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Yoon KW, Jo J, Lee D. Small intestinal adenocarcinoma accompanied by lynch syndrome: A case report. Medicine (Baltimore) 2023; 102:e35323. [PMID: 37773826 PMCID: PMC10545008 DOI: 10.1097/md.0000000000035323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
RATIONALE Lynch syndrome is caused by germline mutations of DNA mismatch repair genes. A significant risk increase for several types of cancer is one of the characteristics of lynch syndrome. PATIENT CONCERNS A 45-year-old female presented to the emergency department with abdominal pain that had persisted for a month. DIAGNOSES The abdominal and pelvic computed tomography scan showed edematous and thickening of the proximal small bowel wall, as well as dilatation of the proximal bowel and stomach. INTERVENTIONS Tumor resection of the small bowel was performed, and adenocarcinoma was confirmed pathologically. Microsatellite instability was also confirmed. OUTCOMES Postoperative imaging revealed soft tissue lesions with potential for tumor seeding. Two months after the first surgery, a secondary surgery was performed as a result of cancer recurrence. The patient received chemotherapy with capecitabine. The latest computed tomography scan, performed 19 months after the cessation of chemotherapy, did not show any recurrence. LESSONS In the rare incidence of small bowel cancer genetic mutation testing and detailed family history should be actively considered.
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Affiliation(s)
- Kyoung Won Yoon
- Division of Critical Care, Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Jaemin Jo
- Division of Hemato-Oncology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Donghyoun Lee
- Department of Surgery, Jeju National University Hospital, Jeju National University College of Medicine, Republic of Korea
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Gu Y, Deng H, Wang D, Li Y. Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study. Front Surg 2021; 8:759162. [PMID: 34950695 PMCID: PMC8691381 DOI: 10.3389/fsurg.2021.759162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/25/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal tumor with high malignancy. The aim of this study was to comprehensively evaluate the distant metastasis pattern and establish nomograms predicting survival for SBA. Methods: From 2010 to 2015, patients diagnosed with SBA were identified based on the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival analysis was applied to compare survival differences between metastasis patterns. Then, univariate and multivariate cox analyses were applied to screened out independent prognostic factors of cancer-specific survival (CSS) and overall survival (OS), and identify the risk factors for metastasis of SBA. To assess the discrimination and calibration of nomograms, the concordance index (C-index), calibration curves, receiver-operating characteristic curve (ROC), and decision curve analysis (DCA) were calculated. Results: Kaplan-Meier curves revealed that metastasis patterns were significantly correlated with CSS (p < 0.001) and OS (p < 0.001). Then, the metastasis pattern was showed to be an independent prognostic factor of OS and CSS in patients with SBA, as well as age, grade, T stage, N stage, surgery, retrieval of regional lymph nodes, and chemotherapy. Combining these factors, we constructed prognostic nomograms, which suggested that the metastasis pattern made the greatest contribution to the survival of patients with SBA. Nomograms for OS and CSS had a C-index of 0.787 and 0.793, respectively. Calibration curves showed an excellent agreement between probability and actual observation in the training and validation cohort. Decision curve analysis also exhibited its clinical value with an improved net benefit. In addition, the models we constructed had better prognostic accuracy and clinical utility than traditional TNM staging based on C-index and ROC. Further, Cox regression analysis showed that old age, poor differentiation, N2, and not receiving chemotherapy were the risk factors for prognosis in patients with metastatic SBA. Conclusion: As an independent prognostic factor, the metastasis pattern exhibited the greatest predictive effect on OS and CSS for patients with SBA. Adjuvant chemotherapy had a positive effect on the survival of patients with SBA. Nomograms for predicting 3-and 5-year OS and CSS of patients with SBA were constructed, which could identify patients with higher risk and might be superior in predicting the survival of patients with SBA than TNM staging.
