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Zhou CM, Cao J, Chen SK, Tuxun T, Apaer S, Wu J, Zhao JM, Wen H. Retrospective analysis based on a clinical grading system for patients with hepatic hemangioma: A single center experience. World J Gastrointest Surg 2024; 16:2047-2053. [PMID: 39087105 PMCID: PMC11287709 DOI: 10.4240/wjgs.v16.i7.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The optimal approach for managing hepatic hemangioma is controversial. AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience. METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018. Patients were classified into four groups based on the clinical grading system and treatment: (1) Observation group with score < 4 (Obs score < 4); (2) Surgical group with score < 4 (Sur score < 4); (3) Observation group with score ≥ 4 (Obs score ≥ 4); and (4) Surgical group with score ≥ 4 (Sur score ≥ 4). The clinico-pathological index and outcomes were evaluated. RESULTS There were significantly fewer symptomatic patients in surgical groups (Sur score ≥ 4 vs Obs score ≥ 4, P < 0.001; Sur score < 4 vs Obs score < 4, χ² = 8.60, P = 0.004; Sur score ≥ 4 vs Obs score < 4, P < 0.001). The patients in Sur score ≥ 4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score ≥ 4 (P < 0.001; P < 0.001). Nevertheless, there was no significant difference in need for intervention and total patients with adverse event between the Sur score < 4 and Obs score < 4 (P > 0.05; χ² = 1.68, P > 0.05). CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma. Surgery can be suggested for patients with a score ≥ 4. For those with < 4, follow-up should be proposed.
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Affiliation(s)
- Cheng-Ming Zhou
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jun Cao
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shao-Ke Chen
- Department of Operation Management, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerhongjiang Tuxun
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shadike Apaer
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jing Wu
- Department of General Surgery, The First Teaching College, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jin-Ming Zhao
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Anguiano-Albarran R, Cain D, Obi F, Pradeep S, Cimo M, Mehta S. Primary Hepatic Angiosarcoma Presenting As Cryptogenic Cirrhosis. Cureus 2023; 15:e43529. [PMID: 37719603 PMCID: PMC10501742 DOI: 10.7759/cureus.43529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Primary hepatic angiosarcoma (PHA) is an exceedingly rare and aggressive neoplasm of mesenchymal origin. PHA makes a very small portion of primary liver tumors and conveys a poor prognosis. Symptomatology can be vague and often mimics primary hepatocellular carcinoma upon presentation. Diagnosis requires careful immunohistopathologic confirmation. We present a case of PHA in a patient with abdominal pain and suspected underlying cryptogenic cirrhosis.
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Affiliation(s)
- Ricardo Anguiano-Albarran
- Internal Medicine, Baylor Scott & White All Saints Medical Center Texas Christian University (TCU) - Internal Medicine Residency, Fort Worth, USA
| | - Daniel Cain
- Internal Medicine, Baylor Scott & White All Saints Medical Center Texas Christian University (TCU) - Internal Medicine Residency, Fort Worth, USA
| | - Franklin Obi
- Internal Medicine, Baylor Scott & White All Saints Medical Center Texas Christian University (TCU) - Internal Medicine Residency, Fort Worth, USA
| | - Sidart Pradeep
- Internal Medicine, Baylor Scott & White All Saints Medical Center Texas Christian University (TCU) - Internal Medicine Residency, Fort Worth, USA
| | - Michael Cimo
- Pathology, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Shivang Mehta
- Transplant Hepatology, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
- Transplant Hepatology, Annette C. & Harold C. Simmons Transplant Institute, Fort Worth, USA
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3
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Skants N, Rönty M, Komulainen O, Keski-Keturi M, Huotari K, Alander-Pekkarinen M, Sihvo M, Laitinen M, Linko R. Case report and review: Angiosarcoma with thrombocytopenia after total hip arthroplasty. Front Surg 2023; 10:1212491. [PMID: 37583390 PMCID: PMC10423994 DOI: 10.3389/fsurg.2023.1212491] [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: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Total hip arthroplasty (THA) is a common treatment for osteoarthritis and is also performed for other conditions, such as secondary arthritis due to developmental dysplasia of the hip. Various THA types may be complicated by osteolysis and an inflammatory pseudotumor due to an adverse reaction to metal debris. Rarely, THA has been associated with malignant tumors, but their causality remains unclear. In this case report, we describe a female patient with developmental dysplasia of the hip. She had undergone left metal-on-polyethylene THA, acetabular revision of the THA, and left total knee arthroplasty. In addition, she had a history of dyslipidemia and telangiectasia of the eyes, anemia, hiatal hernia, and pleuritis. A THA-associated mass (suspected to be a pseudotumor) had been detected during a previous hospital admission due to pleuritis. She was hospitalized due to swelling in her left lower limb, fatigue, and bruises. A clinical examination revealed anemia, thrombocytopenia, and growth of the suspected pseudotumor. Within 6 weeks, she presented with bleeding of the oral mucosa, hemoptysis, melena, severe thrombocytopenia that did not respond to treatment, elevated D-dimer and C-reactive protein levels, severe pain, increased osteolysis, and fractures around the THA. Infection or malignancy was suspected, but two trocar biopsies suggested an inflammatory pseudotumor. Since her anemia and thrombocytopenia were considered to have been caused by an inflammatory process within the suspected pseudotumor, her suspected pseudotumor and all THA components were surgically removed. However, she developed severe alveolar hemorrhaging and hypoxia and died 2 weeks after her surgery. Histopathological analysis of her surgical and autopsy samples revealed highly malignant angiosarcoma. Although individual cases of malignancies associated with THA have been reported, the literature lacks a clear association between THA and increased cancer risk. Most pseudotumors are non-malignant. The patient's case presented in this report exemplifies the challenges to the differential diagnosis of a THA-associated pseudotumor and rare angiosarcoma. Atypically rapid tumor growth, severe osteolysis, and deterioration in the general wellbeing suggest a malignant disease.
