scholarly journals Rare Pseudopapillary Neoplasm of the Pancreas: A 10-Year Experience

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Suvendu Sekhar Jena ◽  
Samrat Ray ◽  
Sri Aurobindo Prasad Das ◽  
Naimish N Mehta ◽  
Amitabh Yadav ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Pancreatic Neoplasm ◽  
Clinical Manifestations ◽  
Malignant Tumour ◽  
The Body ◽  
Low Grade ◽  
Borderline Resectable ◽  
Pancreatic Tumours ◽  
Common Location ◽  
The Mean

Introduction. The solid pseudopapillary epithelial neoplasm (SPN) is a rare form of pancreatic neoplasm with an incidence of 2-3% of all pancreatic tumours. The recent increase in incidence is attributed to the increasing use of imaging techniques for nonspecific abdominal complaints. We report our institutional experience in the management of this tumour over the last decade. Method. We retrospectively analyzed from a prospectively maintained database of patients from January 2011 to December 2020 who were operated upon for SPN. All the patients were followed till date. Results. Of 479 patients operated on for various types of pancreatic tumours during this period, 15 (3.1%) had SPN. The mean age of presentation was 28 years with a female preponderance (12/15, 80%). The most common location was the body and tail of the pancreas (66%), and the mean size was 6.4 cm (2–15 cm). The tumour extent was defined as ‘borderline resectable’ in 20% of cases. Distal pancreatectomy was done in 11 patients with spleen preservation in 3. R0, R1, and R2 resection were done in 12, 2, and 1 patient(s), respectively. The operative mortality was 6.7%. All the patients are doing well on follow-up. Conclusion. SPN is a low-grade malignant tumour with a strong female predilection. Clinical manifestations have no specificity, imaging examination only contributes tumour location, and the final diagnosis rests on pathology. Surgery is the main modality of treatment and carries a good prognosis.

scholarly journals Whipple's Disease and “Tropheryma whippelii”

2001 ◽  
Vol 14 (3) ◽  
pp. 561-583 ◽  
Author(s):  
Fabrizio Dutly ◽  
Martin Altwegg
Keyword(s):  
Bacterial Species ◽  
Periodic Acid ◽  
Clinical Manifestations ◽  
The Body ◽  
Rrna Gene ◽  
Low Grade ◽  
Whipple’S Disease ◽  
Major Step ◽  
Whipple's Disease ◽  
Initial Symptoms

SUMMARY Whipple's disease is a rare bacterial infection that may involve any organ system in the body. It occurs primarily in Caucasian males older than 40 years. The gastrointestinal tract is the most frequently involved organ, with manifestations such as abdominal pain, malabsorption syndrome with diarrhea, and weight loss. Other signs include low-grade fever, lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis, seronegative arthritis, uveitis, spondylodiscitis, and neurological manifestations, and these signs may occur in the absence of gastrointestinal manifestations. Due to the wide variability of manifestations, clinical diagnosis is very difficult and is often made only years or even decades after the initial symptoms have appeared. Trimethoprim-sulfamethoxazole for at least 1 year is usually considered adequate to eradicate the infection. The microbiological diagnosis of this insidious disease is rendered difficult by the virtual lack of culture and serodiagnostic methods. It is usually based on the demonstration of periodic acid-Schiff-positive particles in infected tissues and/or the presence of bacteria with an unusual trilaminar cell wall ultrastructure by electron microscopy. Recently, the Whipple bacteria have been characterized at the molecular level by amplification of their 16S rRNA gene(s). Phylogenetic analysis of these sequences revealed a new bacterial species related to the actinomycete branch which was named “Tropheryma whippelli.” Based on its unique 16S ribosomal DNA (rDNA) sequence, species-specific primers were selected for the detection of the organism in clinical specimens by PCR. This technique is currently used as one of the standard methods for establishing the diagnosis of Whipple's disease. Specific and broad-spectrum PCR amplifications mainly but not exclusively from extraintestinal specimens have significantly improved diagnosis, being more sensitive than histopathologic analysis. However, “T. whippelii” DNA has also been found in persons without clinical and histological evidence of Whipple's disease. It is unclear whether these patients are true asymptomatic carriers or whether differences in virulence exist among strains of “T. whippelii” that might account for the variable clinical manifestations. So far, six different “T. whippelii” subtypes have been found by analysis of their 16S-23S rDNA spacer region. Further studies of the pathogen “T. whippelii” as well as the host immune response are needed to fully understand this fascinating disease. The recent cultivation of the organisms is a promising major step in this direction.

