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Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer

Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2014, Article ID 825929, 3 pages http://dx.doi.org/10.1155/2014/825929 Case Report Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer Vinaya Gaduputi, Chaitanya Chandrala, Hassan Tariq, and Kalyan Kanneganti Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10C, Bronx, NY 10457, USA Correspondence should be addressed to Hassan Tariq; htariq@bronxleb.org Received 18 November 2013; Accepted 30 December 2013; Published 6 February 2014 Academic Editors: S. Ohno and G. P. Vandoros Copyright © 2014 Vinaya Gaduputi 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. The sign of Leser-Tr ela ´ t is a rare paraneoplastic phenomenon marked by accelerated onset of multiple seborrheic keratoses. The occurrence of the sign oeft n points towards underlying visceral malignancies which in a majority are adenocarcinomas of the gastrointestinal tract. We report this case of a 65-year-old man who presented with sign of Leser-Trela ´ t and was diagnosed with poorly differentiated squamous cell cancer of the esophagus. To our knowledge this is only the second such reported association of Leser-Trelat sign with squamous cell cancer of esophagus. 1. Introduction 2. Case Report The sign of Leser-Tr ela ´ t is a misnomer as both Edmund Leser A 65-year-old Hispanic man presented to the clinic with and Ulysse Trela ´ t described skin lesions unrelated (senile complaints of progressively worsening dysphagia and unin- angiomas) to seborrheic keratoses [1, 2]. It was Hollander that tentional weight loss of 30 pounds over the preceding 2 first recognized the possible association between worsening months. Patient reported dysphagia to both solid as well as seborrheic keratoses and underlying visceral malignancies liquid food. Patient also complained of multiple worsening [1]. The sign of Leser-Tr e´lat is a rare paraneoplastic phenom (both in size and in number) dark colored skin lesions on enon marked by accelerated onset of multiple seborrheic his neck and his back. His medical comorbidities included keratoses. This acceleration can manifest both as increase well controlled bronchial asthma and vitamin B12 deficiency. in size and number of the skin lesions. Validity of the The patient admitted to chronic heavy smoking for almost sign is subject to contestation [2, 3]asbothvisceralmalig- 40 years. Physical examination revealed a hemodynamically nancies and seborrheic keratoses increase in incidence in stable, cachectic man (BMI: 19.4) with multiple hyperpig- parallel, with advancing age. Case control studies could not mented, well-demarcated and raised lesions with “stuck-on” demonstrate a strong association of seborrheic keratoses with appearance on both sides of the neck (Figure 1) and the back. underlying visceral malignancies [3–5]. However, it has been The skin lesions were consistent with seborrheic keratoses noted by Schwartz [6] that there is a strong association of distributed in a characteristic “raindrop” or “splash” pattern sign of Leser-Trela ´ t with malignant acanthosis nigricans, a (Figure 2). well established paraneoplastic lesion, and therefore could Initial set of laboratory were remarkable only for normo- itself be regarded as a paraneoplastic phenomenon. Multiple cytic, normochromic anemia (hemoglobin of 10.1 g/dL). He cases have been reported about rapidly growing sebor- underwent a colonoscopy and esophagogastroduodenoscopy rheic keratoses with various underlying malignancies, com- (EGD) for further evaluation of unintentional weight loss and monly including adenocarcinomas of stomach, colon, and dysphagia. Colonoscopy revealed good bowel preparation lymphomas. with a single 3 mm hyperplastic transverse colon polyp. 2 Case Reports in Oncological Medicine Figure 1: Multiple hyperpigmented, well-demarcated and raised Figure 3: A non-circumferential, partially obstructing mass seen in lesions with “stuck-on” appearance are seen on both sides of the the lower third of the esophagus. neck. Figure 4: Biopsies of the esophageal mass showing poorly dieff ren- tiated squamous cell carcinoma. Figure 2: The skin lesions are seen distributed in a characteristic “raindrop” or “splash” patternonthe back. EGD revealed a noncircumferential, partially obstructing mass in the lower third of the esophagus (Figure 3). Biop- sies revealed poorly differentiated invasive squamous cell carcinoma (Figure 4). A subsequent staging computerized tomography (CT) scan of chest, abdomen, and pelvis revealed the mass in the distal esophagus along with several enlarged Figure 5: CT of chest showing a near-obstructing