1
|
Louis M, Lelli E, Aycinena F, Ellis E. Small Cell Carcinoma of the Rectum Associated With a Tubulovillous Adenoma: An Atypical Case Presentation. Cureus 2024; 16:e55995. [PMID: 38606246 PMCID: PMC11007286 DOI: 10.7759/cureus.55995] [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] [Received: 02/01/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Small cell carcinoma of the rectum (SCCR) is a rare and aggressive neuroendocrine tumor. Its association with a tubulovillous adenoma is an exceptional occurrence, presenting significant implications for diagnosis and treatment. This case report details a 62-year-old male, undergoing treatment for hepatocellular carcinoma, presented with symptoms of diarrhea. A colonoscopy initially suggested a benign tubulovillous adenoma, but the presence of discordant clinical findings led to further evaluation. The final diagnosis, established post-surgery, was SCCR originating from a tubulovillous adenoma. This case highlights the diagnostic challenges when unusual presentations arise from atypical pathological findings, especially in patients with concurrent malignancies. The management followed standard care protocols, including robotic transanal surgery, despite the patient's ongoing HCC treatment. This case adds to the limited existing literature on SCCR, particularly its rare association with a tubulovillous adenoma. It emphasizes the importance of a multi-disciplinary approach in diagnosing and managing rare entities in colorectal cancer while demonstrating the feasibility of standard care in patients with complex comorbidities.
Collapse
Affiliation(s)
- Mena Louis
- General Surgery, Northeast Georgia Medical Center Gainsville, Gainesville , USA
| | - Elaine Lelli
- Surgery, Northeast Georgia Medical Center Braselton, Georgia, USA
| | - Fernando Aycinena
- Colorectal Surgery, Northeast Georgia Medical Center Gainesville, Gainesville , USA
| | - Ezra Ellis
- Pathology, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| |
Collapse
|
2
|
Bancheno WM, Adidam SR, Melaku MA. Metastatic rectal neuroendocrine carcinoma presenting with treatment-refractory immune thrombocytopenia: A case report and literature review. Medicine (Baltimore) 2022; 101:e29616. [PMID: 35866784 PMCID: PMC9302362 DOI: 10.1097/md.0000000000029616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Colorectal neuroendocrine cancer (CRNEC) accounts for < 1% of all colorectal cancers. It presents in advanced stages and carries a risk of poor survival. CRNEC may be diagnosed incidentally on imaging or routine endoscopy. When symptomatic, it may mimic colorectal adenocarcinoma. Syncope and immune thrombocytopenic purpura (ITP) have not previously been reported as clinical presentations. PATIENT CONCERNS A 57-year-old man with human immunodeficiency virus infection on treatment, seizure and stroke without residue presented for the evaluation of fall and syncope. DIAGNOSIS Physical examination revealed tachycardia, swelling, and ecchymosis of his proximal left lower extremity. Laboratory tests showed a new isolated thrombocytopenia of 26,000/mm3. Computed tomography for a trauma survey showed an incidental left posterior rectal wall mass. After hospital admission, his platelet count dropped to 14,000/mm3. A peripheral blood smear revealed low platelet count, no schistocytes or immature cells. ITP at a high risk for bleeding was diagnosed and treated with standard medical therapy but remained refractory. Bone marrow biopsy showed metastatic neuroendocrine carcinoma, likely from the rectum. INTERVENTIONS Patient received courses of high-dose dexamethasone and intravenous immunoglobulin. He also receive eleven units of platelet transfusion. A course of rituximab was administered. The platelet count response was suboptimal or short lived with drop to a nadir of 4000/mm3. However, after initiation of Eltrombopag, the thrombocytopenia resolved. Patient was started on etoposide, carboplatin, Atezolizumab. His hospital stay was complicated by neutropenia and sepsis, which was successfully treated. OUTCOMES He was discharged to subacute rehab in stable condition. About 4 months later, he was readmitted for severe thrombocytopenia, septic shock, and acute respiratory failure. Despite appropriate treatment, the patient deteriorated and expired. CONCLUSION CRNEC is a rare aggressive disease with dismal outcome that lacks standardized treatment. Metastasis to the bone marrow is uncommon and concomitant ITP has not been reported. We report a rare case of rectal neuroendocrine carcinoma metastatic to bone marrow associated with refractory ITP and review the relevant literature.