scholarly journals FRACTURES OF THE MANDIBLE AT THE BODY AND ANGLE REGION: PATTERNS, EPIDEMIOLOGY, DIAGNOSTIC PRINCIPLES. PART I

2017 ◽  
Vol 21 (2) ◽  
pp. 100-103
Author(s):  
Sh. Chzhan ◽  
P. S Petruk ◽  
Yu. A Medvedev
Keyword(s):  
Successful Treatment ◽  
Imaging Techniques ◽  
Clinical Manifestations ◽  
Detailed Examination ◽  
Accurate Diagnosis ◽  
The Body ◽  
Mandibular Fractures ◽  
Relevant Today ◽  
Treatment And Prevention ◽  
Key Points

The article reflects the aspects of epidemiology and principles of diagnosis in mandibular fractures. The problem remains relevant today. Due to the complexity of the mechanisms of the injury and their acceptance, a variety of clinical manifestations, the limited knowledge of the patients about their injury, the diagnosis and treatment of these injuries sometimes are difficult. Detailed examination with modern imaging techniques and accurate diagnosis are the key points in successful treatment and prevention of complications in this category of patients.

Supracerebellar infratentorial endoscopically controlled resection of pineal lesions: case series and operative technique

2011 ◽  
Vol 8 (6) ◽  
pp. 554-564 ◽  
Author(s):  
Timothy Uschold ◽  
Adib A. Abla ◽  
David Fusco ◽  
Ruth E. Bristol ◽  
Peter Nakaji
Keyword(s):  
Single Case ◽  
Clinical Manifestations ◽  
Case Series ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Who Grade ◽  
Estimated Blood Loss ◽  
The Mean

Object The heterogeneous clinical manifestations and operative characteristics of pathological entities in the pineal region represent a significant challenge in terms of patient selection and surgical approach. Traditional surgical options have included endoscopic transventricular resection; open supratentorial microsurgical approaches through the midline, choroidal fissure, lateral ventricle, and tentorium; and supracerebellar infratentorial (SCIT) approaches through the posterior fossa. The object of the current study was to review the preoperative characteristics and outcomes for a cohort of patients treated purely via the novel endoscopically controlled SCIT approach. Methods A single-institution series of 9 consecutive patients (4 male and 5 female patients [10 total cases]; mean age 21 years, range 6–37 years) treated via the endoscopically controlled SCIT approach for a pathological entity in the pineal region was retrospectively reviewed. The mean follow-up time was 13.2 months. Results The endoscopically controlled SCIT approach was successfully used to approach a variety of pineal lesions, including pineal cysts (6 patients), epidermoid tumor, WHO Grade II astrocytoma (initial biopsy and recurrence), and malignant mixed germ cell tumor (1 patient each). Gross-total resection and/or adequate cyst fenestration was achieved in 8 cases. Biopsy with conservative debulking was performed for the single case of low-grade astrocytoma and again at the time of recurrence. The mean preoperative tumor and cyst volumes were 9.9 ± 4.4 and 3.7 ± 3.2 cm3, respectively. The mean operating times were 212 ± 71 minutes for tumor cases and 177 ± 72 minutes for cysts. Estimated blood loss was less than 150 ml for all cases. A single case (pineal cyst) was converted to an open microsurgical approach to enhance visualization. There were no operative complications, as well as no documented CSF leaks, additional CSF diversion procedures, or air emboli. Seven patients underwent concomitant third ventriculostomy into the quadrigeminal cistern. At the time of the last follow-up evaluation, all patients had a stable or improved modified Rankin Scale score. Conclusions The endoscopically controlled SCIT approach may be used for the biopsy and resection of appropriately selected solid tumors of the pineal region, in addition to the fenestration and/or resection of pineal cysts. Preoperative considerations include patient presentation, anticipated disease and vascularity, degree of local venous anatomical distortion, and selection of optimal paramedian trajectory.