mass in the distal lymph nodes superior to the celiac axis (Figure 5). An endo- esophagus (yellow arrow). scopic ultrasound (EUS) study revealed invasion of tumor in to the muscularis propria with perilesional lymphadenopa- thy. 3. Discussion Patient underwent surgical gastrostomy for nutritional support. Patient subsequently was started on radiation ther- In spite of various arguments put forth against consider- apy and chemotherapy with weekly Paclitaxel and Carbo- ing the sign of Leser-Tre´lat to be a true paraneoplastic platin regimen. Patient underwent a repeat EGD, upon com- phenomenon, Curth [7] provided diagnostic criteria for pletion of 8 cycles of Paclitaxel and Carboplatin regimen that cutaneous paraneoplastic phenomena such as acanthosis revealed significant improvement in size of the esophageal nigricans and its frequent association-eruptive seborrheic mass. However, the seborrheic keratoses did not regress in keratoses. The pathogenesis of this rare and controversial parallel. sign is poorly understood. It has been postulated that growth Case Reports in Oncological Medicine 3 factors derived from the underlying neoplasm play a role in [3] J. J. Grob, M. C. Rava, J. Gouvernet et al., “eTh relation be- tween seborreic keratoses and malignant solid tumours. A case- development of these paraneoplastic eruptive disorders. The control study,” Acta Dermato-Venereologica,vol.71, no.2,pp. implicated growth factors include immunoreactive human 166–169, 1991. growth hormone [8], transforming growth factor-𝛼 [9], [4] L.E.M.Schwengle,F.H.J.Rampen, andW.T.Wobbes insulinlikegrowthfactor[10], and epidermal growth factor Th., “Seborrhoeic keratoses and internal malignancies. A case [11]. The variance in underlying malignancy explains the control study,” Clinical and Experimental Dermatology,vol.13, different growth factors implicated in pathogenesis. It has no. 3, pp. 177–179, 1988. been noted that the most common visceral malignancies [5] A. Fink, D. Filz, G. Krajnik, W. Jurecka, H. Ludwig, and associated with sign of Leser-Trela ´ t include the adenocar- A. Steiner, “Seborrhoeic keratoses in patients with internal cinomas of the gastrointestinal tract in about a third and malignancies: a case-control study with prospective accrual of lymphomas in about one ftfih of patients [ 10]. Regression of patients,” Journalofthe European AcademyofDermatology and skin lesions upon removal of underlying solid neoplasm is Venereology,vol.23, no.11, pp.1316–1319,2009. seen only in abouthalfofall patients [9, 12]. [6] R.A.Schwartz, “Acanthosisnigricans,” Journal of the American Even as the sign of Leser-Trela ´ t is most commonly associ- Academy of Dermatology,vol.31, no.1,pp. 1–19,1994. ated with carcinomas of gastrointestinal tract, its association [7] H. O. Curth, “Skin manifestations of internal malignant with squamous cell cancer of esophagus is exceedingly rare. tumors,” Maryland Medical Journal,vol.21, no.12, pp.52–56, To our knowledge this is only the second such association reported in theliterature[13]. The most common sites of [8] L. G. Millard and D. J. Gould, “Hyperkeratosis of the palms occurrence of these eruptive lesions are the trunk (in up to and soles associated with internal malignancy and elevated 76%), extremities (38%), face (21%), and neck (13%) [9]. The levels of immunoreactive human growth hormone,” Clinical and lesions in our patient were predominantly distributed on the Experimental Dermatology,vol.1,no. 4, pp.363–368,1976. back and the neck. eTh skin lesions of this paraneoplastic [9] D.L.Ellis andR.A.Yates,“Sign of Leser-Trela ´ t,” Clinics in phenomenon are benign unto themselves and oen ft regress Dermatology, vol. 11, no. 1, pp. 141–148, 1993. upon treatment of underlying neoplasm. However, in our [10] J. J. Benn, R. G. Firth, and P. H. Son ¨ ksen, “Metabolic eeff cts of patient the skin lesions failed to regress even aer ft significant an insulin-like factor causing hypoglycaemia in a patient with shrinkage of tumor size upon radiation and chemotherapy. a haemangiopericytoma,” Clinical Endocrinology,vol.32, no.6, We report this case of sign of Leser-Tre´lat associated with pp. 769–780, 1990. esophageal squamous cell carcinoma to highlight that an [11] Y. Horiuchi, K. Katsuoka, S. Takezaki, and S. Nishiyama, “Study otherwise benign, asymptomatic and oeft n ignored presen- of epidermal growth activity in cultured human keratinocytes tation of eruptive seborrheic keratoses could be an ominous from peripheral-blood lymphocytes of a patient with Sezary syndrome associated with he Leser-Trelat sign,” Archives of sign that should prompt elicitation of detailed history and Dermatological Research,vol.278,no. 1, pp.74–76, 