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A Rare Case of Malignant Tumor of the Larynx with Good Prognosis: Laryngeal Chondrosarcoma

A Rare Case of Malignant Tumor of the Larynx with Good Prognosis: Laryngeal Chondrosarcoma Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 9468194, 4 pages https://doi.org/10.1155/2019/9468194 Case Report A Rare Case of Malignant Tumor of the Larynx with Good Prognosis: Laryngeal Chondrosarcoma 1 1 2 3 Abderrahim Elktaibi , Issam Rharrassi, Nabil Hammoune, Youssef Darouassi, 3 3 Mohammed Amine Hanine, and Haddou Ammar Department of Pathology, Avicenne Military Hospital, Marrakech, Morocco Department of Radiology, Avicenne Military Hospital, Marrakech, Morocco Department of Otolaryngology, Avicenne Military Hospital, Marrakech, Morocco Correspondence should be addressed to Abderrahim Elktaibi; ab.elktaibi@gmail.com Received 16 December 2018; Accepted 14 April 2019; Published 5 May 2019 Academic Editor: Jose I. Mayordomo Copyright © 2019 Abderrahim Elktaibi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Laryngeal chondrosarcoma is a rare laryngeal tumor that most frequently originates from the cricoid cartilage. The majority of lesions are low grade and the distinction from benign chondromas must be made. We present a case of a laryngeal chondrosarcoma arising from the cricoid cartilage in a 75-year-old Arab man who presented with hoarseness, dysphonia, and dyspnea. Endoscopic and radiological examinations showed a mass of the wall of his larynx with displaced structures, airway obstruction, and destruction of the cartilage. The patient underwent total laryngectomy. Histological examination supported the diagnosis of low-grade chondrosarcoma. Five months later, the radiological and clinical findings showed no evidence of recurrence or metastases. Laryngeal chondrosarcomas remain a rare disease of unknown etiology, with slow and insidious symptoms. The treatment is surgical, given the importance of preserving the larynx to patients’ quality of life. The prognosis is favorable and metastases rarely occur. 1. Introduction 2. Case Presentation A 75-year-old Arab male, chronic smoker, presented with a Chondrosarcoma of the larynx is a rare tumor represent- history of progressive dysphonia, hoarseness, airway obstruc- ing about 1% of all laryngeal neoplasms [1]. It was first tion, and worsening odynophagia over a 6-month period. described by Travers in 1816 [2], but the term chondro- The direct laryngoscopic test showed a left paramedian glot- sarcoma at this site was introduced by New in 1935 [3]. tic and subglottic tumefaction, surrounded by intact mucosa The diagnosis requires clinical, histological, and radio- and fixed homolateral hemilarynx. No adenopathy was graphic correlation. It typically exhibits low-grade histol- found in the laterocervical region. The patient underwent ogy, with fairly indolent progression and a relatively low neck computed tomography (CT) which showed a large mass probability of metastatic potential or recurrence. For this of glottic and subglottic plan lateralized on the left measuring reason, conservative surgical excision with negative mar- 5×3 5 cm containing calcifications, causing a retraction of gins is recommended [4]. We present a case of laryngeal the laryngeal diameter and destruction of the cricoid cartilage chondrosarcoma from the cricoid cartilage in a patient (Figure 1). No infiltration of adjacent surgical plans and no who presented with hoarseness and dyspnea and cervicofa- adenopathies were detected. Gross pathology from a biopsy cial computed tomography scan, revealing a large tumor of mass consisted of numerous fragments of soft tissue, with requiring total laryngectomy. 2 Case Reports in Oncological Medicine Figure 1: Computed tomography of the head and neck showed a subglottic mass containing calcifications and causing airway obstruction (star). Figure 2: Mildly cellular field with predominantly small mono- and binucleated chondrocytes with ample cytoplasm, consistent with low grade (grade 1). Haematoxylin & eosin staining; medium power magnification ×250. firm consistency, roughened, and semitranslucent cut sur- of a myxoid matrix and any areas of necrosis. These findings faces. Histological examination of the biopsy showed hyaline are diagnostic of a low-grade (grade 1 of 3) chondrosarcoma cartilage comprised of lobules of binucleated chondrocytes of the larynx. On the basis of the histological