Collapse
Affiliation(s)
- Wouhabe Marai Bancheno
- Internal Medicine, Howard University Hospital, Washington, DC
- * Correspondence: Wouhabe Marai Bancheno, MD, MSc, Internal Medicine, Howard University Hospital, 2041 GA Ave NW, Washington, DC 20060 (e-mail: )
| | | | | |
Collapse
|
3
|
Nannar J, Anciro A, Nanda AK. Collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma: A case report. Ann Med Surg (Lond) 2022; 78:103748. [PMID: 35592827 PMCID: PMC9110971 DOI: 10.1016/j.amsu.2022.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction and Importance Neuroendocrine carcinoma of the colon and rectum account for less than 1% of all colorectal malignancies. Here we report a case of a collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma. Case presentation A 46-year-old asymptomatic female with severe anemia was referred by her primary care physician for admission. Initial imaging showed several innumerable heterogenous hypodense lesions within the liver. Following a colonoscopy and the excision of a rectal mass, the histopathology report revealed a Collision tumor. Clinical discussion There are no specific clinical features or imaging findings. The diagnosis is made post operatively dependent on histopathology. Conclusion It is essential to report these cases to advance a further understanding of the behaviour of these tumors, in addition to develop evidence-based guidelines and treatment strategies. Collision tumors are rare consisting of 2 independent tumors co-existing. Diagnosis is post-operatively and dependent on histology. No current guidelines for treatment. Management focuses on the predominant tumor.
Collapse
|
4
|
Chen I, Zhang D, Velez M, Kovar S, Liao X. Poorly differentiated neuroendocrine carcinomas of the gastrointestinal tract: A single-institute study of 43 cases. Pathol Res Pract 2021; 226:153614. [PMID: 34555651 DOI: 10.1016/j.prp.2021.153614] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To characterize the clinicopathologic and immunohistochemical features of poorly differentiated neuroendocrine carcinomas (NEC) in the gastrointestinal tract. DESIGN A total of 43 cases were identified and reassessed based on modern classification. RESULTS The cohort (27M, 16F; median age: 66 years) included 16 (37%) large cell NEC, 12 (28%) small cell NEC, 5 (12%) NEC not otherwise specified, and 10 (23%) mixed adenoneuroendocrine carcinomas. Tumor predominantly involved the colon (n = 14, 33%), rectum (n = 13, 30%), and esophagus (n = 9, 21%). Immunohistochemically, INSM1 was the most sensitive marker for neuroendocrine differentiation (28/28, 100%), followed by synaptophysin (40/43, 93%), CD56 (22/35, 63%), and chromogranin (18/40, 45%). SATB2, CDX2, CK20, CK7, abnormal p53, and PD-L1 was positive in 21/26 (81%), 26/37 (70%), 11/35 (31%), 10/35 (29%), 19/24 (79%), and 12/23 (52%) cases, respectively. Three of 25 (11%) were mismatch repair protein deficient. Of 21 resected tumors, 19 (90%) were ≥ pT3 and 13 (62%) had nodal metastasis. Twenty-eight (65%) had distant metastasis. The 5-year survival rate was 21%. The prognosis was stage dependent (p < 0.05), but not associated with tumor type, location, or specific immunomarkers. CONCLUSION Gastrointestinal NECs are aggressive neoplasms. INSM1, synaptophysin, and SATB2 are sensitive markers, although not site or tumor type specific.