scholarly journals Elevated Erythropoietin and Multicystic Neoplasm of the Pancreas

2015 ◽  
Vol 8 (1) ◽  
pp. 148-152 ◽  
Author(s):  
Qiang Nai ◽  
Kalyani Regeti ◽  
Sabrina Arshed ◽  
Mohammed Amzad Hossain ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Malignant Transformation ◽  
Early Recognition ◽  
Imaging Techniques ◽  
Pancreatic Neoplasm ◽  
Malignant Potential ◽  
The Body ◽  
Cystic Neoplasm ◽  
Cystic Lesions ◽  
Clinical Presentations ◽  
Precise Diagnosis

Cystic lesions of the pancreas are more frequently recognized due to the widespread use of improved imaging techniques. There are a variety of pancreatic cystic lesions with different clinical presentations and malignant potentials, and their management depends on the type of the cysts. Although the early recognition of a cystic neoplasm with malignant potential provides an opportunity of early surgical treatment, the precise diagnosis of the cystic neoplasm can be a challenge, largely due to the lack of reliable biomarkers of malignant transformation. We report a case of a large, multicystic neoplasm within the body and tail of the pancreas complicated by elevated erythropoietin, which is likely related to the malignant transformation of the pancreatic neoplasm.

scholarly journals Effect of the reconstructed sagittal balance on outcomes in the elderly with degenerative low‑grade spondylolisthesis: single center four-year cohort study

2020 ◽  
Vol 26 (4) ◽  
pp. 555-564
Author(s):  
V.S. Klimov ◽  
◽  
I.I. Vasilenko ◽  
S.O. Ryabykh ◽  
E.V. Amelina ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Sagittal Balance ◽  
Degenerative Spondylolisthesis ◽  
The Body ◽  
Low Grade ◽  
Compensatory Mechanism ◽  
Single Center ◽  
The Mean ◽  
Segmental Lordosis

Objective To explore the effect of surgical reconstruction of the local sagittal balance on the outcomes and quality of life in elderly with degenerative low-grade spondylolisthesis. Design: a retrospective non-randomized single center cohort study. Material and methods This article reviewed 110 elderly patients (91 (82.7 %) females and 19 (17.3 %) males) with degenerative spondylolisthesis who underwent surgical treatment at the Federal State Medical Center, Novosibirsk. The mean age was 66 years (range, 60 to 83 years). Radiography, spiral computed tomography, MRI of the lumbar spine were performed for all patients who were also asked to use the visual analog scale and the Oswestry disability index (ODI). Sagittal spino-pelvic radiographic parameters including PI, SS, PT, LL, SL (Segmental Lordosis), LL4–S1 (Lordosis L4–S1) were measured and related to age. Global lumbar lordosis measurements were made using the formula: LL = 0.54 × PI + 27.6°. Comorbidity assessment was produced with the body mass index (BMI) and the Charlson Comorbidity Index (CCI). Patients were subdivided into three groups according to the severity of the sagittal imbalance as described by Barrey: (1) balanced, (2) balanced with compensatory mechanisms and (3) imbalanced, and their outcomes evaluated. Results Increased body weight was observed in 97.3 % of patients. The mean BMI was 33.7. A comorbid condition was detected in all patients (n = 110). The mean CCI was 57.4 %. The mean PI was 57.4°. Most of patients (n = 95, 86.4 %) had significant segmental imbalance due to the loss of segmental lordosis at the lower lumbar motion segments. Pelvic retroversion was identified as the compensatory mechanism in the pelvis area in 95 % of patients with measurements of PT based on the available PI. A statistically significant increase in LL4-S1 was observed in the groups due to reduction of spondylolisthesis and restoration of the segmental lordosis. A statistically significant increase in LL was observed in the imbalanced group only. No statistically significant differences in ODI scores were observed in TLIF and ALIF/LLIF patients. Complications graded in the Clavien-Dindo classification were identified in 65 (59 %) cases with greater complication rate in TLIF patients (n = 59, 69 %), as compared to ALIF/LLIF (n = 6, 24 %). From them, 5 (0.5 %) were graded IIIB. Conclusion Differentiated use of surgical technologies and MIS is the method of choice for elderly patients with comorbidities. Patients with compensated sagittal balance can benefit from direct spinal canal decompression, reduction and stabilization of degenerative spondylolisthesis using the posterior approach. Treatment of patients with impaired spino-pelvic balance should be aimed at reduction and restoration of the segmental lordosis (SL) using lordotic cages to ensure good clinical and radiological results.