and radiological with increased nucleus to cytoplasmic ratios (Figure 2). examinations performed, the patient underwent total laryn- Mitotic activity was not identified. There was no evidence gectomy (Figure 3). The final histological examination Case Reports in Oncological Medicine 3 Figure 3: Macroscopic appearance of the laryngectomy showing a translucent tumor of the larynx. confirmed the diagnosis of a well-differentiated grade 1 laryngeal chondrosarcomas are histologically low grade, chondrosarcoma of the larynx. The patient was followed up and imaging does not always definitively differentiate a grade 1 chondrosarcoma from a benign chondroma, knowing that for 5 months without any sign of recurrence or metastases. these two lesions can be associated with 62% of cases [4]. Invasion into adjacent soft tissue or bone may be present. 3. Discussion Macroscopically, tumor ranges in size from less than 1 cm Laryngeal chondrosarcoma is a rare tumor, accounting for to up to 10 cm. The specimen is often received fragmented less than 1% of all sarcomas of the body. The tumor most and it consistently shows smooth, lobular, and translucent commonly occurs from the cricoid cartilage and less fre- tissue portions [5]. The histological diagnosis is based on quently from the arytenoid and thyroid cartilage [5]. The the criteria for cartilaginous malignancies reported by Lich- etiology of laryngeal chondrosarcoma is imprecise, but it tenstein and Jaffe in 1943 [8]. There are three different grades seems to result from disordered ossification of the laryngeal of chondrosarcoma: cartilage [6]. The current data do not show a causal relation- (i) Grade 1: similar to a chondroma, more than two ship with smoking or alcohol consumption [1]. The mean nuclei, no mitoses, some areas of calcification and age at diagnosis is 60 to 64 years, with a male predominance actual bone tissue (70–80% of cases) [7]. The symptoms are variable depending on the location of the mass and include hoarseness (most patients) caused by (ii) Grade 2: increase in cell number, low nuclear/cyto- narrowing of the glottic plane and compression of the infe- plasmic ratio, scarce mitoses (10–15% of cases) rior laryngeal nerves; dyspnea and airway obstruction due to endolaryngeal growth; dysphagia due to extralaryngeal (iii) Grade 3: multinucleated cells, increased nuclear/ growth, originating in the posterior cricoid; and neck mass cytoplasmic ratio, high number of mitoses (5– due to tumor involvement of the thyroid cartilage [6]. Imag- 10% of cases) ing, including CT, MRI, or X-ray, has a major contribution for the suggestion of a chondroid neoplasm. An expansive About 80% of laryngeal chondrosarcomas are low grade lesion with variable density and characteristic “popcorn” and are usually well differentiated with a less aggressive pat- tern compared to chondrosarcoma at the more common calcifications is usually observed [1]. The majority of 4 Case Reports in Oncological Medicine [8] L. Lichtenstein and H. Jaffe, “Chondrosarcoma of bone,” sites, mainly the pelvis, long bones, sternum, and ribs [9]. American Journal of Pathology, vol. 19, no. 4, pp. 553–589, The initial treatment of chondrosarcoma of the larynx is sur- gery [10]. The goal is to obtain total excision with negative [9] R. J. Baatenburg de Jong, S. van Lent, and P. C. W. Hogen- margins [11]. For low-grade tumors, the therapeutic modal- doorn, “Chondroma and chondrosarcoma of the larynx,” Cur- ities include CO laser resection, hemicricoidectomy, or rent Opinion in Otolaryngology & Head and Neck Surgery, hemilaryngectomy. For high-grade tumors and recurrences, vol. 12, no. 2, pp. 98–105, 2004. the treatment of choice is total laryngectomy. When cricoi- [10] A. Rinaldo, D. J. Howard, and A. Ferlito, “Laryngeal chondro- dectomy is performed, laryngotracheal anastomosis or sarcoma: a 24-year experience at the Royal National Throat, reconstruction by flap is used to close the defect. The effec- Nose and Ear Hospital,” Acta Oto-laryngologica, vol. 120, tiveness of radiotherapy is still controversial. Chemotherapy no. 6, pp. 680–688, 2000. has no therapeutic interest [12]. According to the data of [11] Z. Gil and D. M. Fliss, “Contemporary management of head the literature, the rate of tumor recurrence varies from 18 and neck cancers,” The Israel Medical Association Journal, to 40% [1]. Nevertheless, the long-term prognosis of laryn- vol. 11, no. 5, pp. 296–300, 2009. geal