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Affiliation(s)
- Noora Skants
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Mikko Rönty
- Department of Pathology, HUSLAB, Hospital District of Helsinki and Uusimaa, Diagnostic Center and University of Helsinki, Helsinki, Finland
| | - Olli Komulainen
- Musculoskeletal and Plastic Surgery, Arthroplasty Center, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Miikka Keski-Keturi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Huotari
- Department of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maria Alander-Pekkarinen
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjut Sihvo
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Minna Laitinen
- Musculoskeletal and Plastic Surgery, Bridge Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rita Linko
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
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Lin Y, Chen Z, Yang J, Lin Y, Chen S, Xie Y, Wu S. Advanced diffuse hepatic angiosarcoma treated successfully with TACE and targeted immunotherapy: A case report. Front Oncol 2023; 13:1071403. [PMID: 37152029 PMCID: PMC10157244 DOI: 10.3389/fonc.2023.1071403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Primary hepatic angiosarcoma (PHA), a rare soft tissue tumor, accounts for only 2% of all liver malignancies. Pathologically challenging, PHA is difficult to be distinguished from other malignancies with ultrasound, Computed Tomography (CT), or Magnetic Resonance Imaging (MRI). Due to late diagnosis and resistance against traditional chemotherapy and/or radiotherapy, only 3% of PHA patients can survive up to two years after diagnosis. To our best knowledge, this case report presents the first case of an advanced diffuse PHA with ruptured hemorrhage that has been effectively treated with TACE and Anlotinib plus Camrelizumab. So far, the patient has received 10 cycles of treatment and is faring well. Latest MRI results show that the tumor has shrunk by 56% and can be assessed as a partial response (PR). This case report includes our experience in treating such a advanced malignancy, and we hope that larger studies on advanced PHA can better quantify the potential benefit.
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Affiliation(s)
- Yucheng Lin
- Department of Ultrasonography, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Shengli Clinical Medical College, Fuzhou, China
| | - Zheng Chen
- Department of Oncology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jianchuan Yang
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ying Lin
- Department of Pathology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ying Xie
- Department of Hematology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Songsong Wu, ; Ying Xie,
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Songsong Wu, ; Ying Xie,
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Dobrindt EM, Öllinger R, Flörcken A, Märdian S, Schmelzle M, Lurje G, Pratschke J, Schoening W. Primäre Lebersarkome – Empfehlungen zur chirurgischen Therapie. Zentralbl Chir 2022; 148:165-179. [PMID: 35211924 DOI: 10.1055/a-1728-6939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eva Maria Dobrindt
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Robert Öllinger
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anne Flörcken
- Medizinische Klinik m.S. Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sven Märdian
- Zentrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Moritz Schmelzle
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Georg Lurje
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Johann Pratschke
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wenzel Schoening
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Tang Z, Hu H, Liao Y, Li C, Deng X, Qiu S. Transarterial chemoembolization for Kasabach-Merritt syndrome caused by hepatic angiosarcoma: A case report. Radiol Case Rep 2021; 16:3354-3358. [PMID: 34484544 PMCID: PMC8408428 DOI: 10.1016/j.radcr.2021.08.004] [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: 07/21/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatic angiosarcoma is a rare disease, and hepatic hemangiosarcoma with Kasabach-Merritt syndrome (KMS) is even rarer. Although there have been several reports about KMS caused by hepatic angiosarcoma, there has been no mention of successful treatment regimens for hepatic angiosarcoma with KMS. A 64-year-old female patient presented with right upper abdominal pain and multiple cutaneous purpuras for 10 days. Blood analysis revealed that hemoglobin, platelet and fibrinogen were significantly decreased, prothrombin time was prolonged, fibrinogen degradation products were increased. Contrast-enhanced computed tomography scan of the abdomen demonstrated a large mass in the right lobe of the liver, which is pathologically suggestive of hepatic angiosarcoma. Based on the above examination, the patient was diagnosed with KMS caused by hepatic angiosarcoma. Repeated transfusion of blood products could only temporarily improve the coagulation function of the patient. After transarterial chemoembolization, the patient experienced a long-term improvement of blood clotting, and the patient's survival increased by six months. Transarterial chemoembolization should be considered one of effective therapies for hepatic angiosarcoma with KMS.