Collapse
Affiliation(s)
- Irene Chen
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Moises Velez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Sierra Kovar
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| |
Collapse
|
5
|
Gerosa M, Incarbone N, Di Fratta E, Mari GM, Guttadauro A, Cioffi U, Maggioni D. Incarcerated sigmoid large-cell neuroendocrine carcinoma in an inguinal hernia. J Surg Case Rep 2021; 2021:rjaa585. [PMID: 33604019 PMCID: PMC7880701 DOI: 10.1093/jscr/rjaa585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Large-cell neuroendocrine carcinomas (NECs) of the colon are extremely rare aggressive tumors. A 79-year-old man presented at our hospital for muco-hematic diarrhea, weight loss and incarcerated hernia in his left groin. Colonoscopy revealed sigmoid stenosis. Computed tomography confirmed an incarcerated hernia containing sigmoid mass and massive abdominal adenopathy. In absence of colonic obstruction, the patient underwent elective palliative sigmoid resection and colostomy by laparoscopic approach, and direct hernia repair through inguinal access. Histopathological examination revealed a large cells sigmoid NEC. We report the first case of large-cell neuroendocrine colon cancer incarcerated in an inguinal hernia. Due to the advanced stage, we have performed a palliative laparoscopic resection in order to reduce surgical trauma, confirm pre-operative results and minimize post-operative complications, and direct hernia repair through inguinal access.
Collapse
Affiliation(s)
- Martino Gerosa
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Niccolò Incarbone
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Emanuele Di Fratta
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Giulio Maria Mari
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Angelo Guttadauro
- Department of Surgery, University of Milan Bicocca, Istituti Clinici Zucchi, Via Zucchi 24, Monza, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Via F. Sforza 35, Milan, Italy
| | - Dario Maggioni
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| |
Collapse
|
6
|
Ueberroth BE, Liu AJ, Starr JS, Hobday TJ, Ashman JB, Mishra N, Bekaii-Saab TS, Halfdanarson TR, Sonbol MB. Neuroendocrine Carcinoma of the Anus and Rectum: Patient Characteristics and Treatment Options. Clin Colorectal Cancer 2020; 20:e139-e149. [PMID: 33551318 DOI: 10.1016/j.clcc.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Anorectal neuroendocrine carcinomas (NECs) are uncommon malignancies with poor prognosis. Consensus guidelines exist for treating extrapulmonary NEC. However, limited data is available to guide treatment for anorectal NEC. In this study, we sought to review the clinical characteristics and outcomes of patients with NEC of the rectum and/or anus at Mayo Clinic. PATIENTS AND METHODS This is a retrospective study of all patients with the diagnosis of NEC of the anus and/or rectum treated across Mayo Clinic sites since 2000. Baseline patient characteristics, tumor pathology, imaging profiles, treatment strategies utilized, and survival outcomes were analyzed. Kaplan-Meier analysis was used with a significance level of P < .05. RESULTS The study included a total of 38 patients with primary NEC of the anus and/or rectum. The median age at diagnosis was 55.5 years. The median follow-up was 18.8 months. Fifteen patients had locoregional disease (LRD) at diagnosis. The remaining 23 had metastatic disease. Overall survival was significantly shorter in patients with LRD compared with those with metastatic disease at diagnosis (18.1 vs. 13.8 months; P = .039). The majority (n = 11) of patients with LRD were treated with concurrent chemoradiation therapy, and 10 underwent surgical resection of the primary tumor. The majority (13/15) of patients with LRD progressed, with the majority (11/15) of progressions being distant. The median progression-free survival for patients with LRD was 5.7 months (1-year progression-free survival, 26.7%). CONCLUSION Anorectal NEC is an aggressive malignancy with poor prognosis requiring multidisciplinary discussion. In addition, the systemic nature of anorectal NEC with distant recurrences in LRD and poor outcomes in metastatic disease emphasizes the need to further develop better systemic treatment options that can potentially improve outcomes in NEC.