chondrosarcoma is good (95%, 10-year survival) [1]. [12] S. Gripp, H. Pape, and G. Schmitt, “Chondrosarcoma of the Metastatic potential is rare in grade 1 chondrosarcomas and larynx: the role of radiotherapy revisited – a case report and seen in only 10% of grade 2 lesions [4]. A study of 111 cases review of the literature,” Cancer, vol. 82, no. 1, pp. 108–115, conducted by the Armed Forces Institute of Pathology revealed that only 1.9% of cases had developed metastases [5]. For this reason, conservative therapy is the treatment of choice. Total laryngectomy is reserved for large tumors in which surgery would cause destabilization of the cricoid cartilage [6]. Consent Consent was obtained from the patient for the publication of materials related to this study. Conflicts of Interest The authors declare that there are no conflicts of interest regarding the publication of this paper. References [1] I. Buda, R. Hod, R. Feinmesser, and J. Shvero, “Chondrosar- coma of the larynx,” The Israel Medical Association Journal, vol. 14, no. 11, pp. 681–684, 2012. [2] F. Travers, “A Caseof Ossification and Bony Growth of the Cartilages of the Larynx, Preventing Deglutition,” Journal of the Royal Society of Medicine, vol. MCT-7, no. 1, pp. 150– 153, 1816. [3] G. B. New, “Sarcoma of the larynx: report of two cases,” Archives of otolaryngology, vol. 21, no. 6, pp. 648–652, 1935. [4] E. M. Potochny and A. R. Huber, “Laryngeal chondrosar- coma,” Head and Neck Pathology, vol. 8, no. 1, pp. 114–116, [5] L. D. R. Thompson and F. H. Gannon, “Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature,” American Journal of Surgical Pathology, vol. 26, no. 7, pp. 836–851, 2002. [6] O. Casiraghi, F. Martinez-Madrigal, K. Pineda-Daboin, G. Mamelle, L. Resta, and M. A. Luna, “Chondroid tumors of the larynx: a clinicopathologic study of 19 cases, including two dedifferentiated chondrosarcomas,” Annals of Diagnostic Pathology, vol. 8, no. 4, pp. 189–197, 2004. [7] Q. Wang, H. Chen, and S. Zhou, “Chondrosarcoma of the lar- ynx: report of two cases and review of the literature,” Interna- tional Journal of Clinical and Experimental Pathology, vol. 8, no. 2, pp. 2068–2073, 2015. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

A Rare Case of Malignant Tumor of the Larynx with Good Prognosis: Laryngeal Chondrosarcoma

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Copyright © 2019 Abderrahim Elktaibi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 9468194, 4 pages https://doi.org/10.1155/2019/9468194 Case Report A Rare Case of Malignant Tumor of the Larynx with Good Prognosis: Laryngeal Chondrosarcoma 1 1 2 3 Abderrahim Elktaibi , Issam Rharrassi, Nabil Hammoune, Youssef Darouassi, 3 3 Mohammed Amine Hanine, and Haddou Ammar Department of Pathology, Avicenne Military Hospital, Marrakech, Morocco Department of Radiology, Avicenne Military Hospital, Marrakech, Morocco Department of Otolaryngology, Avicenne Military Hospital, Marrakech, Morocco Correspondence should be addressed to Abderrahim Elktaibi; ab.elktaibi@gmail.com Received 16 December 2018; Accepted 14 April 2019; Published 5 May 2019 Academic Editor: Jose I. Mayordomo Copyright © 2019 Abderrahim Elktaibi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Laryngeal chondrosarcoma is a rare laryngeal tumor that most frequently originates from the cricoid cartilage. The majority of lesions are low grade and the distinction from benign chondromas must be made. We present a case of a laryngeal chondrosarcoma arising from the cricoid cartilage in a 75-year-old Arab man who presented with hoarseness, dysphonia, and dyspnea. Endoscopic and radiological examinations showed a mass of the wall of his larynx with displaced structures, airway obstruction, and destruction of the cartilage. The patient underwent total laryngectomy. Histological examination supported the diagnosis of low-grade chondrosarcoma. Five months later, the radiological and clinical findings showed no evidence of recurrence or metastases. Laryngeal chondrosarcomas remain a rare disease of unknown etiology, with slow and insidious symptoms. The treatment is surgical, given the importance of preserving the larynx to patients’ quality of life. The prognosis is favorable and metastases rarely occur. 