP who presented with a large paraspinal lipoma. Magnetic resonance imaging showed no other lipomas. She had the metabolic syndrome, a family history suggestive of lipomas and was on lipid-lowering and antihypertensive therapy. Her plasma HDL-cholesterol concentration was 4.9 mmol/L (>95th percentile for age and sex) and was not explained by typical secondary causes. HDL(2) and HDL(3) subfractions were increased, with HDL(2) predominance. The excised lipoma histology demonstrated benign tissue and normal karyotype. Postoperative lipid profiles showed no change in HDL-cholesterol concentrations. In summary, we report a case of extreme HALP that persisted after excision of a solitary paraspinal lipoma.
Collapse
Affiliation(s)
- Samarina Musaad
- Department of Chemical Pathology, Middlemore Hospital, Auckland, New Zealand.
| | | | | | | | | | | | | |
Collapse
|
12
|
Self TH, Akins D. Dramatic reduction in lipoma associated with statin therapy. J Am Acad Dermatol 2008; 58:S30-1. [DOI: 10.1016/j.jaad.2007.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 08/07/2007] [Accepted: 08/28/2007] [Indexed: 12/29/2022]
|
13
|
Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ. From the archives of the AFIP: benign musculoskeletal lipomatous lesions. Radiographics 2005; 24:1433-66. [PMID: 15371618 DOI: 10.1148/rg.245045120] [Citation(s) in RCA: 357] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Benign lipomatous lesions involving soft tissue are common musculoskeletal masses that are classified into nine distinct diagnoses: lipoma, lipomatosis, lipomatosis of nerve, lipoblastoma or lipoblastomatosis, angiolipoma, myolipoma of soft tissue, chondroid lipoma, spindle cell lipoma and pleomorphic lipoma, and hibernoma. Soft-tissue lipoma accounts for almost 50% of all soft-tissue tumors. Radiologic evaluation is diagnostic in up to 71% of cases. These lesions are identical to subcutaneous fat on computed tomographic (CT) and magnetic resonance (MR) images and may contain thin septa. Lipomatosis represents a diffuse overgrowth of mature fat affecting either subcutaneous tissue, muscle or nerve, and imaging is needed to evaluate lesion extent. Lipoblastoma is a tumor of immature fat occurring in young children, and imaging features may reveal a mixture of fat and nonadipose tissue. Angiolipoma, myolipoma, and chondroid lipoma are rare lipomatous lesions that are infrequently imaged. Spindle cell and pleomorphic lipoma appear as a subcutaneous lipomatous mass in the posterior neck or shoulder, with frequent nonadipose components. Hibernoma appears as a lipomatous mass with serpentine vascular elements. Benign lipomatous lesions affecting bone, joint, or tendon sheath include intraosseous lipoma, parosteal lipoma, liposclerosing myxofibrous tumor, discrete lipoma of joint or tendon sheath, and lipoma arborescens. Intraosseous and parosteal lipoma have a pathognomonic CT or MR appearance, with fat in the marrow space or on the bone surface, respectively. Liposclerosing myxofibrous tumor is a rare intermixed histologic lesion commonly located in the medullary canal of the intertrochanteric femur. Benign lipomatous lesions may occur focally in a joint or tendon sheath or with diffuse villonodular proliferation in the synovium (lipoma arborescens) and are diagnosed based on location and identification of fat. Understanding the spectrum of appearances of the various benign musculoskeletal lipomatous lesions improves radiologic assessment and is vital for optimal patient management.
Collapse
Affiliation(s)
- Mark D Murphey
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Bldg 54, Rm M-133A, Washington, DC 20306, USA.
| | | | | | | | | | | |
Collapse
|