Collapse
Affiliation(s)
| | - Alex J Liu
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Jason S Starr
- Department of Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | - Nitin Mishra
- Department of Colon and Rectal Surgery, Mayo Clinic, Phoenix, AZ
| | | | | | | |
Collapse
|
7
|
Kanthan R, Tharmaradinam S, Asif T, Ahmed S, Kanthan SC. Mixed epithelial endocrine neoplasms of the colon and rectum – An evolution over time: A systematic review. World J Gastroenterol 2020; 26:5181-5206. [PMID: 32982118 PMCID: PMC7495040 DOI: 10.3748/wjg.v26.i34.5181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mixed tumors of the colon and rectum, composed of a combination of epithelial and endocrine elements of benign and malignant potential are rare neoplasms. These can occur anywhere in the gastrointestinal tract and are often diagnosed incidentally. Though they have been a well-documented entity in the pancreas, where the exocrine-endocrine mixed tumors have been known for a while, recognition and accurate diagnosis of these tumors in the colon and rectum, to date, remains a challenge. This is further compounded by the different terminologies that have been attributed to these lesions over the years adding to increased confusion and misclassification. Therefore, dedicated literature reviews of these lesions in the colon and rectum are inconsistent and are predominantly limited to case reports and case series of limited case numbers. Though, most of these tumors are high grade and of advanced stage, intermediate and low grade lesions of these mixed tumors are also increasingly been reported. There are no established independent consensus based guidelines for the therapeutic patient management of these unique lesions.
AIM To provide a comprehensive targeted literature review of these complex mixed tumors in the colon and rectum that chronicles the evolution over time with summarization of historical perspectives of terminology and to further our understanding regarding their pathogenesis including genomic landscape, clinicoradiological features, pathology, treatment, prognosis, the current status of the management of the primary lesions, their recurrences and metastases.
METHODS A comprehensive review of the published English literature was conducted using the search engines PubMed, MEDLINE and GOOGLE scholar. The following search terms [“mixed tumors colon” OR mixed endocrine/neuroendocrine tumor/neoplasm/lesion colon OR adenocarcinoma and endocrine/neuroendocrine tumor colon OR mixed adenocarcinoma and endocrine/neuroendocrine carcinoma colon OR Amphicrine tumors OR Collision tumors] were used. Eligibility criteria were defined and all potential relevant items, including full articles and/or abstracts were independently reviewed, assessed and agreed upon items were selected for in-depth analysis.
RESULTS In total 237 full articles/abstracts documents were considered for eligibility of which 45 articles were illegible resulting in a total of 192 articles that were assessed for eligibility of which 139 have been selected for reference in this current review. This seminal manuscript is a one stop article that provides a detailed outlook on the evolution over time with summarization of historical perspectives, nomenclature, clinicoradiological features, pathology, treatment, prognosis and the current status of the management of both the primary lesions, their recurrences and metastases. Gaps in knowledge have also been identified and discussed. An important outcome of this manuscript is the justified proposal for a new, simple, clinically relevant, non-ambiguous terminology for these lesions to be referred to as mixed epithelial endocrine neoplasms (MEENs).
CONCLUSION MEEN of the colon and rectum are poorly understood rare entities that encompass an extensive range of heterogeneous tumors with a wide variety of combinations leading to tumors of high, intermediate or low grade malignant potential. This proposed new revised terminology of MEEN will solve the biggest hurdle of confusion and misclassification that plagues these rare unique colorectal neoplasms thus facilitating the future design of multi institutional prospective randomized controlled clinical trials to develop and evaluate newer therapeutic strategies that are recommended for continued improved understanding and personal optimization of clinical management of these unique colorectal neoplasms.