1985. thorough physical examination. Any alarm symptoms or signs should be followed up by correlative testing. [12] J. H. Cohen, S. R. Lessin, B. R. Vowels, B. Benoit, W. K. Witmer, andA.H.Rook, “es Th ignofLeser-Trelatinassociation with Sezary syndrome: simultaneous disappearance of seborrheic Disclosure keratoses and malignant T-cell clone during combined therapy with photopheresis and interferon alfa,” Archives of Dermatol- All authors have confirmed that the paper is not under ogy, vol. 129, no. 9, pp. 1213–1215, 1993. consideration for review at any other journal. [13] T. Chiba, T. Shitomi, O. Nakano et al., “The sign of Leser- Trelat associated with esophageal carcinoma,” American Journal of Gastroenterology,vol.91, no.4,pp. 802–804, 1996. Conflict of Interests eTh authorsofthepaperdonothaveadirectfinancialrelation with any of the commercial identities mentioned in the paper that mightleadtoaconflictofinterests. Authors’ Contribution All authors have made contributions to the paper and have reviewed it before submission. References [1] R. A. Schwartz, “Sign of Leser-Trela ´ t,” Journal of the American Academy of Dermatology, vol. 35, no. 1, pp. 88–95, 1996. [2] H. J. Rampen and L. E. Schwengle, “eTh sign of Leser-Tr ela ´ t: does it exist?” Journal of the American Academy of Dermatology, vol. 21,no. 1, pp.50–55,1989. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer

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Copyright © 2014 Vinaya Gaduputi 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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Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2014, Article ID 825929, 3 pages http://dx.doi.org/10.1155/2014/825929 Case Report Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer Vinaya Gaduputi, Chaitanya Chandrala, Hassan Tariq, and Kalyan Kanneganti Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10C, Bronx, NY 10457, USA Correspondence should be addressed to Hassan Tariq; htariq@bronxleb.org Received 18 November 2013; Accepted 30 December 2013; Published 6 February 2014 Academic Editors: S. Ohno and G. P. Vandoros Copyright © 2014 Vinaya Gaduputi 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. The sign of Leser-Tr ela ´ t is a rare paraneoplastic phenomenon marked by accelerated onset of multiple seborrheic keratoses. The occurrence of the sign oeft n points towards underlying visceral malignancies which in a majority are adenocarcinomas of the gastrointestinal tract. We report this case of a 65-year-old man who presented with sign of Leser-Trela ´ t and was diagnosed with poorly differentiated squamous cell cancer of the esophagus. To our knowledge this is only the second such reported association of Leser-Trelat sign with squamous cell cancer of esophagus. 1. Introduction 2. Case Report The sign of Leser-Tr ela ´ t is a misnomer as both Edmund Leser A 65-year-old Hispanic man presented to the clinic with and Ulysse Trela ´ t described skin lesions unrelated (senile complaints of progressively worsening dysphagia and unin- angiomas) to seborrheic keratoses [1, 2]. It was Hollander that tentional weight loss of 30 pounds over the preceding 2 first recognized the possible association between worsening months. Patient reported dysphagia to both solid as well as seborrheic keratoses and underlying visceral malignancies liquid food. Patient also complained of multiple worsening [1]. The sign of Leser-Tr e´lat is a rare paraneoplastic phenom (both in size and in number) dark colored skin lesions on enon marked by accelerated onset of multiple seborrheic his neck and his back. His medical comorbidities included keratoses. This acceleration can manifest both as increase well controlled bronchial asthma and vitamin B12 deficiency. in size and number of the skin lesions. Validity of the The patient admitted to chronic heavy smoking for almost sign is subject to contestation [2, 3]asbothvisceralmalig- 40 years. Physical examination revealed a hemodynamically nancies and seborrheic keratoses increase in incidence in stable, cachectic man (BMI: 19.4) with multiple hyperpig- parallel, with advancing age. Case control studies could not mented, well-demarcated and raised lesions with “stuck-on” demonstrate a strong association of seborrheic keratoses with appearance on both sides of the neck (Figure 1) and the back. underlying visceral malignancies [3–5]. However, it has been The skin lesions were consistent with seborrheic keratoses noted by Schwartz [6] that there is a strong association of distributed in a characteristic “raindrop” or “splash” pattern sign of Leser-Trela ´ t with malignant acanthosis nigricans, a (Figure 2). well established paraneoplastic lesion, and therefore could Initial set of laboratory were remarkable only for normo- itself be regarded as a paraneoplastic phenomenon. Multiple cytic, normochromic anemia (hemoglobin of 10.1 g/dL). He cases have been reported about rapidly growing sebor- underwent a colonoscopy and esophagogastroduodenoscopy rheic keratoses with various underlying malignancies, com- (EGD) for further evaluation of unintentional weight loss and monly including adenocarcinomas of stomach, colon, and dysphagia. Colonoscopy revealed good bowel preparation lymphomas. with a single 3 mm hyperplastic transverse colon polyp. 