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Affiliation(s)
- Yanmei Gu
- Department of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Haixiao Deng
- Department of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Daijun Wang
- Department of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yumin Li
- Department of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, China.,Key Laboratory of Digestive System Tumors of Gansu, Lanzhou, China
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Sharma P, Kajaria D. Role of Kalpa Chikitsa in the management of Lynch syndrome- A case report. J Family Med Prim Care 2020; 9:2487-2491. [PMID: 32754525 PMCID: PMC7380758 DOI: 10.4103/jfmpc.jfmpc_161_20] [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: 01/25/2020] [Revised: 03/13/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022] Open
Abstract
Lynch syndrome (hereditary non-polyposis colorectal cancer) is an autosomal dominant condition and it is caused by germline mutations in the DNA mismatch repair genes. The present case report was conducted to evaluate the efficacy of Madhuyasti (Glycyrrhiza glabra) Ksheerpaka kalpa in Lynch syndrome. A 28-year-old male was diagnosed with Lynch syndrome in 2016. The patient was operated three times followed by chemotherapy. In 2019, he was diagnosed with adenocarcinoma and advised for surgery. But despite getting surgery patient prefer to take Ayurvedic consultation considering his miserable condition after previous surgeries. It is decided to give the kalpa method of therapy prescribed in Ayurveda for rejuvenation and overall improvement of health. After the 15 days of treatment with Madhuyasti (Glycyrrhiza glabra) Ksheerpaka Kalpa chikitsa, the patient showed significant improvement in quality of life (P < 0.001 for SPF) and CT abdomen showed a reduction in circumferential thickening from 2.8 to 1.5 cm (~50% improvement) with no worsening complications. Although the pathogenesis cannot be revert back to the normalcy as the patient already had resection of the total colon, it can be concluded that with the help of Ayurveda, the appearance of complications can be delayed and the quality of life can be improved in such patients. It is further suggested that better result may obtained if the Ayurvedic therapy starts at earlier stage.
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Affiliation(s)
- Pooja Sharma
- MD Scholar, All India institute of Ayurveda, New Delhi, India
| | - Divya Kajaria
- Assistant Professor,Department of Kayachikitsa, All India institute of Ayurveda, New Delhi, India
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Sun KK, Liu G, Shen X, Wu X. Small bowel adenocarcinoma in Lynch syndrome: A case report. Oncol Lett 2016; 12:1602-1604. [PMID: 27446478 DOI: 10.3892/ol.2016.4753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/23/2016] [Indexed: 11/06/2022] Open
Abstract
Small bowel adenocarcinoma is part of the tumor spectrum of Lynch syndrome, which is caused by germline mutations in the mismatch repair genes. The present study describes the case of a 51-year-old man fulfilling the Amsterdam II criteria for Lynch syndrome, who had a 15-mm early-stage colorectal cancer resected endoscopically from the ascending colon. Due to upper abdominal discomfort after eating and consequent anorexia, a computed tomography scan performed 1 month later showed a tumoral mass of the upper jejunum with local lymphadenopathy. The laparotomy revealed a completely obstructing mass. Intraoperative frozen section showed a small bowel adenocarcinoma. Subsequent genetic testing confirmed the germline mutation of mutL homolog 1. The patient received 6 cycles of an adjuvant folinic acid, fluorouracil and ocaliplatin chemotherapy regimen. The latest CT scan, 16 months after the chemotherapy, did not show any recurrence. This case highlights the importance of considering the possibility of small bowel adenocarcinoma in patients with upper bowel obstruction, particularly for patients with Lynch syndrome.
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Affiliation(s)
- Ke-Kang Sun
- Department of Gastrointestinal Surgery, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Gang Liu
- Department of Gastrointestinal Surgery, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Xiaojun Shen
- Department of Gastrointestinal Surgery, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Xiaoyang Wu
- Department of Gastrointestinal Surgery, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
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Primary adenocarcinoma of the small intestine presenting as superior mesenteric artery syndrome: A case report. Oncol Lett 2016; 11:1903-1906. [PMID: 26998097 DOI: 10.3892/ol.2016.4116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/14/2015] [Indexed: 11/05/2022] Open
Abstract
Superior mesenteric artery syndrome (SMAS) is an uncommon cause of vomiting and weight loss due to compression of the third part of the duodenum by the superior mesenteric artery. Small bowel adenocarcinoma is an uncommon tumor, which is frequently delayed in diagnosis as its symptoms and signs are non-specific. The present study describes a case of SMAS occurring in a 51-year-old man, caused by intestinal obstruction secondary to a primary adenocarcinoma of the duodenal-jejunal junction. To the best of our knowledge, the present case is the first report of small bowel adenocarcinoma masquerading as SMAS. The present case highlights the importance of considering the possibility of SMAS in patients with upper bowel obstruction caused by intestinal carcinoma.