1. Introduction 2. Case Presentation A 75-year-old Arab male, chronic smoker, presented with a Chondrosarcoma of the larynx is a rare tumor represent- history of progressive dysphonia, hoarseness, airway obstruc- ing about 1% of all laryngeal neoplasms [1]. It was first tion, and worsening odynophagia over a 6-month period. described by Travers in 1816 [2], but the term chondro- The direct laryngoscopic test showed a left paramedian glot- sarcoma at this site was introduced by New in 1935 [3]. tic and subglottic tumefaction, surrounded by intact mucosa The diagnosis requires clinical, histological, and radio- and fixed homolateral hemilarynx. No adenopathy was graphic correlation. It typically exhibits low-grade histol- found in the laterocervical region. The patient underwent ogy, with fairly indolent progression and a relatively low neck computed tomography (CT) which showed a large mass probability of metastatic potential or recurrence. For this of glottic and subglottic plan lateralized on the left measuring reason, conservative surgical excision with negative mar- 5×3 5 cm containing calcifications, causing a retraction of gins is recommended [4]. We present a case of laryngeal the laryngeal diameter and destruction of the cricoid cartilage chondrosarcoma from the cricoid cartilage in a patient (Figure 1). No infiltration of adjacent surgical plans and no who presented with hoarseness and dyspnea and cervicofa- adenopathies were detected. Gross pathology from a biopsy cial computed tomography scan, revealing a large tumor of mass consisted of numerous fragments of soft tissue, with requiring total laryngectomy. 2 Case Reports in Oncological Medicine Figure 1: Computed tomography of the head and neck showed a subglottic mass containing calcifications and causing airway obstruction (star). Figure 2: Mildly cellular field with predominantly small mono- and binucleated chondrocytes with ample cytoplasm, consistent with low grade (grade 1). Haematoxylin & eosin staining; medium power magnification ×250. firm consistency, roughened, and semitranslucent cut sur- of a myxoid matrix and any areas of necrosis. These findings faces. Histological examination of the biopsy showed hyaline are diagnostic of a low-grade (grade 1 of 3) chondrosarcoma cartilage comprised of lobules of binucleated chondrocytes of the larynx. On the basis of the histological and radiological with increased nucleus to cytoplasmic ratios (Figure 2). examinations performed, the patient underwent total laryn- Mitotic activity was not identified. There was no evidence gectomy (Figure 3). The final histological examination Case Reports in Oncological Medicine 3 Figure 3: Macroscopic appearance of the laryngectomy showing a translucent tumor of the larynx. confirmed the diagnosis of a well-differentiated grade 1 laryngeal chondrosarcomas are histologically low grade, chondrosarcoma of the larynx. The patient was followed up and imaging does not always definitively differentiate a grade 1 chondrosarcoma from a benign chondroma, knowing that for 5 months without any sign of recurrence or metastases. these two lesions can be associated with 62% of cases [4]. Invasion into adjacent soft tissue or bone may be present. 3. Discussion Macroscopically, tumor ranges in size from less than 1 cm Laryngeal chondrosarcoma is a rare tumor, accounting for to up to 10 cm. The specimen is often received fragmented less than 1% of all sarcomas of the body. The tumor most and it consistently shows smooth, lobular, and translucent commonly occurs from the cricoid cartilage and less fre- tissue portions [5]. The histological diagnosis is based on quently from the arytenoid and thyroid cartilage [5]. The the criteria for cartilaginous malignancies reported by Lich- etiology of laryngeal chondrosarcoma is imprecise, but it tenstein and Jaffe in 1943 [8]. There are three different grades seems to result from disordered ossification of the laryngeal of chondrosarcoma: cartilage [6]. The current data do not show a causal relation- (i) Grade 1: similar to a chondroma, more than two ship with smoking or alcohol consumption [1]. The mean nuclei, no mitoses, some areas of calcification and age at diagnosis is 60 to 64 years, with a male predominance actual bone tissue (70–80% of cases) [7]. The symptoms are variable depending on the location of the mass and include hoarseness (most patients) caused by (ii) Grade 2: increase in cell number, low nuclear/cyto- narrowing of the glottic plane and compression of the infe- plasmic ratio, scarce mitoses (10–15% of cases) rior laryngeal nerves; dyspnea and airway obstruction due to endolaryngeal growth; dysphagia due