Does treatment approach for small renal masses affect survival in patients 70 years old?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 658-658
Author(s):  
Lukas Hockman ◽  
Tyler Haden ◽  
Alex Henderson ◽  
Naveen Pokala
Keyword(s):  
Overall Survival ◽  
Tumor Size ◽  
Cox Regression ◽  
Imaging Techniques ◽  
Low Grade ◽  
Small Renal Masses ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Significant Difference ◽  
The Mean

658 Background: With the advent of modern imaging techniques small renal masses are being diagnosed more frequently. Many of these masses are benign, and those that are malignant are often low grade and rarely affect the survival. Surveillance is more commonly being advocated as an option for these masses. This study elucidates survival following different treatment approaches. Methods: SEER 18 data from 2004-13 identified 10,477 patients 70 years and older with renal cell carcinoma and tumors greater than or equal to 3 cm. Exclusion criteria included multiple primaries, distant metastasis and node positive disease. Data was collected on demographics, treatment patterns, overall survival and cancer specific survival. Kaplan-Meier analysis and Cox regression models were used to compare outcomes. Results: After exclusion 5084 patients remained. The mean age was 76.4 years. The mean tumor size was 2.3cm. Tumor laterality was right in 2610, left in 2467, bilateral in 2 and unspecified in 5. Racial analysis identified 84% of patients as white, 9% as black and 7% as other. Gender split was 51% male. Treatment methods included 791 ablations and 3324 surgical resections (radical or partial nephrectomy). The remaining 969 patients did not have treatment (surveillance). Survival was measured at 60 and 118 months. The overall survival was 75% and 54% respectively for ALL patients, 82% and 62% for ablation, 42% and 19% for surveillance and 82% and 62% for resection. Cancer specific survival was 97% and 96% for ablation, 83% and 74% for surveillance and 96% and 94% for resection. Surgical resection or ablation significantly improved survival at 5 and 10 years (p = < 0.0001). Multivariate analysis showed survival was affected by age and year of diagnosis, but not by tumor size. Conclusions: The significant difference in overall survival suggests appropriate selection of patients for surveillance based on medical comorbidities. Treatment with curative intent improves survival in patients with greater than or equal to 3 cm renal masses, even in patients 70 years and older, and must be offered to patients without significant comorbidities.

scholarly journals Thinking about the misdiagnosis: A case report of intra-abdominal desmoid-type fibromatosis and literature review

2020 ◽  
Author(s):  
XuChang He ◽  
Wenhui An ◽  
Qingbin Zeng ◽  
Kui Long ◽  
Wenzhi Dong ◽  
...  
Keyword(s):  
Preoperative Diagnosis ◽  
Abdominal Mass ◽  
Abdominal Cavity ◽  
The Body ◽  
Low Grade ◽  
Mesenchymal Progenitor Cells ◽  
Treatment Needs ◽  
Stromal Tumors ◽  
Common Location ◽  
Low Incidence

Abstract Background Desmoid-type fibromatosis is a low grade soft tissue sarcoma that derives from mesenchymal progenitor cells. Without characteristics of imaging, desmoid-type fibromatosis often confused with stromal tumors clinically. The disease characterized by local invasiveness and local recurrence but rare do metastasize. It can occur anywhere in the body. Most common location is the abdominal wall, nearly 30%~50% in all cases. It can also occur in the abdominal cavity, with a low incidence. At present, all types of desmoid-type fibromatosis follow the treatment consensus of extra-abdominal type. However, because of the difficulty in preoperative diagnosis, sometimes it is hard to choose the appropriate treatment. Case presentation We describe the case of a 22-years-old woman, who was diagnosed with an abdominal mass . She was a healthy individual who was incidentally diagnosed with abdominal mass. The mass was under the suspicion of gastrointestinal stromal tumors in a local hospital, according to the result of MRI scan. A CT scan of her abdomen showed a huge hypoechoic mass in the hepatic. Under misdiagnosis as hemangioma of liver in our hospital, she underwent a laparoscopic resection of the tumor . Postoperatively, the tumor was confirmed to be a desmoid-type fibromatosis by patholgical and immunohistochemical findings. Conclusions In conclusion, due to the high risk of recurrence, the diagnosis before treatment is the most important part in the management of desmoid-type fibromatosis. Even if it is rare, DF should also be included in the differential diagnosis. Treatment needs to be evaluated according to the location of the lesion. For lesions on the body surface, pathologic examination will be safer and more useful. Surgery is still one of the best choice for intra-abdominal desmoid-type fibromatosis patients. Meanwhile, in order to change the operation in time, the clinicals should keep a rigorous attitude in surgery, if preoperative diagnosis is difficult.