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Non-colorectal intestinal tract carcinomas in inflammatory bowel disease: results of the 3rd ECCO Pathogenesis Scientific Workshop (II). J Crohns Colitis 2014; 8:19-30. [PMID: 23664498 DOI: 10.1016/j.crohns.2013.04.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 02/08/2023]
Abstract
Patients with inflammatory bowel diseases (IBD) have an excess risk of certain gastrointestinal cancers. Much work has focused on colon cancer in IBD patients, but comparatively less is known about other more rare cancers. The European Crohn's and Colitis Organization established a pathogenesis workshop to review what is known about these cancers and formulate proposals for future studies to address the most important knowledge gaps. This article reviews the current state of knowledge about small bowel adenocarcinoma, ileo-anal pouch and rectal cuff cancer, and anal/perianal fistula cancers in IBD patients.
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Fernandes DD, Galwa RP, Fasih N, Fraser-Hill M. Cross-Sectional Imaging of Small Bowel Malignancies. Can Assoc Radiol J 2012; 63:215-21. [DOI: 10.1016/j.carj.2010.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/25/2010] [Accepted: 10/07/2010] [Indexed: 12/20/2022] Open
Abstract
Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.
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Affiliation(s)
- Dellano D. Fernandes
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Ram Prakash Galwa
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Najla Fasih
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Margaret Fraser-Hill
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Yoshida H, Tanaka N, Suzuki Y. Primary Adenocarcinoma of the Jejunum with Intramural Metastasis: Is This a Rare Event? J Gastrointest Cancer 2012; 43 Suppl 1:S276-9. [PMID: 22752454 DOI: 10.1007/s12029-012-9411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroshi Yoshida
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan.
| | - Noriyuki Tanaka
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan
| | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan
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Tripodi F, Pagliarin R, Fumagalli G, Bigi A, Fusi P, Orsini F, Frattini M, Coccetti P. Synthesis and Biological Evaluation of 1,4-Diaryl-2-azetidinones as Specific Anticancer Agents: Activation of Adenosine Monophosphate Activated Protein Kinase and Induction of Apoptosis. J Med Chem 2012; 55:2112-24. [DOI: 10.1021/jm201344a] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Farida Tripodi
- Department of Biotechnology
and Biosciences, University of Milan-Bicocca, Piazza della Scienza 2, 20126 Milan, Italy
| | - Roberto Pagliarin
- Department of Organic and Industrial
Chemistry, University of Milan, Via Venezian
21, 20133 Milan, Italy
| | - Gabriele Fumagalli
- Department of Organic and Industrial
Chemistry, University of Milan, Via Venezian
21, 20133 Milan, Italy
| | - Alessandra Bigi
- Department of Biotechnology
and Biosciences, University of Milan-Bicocca, Piazza della Scienza 2, 20126 Milan, Italy
| | - Paola Fusi
- Department of Biotechnology
and Biosciences, University of Milan-Bicocca, Piazza della Scienza 2, 20126 Milan, Italy
| | - Fulvia Orsini
- Department of Organic and Industrial
Chemistry, University of Milan, Via Venezian
21, 20133 Milan, Italy
| | - Milo Frattini
- Institute of Pathology, Via in Selva 24,
6600 Locarno, Switzerland
| | - Paola Coccetti
- Department of Biotechnology
and Biosciences, University of Milan-Bicocca, Piazza della Scienza 2, 20126 Milan, Italy
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Nicholl MB, Ahuja V, Conway WC, Vu VD, Sim MS, Singh G. Small bowel adenocarcinoma: understaged and undertreated? Ann Surg Oncol 2010; 17:2728-32. [PMID: 20458546 DOI: 10.1245/s10434-010-1109-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary small bowel adenocarcinoma (SBA) is a rare, chemoresistant tumor with an aggressive clinical nature. Surgery is the mainstay of therapy, but the extent of lymph node (LN) recovery necessary for optimal care of jejunoileal SBA is unknown. MATERIALS AND METHODS The SEER database was queried to identify patients whose primary jejunoileal SBA was diagnosed between 1995 and 2005. Patients were grouped by AJCC stage and number of LNs recovered from the surgical specimen. RESULTS Of 1444 patients with primary SBA, 93 (6.4%), 529 (36.6%), 356 (24.7%), and 466 (32.3%) were initially diagnosed with stage I, II, III, and IV disease, respectively. Five-year overall survival (OS) rate was 59.8%, 39.5%, 27.0%, and 3.2% for patients with stage I, II, III, and IV SBA, respectively. When ≥10 nodes were recovered, OS rate increased nonsignificantly in stage I (73.2% vs. 55.6%) and significantly in stage II (61.8% vs. 32.9%, P < .001) but was unchanged in stage III (27.4% vs. 27.3%, P = .13). Recovery of ≥10 nodes occurred in 26.9%, 23.6%, and 42.1% of patients with stage I, II, and III SBA, respectively. Multivariate analysis identified age, AJCC stage, site of primary tumor, recovery of ≥10 LNs, and number of positive nodes as significant for OS. CONCLUSIONS We have found SBA staging is largely inadequate. Our results suggest recovery of ≥10 LNs ensures accurate staging. Improvement in stage II SBA OS after adequate LN may reflect a high degree of understaging in this dataset rather than a therapeutic effect of LAD.