to extralaryngeal (iii) Grade 3: multinucleated cells, increased nuclear/ growth, originating in the posterior cricoid; and neck mass cytoplasmic ratio, high number of mitoses (5– due to tumor involvement of the thyroid cartilage [6]. Imag- 10% of cases) ing, including CT, MRI, or X-ray, has a major contribution for the suggestion of a chondroid neoplasm. An expansive About 80% of laryngeal chondrosarcomas are low grade lesion with variable density and characteristic “popcorn” and are usually well differentiated with a less aggressive pat- tern compared to chondrosarcoma at the more common calcifications is usually observed [1]. The majority of 4 Case Reports in Oncological Medicine [8] L. Lichtenstein and H. Jaffe, “Chondrosarcoma of bone,” sites, mainly the pelvis, long bones, sternum, and ribs [9]. American Journal of Pathology, vol. 19, no. 4, pp. 553–589, The initial treatment of chondrosarcoma of the larynx is sur- gery [10]. The goal is to obtain total excision with negative [9] R. J. Baatenburg de Jong, S. van Lent, and P. C. W. Hogen- margins [11]. For low-grade tumors, the therapeutic modal- doorn, “Chondroma and chondrosarcoma of the larynx,” Cur- ities include CO laser resection, hemicricoidectomy, or rent Opinion in Otolaryngology & Head and Neck Surgery, hemilaryngectomy. For high-grade tumors and recurrences, vol. 12, no. 2, pp. 98–105, 2004. the treatment of choice is total laryngectomy. When cricoi- [10] A. Rinaldo, D. J. Howard, and A. Ferlito, “Laryngeal chondro- dectomy is performed, laryngotracheal anastomosis or sarcoma: a 24-year experience at the Royal National Throat, reconstruction by flap is used to close the defect. The effec- Nose and Ear Hospital,” Acta Oto-laryngologica, vol. 120, tiveness of radiotherapy is still controversial. Chemotherapy no. 6, pp. 680–688, 2000. has no therapeutic interest [12]. According to the data of [11] Z. Gil and D. M. Fliss, “Contemporary management of head the literature, the rate of tumor recurrence varies from 18 and neck cancers,” The Israel Medical Association Journal, to 40% [1]. Nevertheless, the long-term prognosis of laryn- vol. 11, no. 5, pp. 296–300, 2009. geal chondrosarcoma is good (95%, 10-year survival) [1]. [12] S. Gripp, H. Pape, and G. Schmitt, “Chondrosarcoma of the Metastatic potential is rare in grade 1 chondrosarcomas and larynx: the role of radiotherapy revisited – a case report and seen in only 10% of grade 2 lesions [4]. A study of 111 cases review of the literature,” Cancer, vol. 82, no. 1, pp. 108–115, conducted by the Armed Forces Institute of Pathology revealed that only 1.9% of cases had developed metastases [5]. For this reason, conservative therapy is the treatment of choice. Total laryngectomy is reserved for large tumors in which surgery would cause destabilization of the cricoid cartilage [6]. Consent Consent was obtained from the patient for the publication of materials related to this study. Conflicts of Interest The authors declare that there are no conflicts of interest regarding the publication of this paper. References [1] I. Buda, R. Hod, R. Feinmesser, and J. Shvero, “Chondrosar- coma of the larynx,” The Israel Medical Association Journal, vol. 14, no. 11, pp. 681–684, 2012. [2] F. Travers, “A Caseof Ossification and Bony Growth of the Cartilages of the Larynx, Preventing Deglutition,” Journal of the Royal Society of Medicine, vol. MCT-7, no. 1, pp. 150– 153, 1816. [3] G. B. New, “Sarcoma of the larynx: report of two cases,” Archives of otolaryngology, vol. 21, no. 6, pp. 648–652, 1935. [4] E. M. Potochny and A. R. Huber, “Laryngeal chondrosar- coma,” Head and Neck Pathology, vol. 8, no. 1, pp. 114–116, [5] L. D. R. Thompson and F. H. Gannon, “Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature,” American Journal of Surgical Pathology, vol. 26, no. 7, pp. 836–851, 2002. [6] O. Casiraghi, F. Martinez-Madrigal, K. Pineda-Daboin, G. Mamelle, L. Resta, and M. A. Luna, “Chondroid tumors of the larynx: a clinicopathologic study of 19 cases, including two dedifferentiated chondrosarcomas,” Annals of Diagnostic Pathology, vol. 8, no. 4, pp. 189–197, 2004. [7] Q. Wang, H. Chen, and S. Zhou, “Chondrosarcoma of the lar- ynx: report of two cases and review of the literature,” Interna- tional Journal of Clinical and Experimental Pathology, vol. 8, no. 2, pp. 2068–2073, 2015. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: May 5, 2019

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