scholarly journals Multidetector computed tomography study to measure thoracic aorta diameters in Egyptian population

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ahmed Shehata Mohamed Ismail ◽  
Shareefa Ali Mohammad Al-Suraimi ◽  
Hossam El Din Ghanem El Hossary ◽  
Mohamed Ali Salem ◽  
Hossam Ibrahim Hamed Kandil
Keyword(s):  
Wide Spectrum ◽  
Imaging Techniques ◽  
Reference Value ◽  
The Body ◽  
Aortic Diseases ◽  
Computed Tomographic ◽  
Egyptian Population ◽  
Normal Reference ◽  
Study Population ◽  
The Mean

Abstract Background The aorta is the largest and strongest artery in the body that plays an important role in the control of systemic vascular resistance and heart rate. Aortic diseases contribute to the wide spectrum of arterial diseases that may be diagnosed after a long period of subclinical development. Multidetector computed tomographic scanners (≥ 64 detector rows) for aortic imaging remain one of the most preferred imaging techniques for diagnosis and follow-up of aortic conditions in acute as well as chronic presentations. The aim of this study is to establish a normal reference values for aortic diameters among Egyptian population and to find which of the cardiovascular risk factors could be an independent determinant of the aortic diameters. Results Five hundred and sixteen Egyptian individuals were enrolled in our study, the mean age was 53.5 ± 10.9, and males comprised 61.4% of the study population. Aortic root diameters measured at the annulus, sinus and STJ were 23.09 ± 2.55 mm, 33.75 ± 3.93 mm and 26.13 ± 3.05 mm, respectively. The BSA-indexed diameters were 11.70 ± 1.39, 17.10 ± 2.10 and 13.25 ± 1.65, respectively. The diameter of the tubular part of ascending aorta was 30.97 ± 4.16 mm, and the BSA-indexed diameter was 15.71 ± 2.28. The aortic diameters measured at the level of the pulmonary bifurcation were 24.56 ± 2.95 mm and 23.79 ± 2.96 mm at systolic and diastolic phases, respectively. The BSA-indexed diameters were 12.44 ± 1.52 and 12.05 ± 1.52 at systolic and diastolic phases, respectively. At the diaphragmatic level, the mean diameters were 22.39 ± 2.72 mm and 21.49 ± 2.79 mm at systolic and diastolic phases, respectively. The BSA-indexed diameters were 11.34 ± 1.43 and 10.98 ± 1.48 at systolic and diastolic phases, respectively. Age, gender, BSA, BMI and hypertension were statistically significant independent predictors of ascending and descending aortic diameters. Conclusions Our study established a normal reference value for thoracic aortic diameters among Egyptians using contrast enhanced MSCT aortography. Age, Gender, BSA, BMI and hypertension are the major determinants of aortic diameters.

scholarly journals Study of Location and Staging of Tumours in Patients of Gastric Carcinoma at a Tertiary Hospital

2020 ◽  
Vol 11 (3) ◽  
pp. 4499-4502
Author(s):  
AvinashRinait ◽  
Yashwant Lamture R ◽  
Pulavarty Prateek ◽  
Dilip Gode
Keyword(s):  
Gastric Carcinoma ◽  
Early Stage ◽  
Tertiary Hospital ◽  
The Body ◽  
Stage Ii ◽  
Common Location ◽  
Male Patients ◽  
The Mean ◽  
A Prospective Study ◽  
Stage 1