Collapse
Affiliation(s)
- Rani Kanthan
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon S7N 0W8, SK, Canada
| | - Suresh Tharmaradinam
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon S7N 0W8, SK, Canada
| | - Tehmina Asif
- Division of Oncology, Saskatoon Cancer Centre, Saskatoon S7N 0W8, SK, Canada
| | - Shahid Ahmed
- Division of Oncology, Saskatoon Cancer Centre, Saskatoon S7N 0W8, SK, Canada
| | - Selliah C Kanthan
- Division of General Surgery, University of Saskatchewan, Saskatoon S7N 0W8, SK, Canada
| |
Collapse
|
8
|
Warsinggih, Liliyanto, Prihantono, Ariani GDW, Faruk M. Colorectal neuroendocrine tumors: A case series. Int J Surg Case Rep 2020; 72:411-417. [PMID: 32563832 PMCID: PMC7306531 DOI: 10.1016/j.ijscr.2020.06.030] [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: 05/07/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Neuroendocrine tumors (NET) of the colon and sigmoid colon are uncommon compared to colorectal adenocarcinoma. Few reports have been made of NET of the colon and sigmoid colon that presents with peritonitis and large bowel obstruction. CASE PRESENTATION Here, we report two cases of NET of the colon and sigmoid colon, which were diagnosed and treated at our institution. In our first case, a 66-year-old man with a history of abdominal distension was diagnosed with NET via histopathology of the sigmoid colon. The second case involved a 45-year-old woman with the chief complaints of abdominal distention and inability to defecate; specimen histopathology of the descending colon showed neuroendocrine carcinoma features. Clinical outcome was very poor in our patients: eight months after the resection, the second patient demonstrated a sign of metastasis on the liver. CONCLUSION An uncommon case of colon and sigmoid colon carcinoma with neuroendocrine and diagnostic difficulties precludes an exact description of the initial diagnostic criteria and management. Thus, our case series offers an overview of initial symptoms, radiological and histopathological features for early diagnosis, and proper management of NET.
Collapse
Affiliation(s)
- Warsinggih
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University Makassar, Indonesia.
| | - Liliyanto
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University Makassar, Indonesia.
| | - Prihantono
- Division of Oncology, Department of Surgery, Faculty of Medicine, Hasanuddin University Makassar, Indonesia.
| | - Gusti Deasy Wilda Ariani
- Department of Anatomic Pathology, Faculty of Medicine, Hasanuddin University Makassar, Indonesia.
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University Makassar, Indonesia.
| |
Collapse
|
9
|
Shi H, Qi C, Meng L, Yao H, Jiang C, Fan M, Pang S, Zhang Q, Lin R. Do neuroendocrine carcinomas and mixed neuroendocrine-non-neuroendocrine neoplasm of the gastrointestinal tract have the same prognosis? A SEER database analysis of 12,878 cases. Ther Adv Endocrinol Metab 2020; 11:2042018820938304. [PMID: 32670540 PMCID: PMC7338725 DOI: 10.1177/2042018820938304] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/08/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Neuroendocrine carcinomas (NECs) and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) in the gastrointestinal (GI) tract are both rare and malignant; however, it is unclear whether their prognosis is the same. METHODS In this cross-sectional study, a total of 12,878 patients with NEC or MiNEN in the GI tract were reviewed retrospectively by searching the Surveillance, Epidemiology, and End Results (SEER) program database. Next, we compared the characteristics and survival between patients with NEC or MiNEN and further analyzed the prognostic factors for the patients. RESULTS The data showed that patients with MiNEN had a worse prognosis as compared with patients with pure NEC in the small intestine (SI) and appendix, whereas there was no significant survival difference between NEC and MiNEN in the other parts of the GI system. On the whole, age ⩾55 years (p < 0.0001), male (p = 0.002), being diagnosed at TNM Stage II-IV (p < 0.0001) or not receiving surgical treatment (p < 0.0001) were the independent negative prognostic factors for NEC patients, whereas age ⩾55 years (p = 0.003), being diagnosed at TNM Stage III-IV (p < 0.001) or not receiving surgical treatment (p < 0.001) were identified as the independent negative prognostic factors for the MiNEN patients. Furthermore, when NECs or MiNENs were classified based on the primary tumor site, the results showed that the prognostic factors for NEC and MiNEN varied between the tumor sites. CONCLUSION The prognostic differences between NECs and MiNENs in the GI tract are heterogeneous and site-related. Patients with appendiceal or SI MiNEN have a poorer prognosis than patients with pure appendiceal or SI NEC. Therefore, we should pay more attention to patients with MiNEN in the SI and appendix and monitor them more closely.
Collapse
Affiliation(s)
| | | | - Lingjun Meng
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Hailing Yao
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Chen Jiang
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Mengke Fan
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Suya Pang
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Qin Zhang
- Department of Pathology, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
| | | |
Collapse
|