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Affiliation(s)
- Michael B Nicholl
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA
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Ono M, Shirao K, Takashima A, Morizane C, Okita N, Takahari D, Hirashima Y, Eguchi-Nakajima T, Kato K, Hamaguchi T, Yamada Y, Shimada Y. Combination chemotherapy with cisplatin and irinotecan in patients with adenocarcinoma of the small intestine. Gastric Cancer 2009; 11:201-5. [PMID: 19132481 DOI: 10.1007/s10120-008-0484-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/29/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Small-bowel adenocarcinoma (SBA) is a rare tumor that has a poor response to chemotherapy and a poor prognosis. Treatment strategies for SBA have not been clearly established. METHODS All patients with SBA treated using a combination of cisplatin and irinotecan (IP) as first-line chemotherapy at the National Cancer Center Hospital in Japan between January 1999 and February 2007 were studied retrospectively. RESULTS Eight patients received IP as first-line chemotherapy. The median follow-up was 9.5 months (range, 4.2-37.5 months). The median number of cycles of IP was three (range, 1-5). The overall response rate (complete or partial response) was 12.5% (complete response, n = 0; partial response, n = 1). The disease control rate (complete or partial response or stable disease) was 75%. The median time to treatment failure was 4.5 months (95% confidence interval, 0.9-5.8 months), and overall survival was 17.3 months (range, 1.9-21.3 months). The most common adverse events were neutropenia and anorexia. CONCLUSION IP combination chemotherapy may be an acceptable option for patients with SBA. Further studies are warranted to determine the optimal chemotherapeutic regimen for SBA.
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Affiliation(s)
- Makiko Ono
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
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Verma D, Stroehlein JR. Adenocarcinoma of the small bowel: a 60-yr perspective derived from M. D. Anderson Cancer Center Tumor Registry. Am J Gastroenterol 2006; 101:1647-54. [PMID: 16863573 DOI: 10.1111/j.1572-0241.2006.00625.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To analyze subsite distribution of small bowel adenocarcinoma (SBA) over a 60-yr interval and to determine the impact of age, gender, and ethnicity on SBA cross-referenced for selected variables including anatomic distribution. METHODS Data from 1944 to 2003 were extracted from the M. D. Anderson Cancer Center Tumor Registry (MDACCTR) and analyzed by age, gender, ethnicity, anatomic site, and time intervals. RESULTS A total of 523 confirmed cases with 460 specified for subsite were identified. Peak incidence occurred in the sixth decade with male predominance (58%). Relative distribution for subsites was stable over the period of study; however, site-specific incidence differed significantly with age. Although jejunal SBA comprised only 21% of site-specific total (SST), 49% occurred in 0-49 age group rendering duodenal SBA (59% of SST) more common with increasing age (p < 0.001). A higher percentage of women presented at younger age; however, the difference was not significant (p = 0.061). Subsite distribution was similar for both genders, but varied significantly among ethnicities (p = 0.048) with Hispanics and African Americans having a higher percentage of duodenal SBA. The age and gender distribution among ethnicities varied significantly. African Americans having SBA presented at a younger age (p < 0.001), and comprised a higher percentage of women (p = 0.026). CONCLUSION Differences exist for SBA subsite distribution within age and ethnic groups but not gender. Unlike colon cancer, SBA subsite distribution has been stable during the last six decades. Different risk factors for SBA appear to affect different subsites. Site- and age-related distribution impacts on diagnostic evaluation for SBA.
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Affiliation(s)
- Dharmendra Verma
- Department of Internal Medicine, University of Texas Houston Health Science Center, Houston, Texas, USA
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Kummar S. Small Bowel Adenocarcinoma. Clin Colorectal Cancer 2004. [DOI: 10.1016/s1533-0028(11)70123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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