Cancer is also known as the captain of death for humanity. It ranks second only after heart disease leading to death worldwide. In India, the incidence of gastric cancer is considered low and variable in different parts of the world. Gastric carcinoma plays an essential role in determining its management also its location gives some idea about the etiopathogenesis; hence this study was undertaken to study the situation and staging of tumours in patients of gastric carcinoma. This was a prospective study in which 50 patients of gastric adenocarcinoma admitted in the department of surgery at a tertiary hospital were studied. Out of 50 patients studied, 36 were males, and 14 were females. Even though the mean age for male patients is slightly higher than female patients (62 versus 60), the most common location of the tumour was the antrum (88%) followed by the cardia (6%) while the body had just 4% of the tumours and 2% of the tumours were diffused. The most common stage for tumours was stage II (88%), followed by stage III (12%). There were no tumours in stage 1 and IV. Most patients were males who presented in early-stage II with antrum being the most common location of the tumour.

Parotidektomi radikal pada karsinoma sel asinus parotis

2013 ◽  
Vol 40 (2) ◽  
Author(s):  
Marlinda Adham ◽  
Meila Sutanti
Keyword(s):  
Cell Carcinoma ◽  
Fine Needle Aspiration ◽  
Clinical Manifestations ◽  
Malignant Tumour ◽  
Needle Aspiration ◽  
Acinic Cell Carcinoma ◽  
Low Grade ◽  
Fine Needle ◽  
Parotid Tumour ◽  
Acinic Cell

Background: Acinic cell carcinoma is an uncommon type of parotid malignant tumour. One commonsymptom of this low grade malignancy is slowly growing parotid mass. Pain in parotid area and facialnerve paresis are important symptoms that indicate malignancy. From clinical manifestations, it is difficultto differentiate between this kind of malignancy with benign parotid tumour. Fine needle aspiration biopsyand CT scan are important in diagnosing acinic cell parotid carcinoma, and surgery is the main therapy.Purpose: We present this case to enlighten general practitioners and also otorhinolaryngologists aboutthis kind of parotid malignancy that has similar presentation with benign parotid tumour. Case: Onecase of acinic cell carcinoma of the parotis was reported. A 53 years old man was diagnosed as stage IVacinic cell carcinoma. Case management: The patient underwent radical parotidectomy. He was plannedfor chemotherapy and radiotherapy but untill now, he still refused further treatment. Conclusion: Aciniccell carcinoma is one of malignant tumour that has a good prognosis, especially if diagnosed early andadequately treated.Key words: malignant parotid tumour, acinic cell carcinoma, fine needle aspiration biopsy,parotidectomy.Abstrak : Latar belakang: Karsinoma sel asinus adalah salah satu tipe keganasan kelenjar liur yang jarang sekaliterjadi. Karsinoma ini bersifat low grade yang ditandai oleh benjolan pada daerah parotis yang tumbuhsecara lambat. Dari pemeriksaan klinis, keganasan ini sulit dibedakan dengan tumor jinak. Salah satugejala yang membedakan dari tumor jinak adalah rasa nyeri dan paresis nervus fasialis. Pemeriksaan biopsiaspirasi jarum halus dan tomografi komputer dapat menegakkan diagnosis karsinoma parotis jenis ini.Terapi utamanya adalah parotidektomi. Tujuan: Kasus ini diajukan agar para dokter umum dan dokterspesialis Telinga, Hidung, Tenggorok dapat mengenali adanya karsinoma parotis yang bermanifestasiklinis seperti tumor jinak ini. Kasus: Dilaporkan satu pasien, laki-laki berusia 53 tahun yang didiagnosiskarsinoma sel asinus kelenjar parotis stadium IV. Penatalaksanaan: Pada pasien ini dilakukan operasiparotidektomi radikal dan direncanakan untuk radiasi dan kemoterapi. Sampai saat ini, pasien masihmenolak untuk tatalaksana lebih lanjut pascabedah.Kesimpulan: Karsinoma sel asinus merupakan kasuskeganasan yang memiliki prognosis baik, terutama jika didiagnosis dini dan diterapi secara adekuat.Kata kunci: tumor ganas parotis, sel asinus, biopsi aspirasi jarum halus, parotidektomi.

Sign in / Sign up

Export Citation Format

Share Document