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Affiliation(s)
- Ziyu Tang
- Department of Interventional Radiology, Nanchong Central Hospital, Sichuan Province, China
| | - Hong Hu
- Department of Interventional Radiology, Nanchong Central Hospital, Sichuan Province, China
| | - Yunguo Liao
- Department of Interventional Radiology, Nanchong Central Hospital, Sichuan Province, China
| | - Chao Li
- Department of Interventional Radiology, Nanchong Central Hospital, Sichuan Province, China
| | - Xing Deng
- Department of Interventional Radiology, Nanchong Central Hospital, Sichuan Province, China
| | - Shixiang Qiu
- Department of Interventional Radiology, Nanchong Central Hospital, Sichuan Province, China
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7
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Tang T, Wang X, Mao Y, Li J, Wen T, Jia W, Chen Y, Peng T, Liu L, Fan R, Ma K, Xia F. Real-world data on the clinicopathological traits and outcomes of hospitalized liver hemangioma patients: a multicenter study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1067. [PMID: 34422979 PMCID: PMC8339840 DOI: 10.21037/atm-20-4684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/28/2021] [Indexed: 02/05/2023]
Abstract
Background There is currently a lack of consensus regarding the clinical features, diagnosis, treatment indications and options, and risk assessment of hepatic hemangioma patients. Methods This was a multicenter, real-world study that analyzed a large number of hepatic hemangioma cases in China and included patient data on epidemiology, diagnosis, treatment methods, and outcomes. Results A total of 5,143 patients hospitalized for hepatic hemangioma were included, of whom 34.42% were male and 65.58% were female. The age distribution was concentrated between 30 and 60 years old, accounting for 87.41% of the patients. Among the hepatic hemangioma patients, 60.8% had only one tumor, with the most common pathological type being cavernous hemangioma (96.07% of cases). The treatment motivations and indications included anxiety, obvious clinical symptoms, rapid tumor growth, unclear diagnoses and acute emergencies. Overall, 41.4% of the patients were treated for psychological reasons, while 30.59% were treated because they presented obvious (primarily nonspecific) clinical symptoms. Hepatic resection was the main therapeutic method and was based on various indications. There were a small number of patients with Kasabach-Merritt syndrome, according to its generally recognized definition. Conclusions Most patients in this study who were hospitalized for hepatic hemangioma did not meet the indications for requiring treatment. Surveillance is the recommended course of action for definitively diagnosed hepatic hemangioma, and a new classification system is needed to standardize the diagnosis of this condition.
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Affiliation(s)
- Tengqian Tang
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xishu Wang
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Li
- The Institute of Hepatobiliary Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Tianfu Wen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Weidong Jia
- Department of Hepatobiliary Surgery, Anhui Provincial Hospital, Hefei, China
| | - Yongjun Chen
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Peng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ruifang Fan
- Department of Hepatobiliary Surgery, Lanzhou General Hospital of Lanzhou Military Area Command, PLA, Lanzhou, China
| | - Kuansheng Ma
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Feng Xia
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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Serra JT, Silva R, Aldomiro F, Duarte FP. Bone Marrow Langerhans Cell Histiocytosis in Association with Kasabach-Merritt Syndrome: The Difficulty of a Differential Diagnosis. Case Rep Oncol 2020; 13:408-413. [PMID: 32355498 PMCID: PMC7184841 DOI: 10.1159/000506539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/14/2022] Open
Abstract
Langerhans cell histiocytosis is a rare haematological disorder with variable clinical findings and a high mortality rate. On the other hand, Kasabach-Merritt syndrome is of rare onset at adult age, requiring the simultaneous presentation of vascular lesion, thrombocytopenia, and consumptive coagulopathy. We present the first reported case of both diseases in a single patient and highlight the difficulties of diagnostic. A 69-year-old woman with immune thrombocytopenic purpura underwent surgery for the removal of giant skin haemangiomas. During post-operative care, intravascular disseminated coagulopathy developed. After weeks of corticosteroids and immunosuppressive therapy with no clinical improvement, pulmonary tuberculosis was diagnosed and appropriate treatment initiated. Despite all the efforts, the patient's clinical condition kept worsening and she eventually died. An autopsy revealed bone marrow Langerhans cell histiocytosis. In this case, the patient's autoimmune background together with tuberculosis and intravascular disseminated coagulopathy masked the presentation and made the diagnosis of a rapidly progressive fatal disease very difficult.
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Affiliation(s)
- Joao Tiago Serra
- Department of Internal Medicine II, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - Raquel Silva
- Department of Internal Medicine II, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - Fernando Aldomiro
- Department of Internal Medicine II, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - Fernanda Paixao Duarte
- Department of Internal Medicine II, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
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Chen TW, Hung SY. A patient with hepatic angiosarcoma and Kasabach–Merritt syndrome effectively controlled by weekly paclitaxel therapy. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_30_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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