2 Case Reports in Oncological Medicine Figure 1: Multiple hyperpigmented, well-demarcated and raised Figure 3: A non-circumferential, partially obstructing mass seen in lesions with “stuck-on” appearance are seen on both sides of the the lower third of the esophagus. neck. Figure 4: Biopsies of the esophageal mass showing poorly dieff ren- tiated squamous cell carcinoma. Figure 2: The skin lesions are seen distributed in a characteristic “raindrop” or “splash” patternonthe back. EGD revealed a noncircumferential, partially obstructing mass in the lower third of the esophagus (Figure 3). Biop- sies revealed poorly differentiated invasive squamous cell carcinoma (Figure 4). A subsequent staging computerized tomography (CT) scan of chest, abdomen, and pelvis revealed the mass in the distal esophagus along with several enlarged Figure 5: CT of chest showing a near-obstructing mass in the distal lymph nodes superior to the celiac axis (Figure 5). An endo- esophagus (yellow arrow). scopic ultrasound (EUS) study revealed invasion of tumor in to the muscularis propria with perilesional lymphadenopa- thy. 3. Discussion Patient underwent surgical gastrostomy for nutritional support. Patient subsequently was started on radiation ther- In spite of various arguments put forth against consider- apy and chemotherapy with weekly Paclitaxel and Carbo- ing the sign of Leser-Tre´lat to be a true paraneoplastic platin regimen. Patient underwent a repeat EGD, upon com- phenomenon, Curth [7] provided diagnostic criteria for pletion of 8 cycles of Paclitaxel and Carboplatin regimen that cutaneous paraneoplastic phenomena such as acanthosis revealed significant improvement in size of the esophageal nigricans and its frequent association-eruptive seborrheic mass. However, the seborrheic keratoses did not regress in keratoses. The pathogenesis of this rare and controversial parallel. sign is poorly understood. It has been postulated that growth Case Reports in Oncological Medicine 3 factors derived from the underlying neoplasm play a role in [3] J. J. Grob, M. C. Rava, J. Gouvernet et al., “eTh relation be- tween seborreic keratoses and malignant solid tumours. A case- development of these paraneoplastic eruptive disorders. The control study,” Acta Dermato-Venereologica,vol.71, no.2,pp. implicated growth factors include immunoreactive human 166–169, 1991. growth hormone [8], transforming growth factor-𝛼 [9], [4] L.E.M.Schwengle,F.H.J.Rampen, andW.T.Wobbes insulinlikegrowthfactor[10], and epidermal growth factor Th., “Seborrhoeic keratoses and internal malignancies. A case [11]. The variance in underlying malignancy explains the control study,” Clinical and Experimental Dermatology,vol.13, different growth factors implicated in pathogenesis. It has no. 3, pp. 177–179, 1988. been noted that the most common visceral malignancies [5] A. Fink, D. Filz, G. Krajnik, W. Jurecka, H. Ludwig, and associated with sign of Leser-Trela ´ t include the adenocar- A. Steiner, “Seborrhoeic keratoses in patients with internal cinomas of the gastrointestinal tract in about a third and malignancies: a case-control study with prospective accrual of lymphomas in about one ftfih of patients [ 10]. Regression of patients,” Journalofthe European AcademyofDermatology and skin lesions upon removal of underlying solid neoplasm is Venereology,vol.23, no.11, pp.1316–1319,2009. seen only in abouthalfofall patients [9, 12]. [6] R.A.Schwartz, “Acanthosisnigricans,” Journal of the American Even as the sign of Leser-Trela ´ t is most commonly associ- Academy of Dermatology,vol.31, no.1,pp. 1–19,1994. ated with carcinomas of gastrointestinal tract, its association [7] H. O. Curth, “Skin manifestations of internal malignant with squamous cell cancer of esophagus is exceedingly rare. tumors,” Maryland Medical Journal,vol.21, no.12, pp.52–56, To our knowledge this is only the second such association reported in theliterature[13]. The most common sites of [8] L. G. Millard and D. J. Gould, “Hyperkeratosis of the palms occurrence of these eruptive lesions are the trunk (in up to and soles associated with internal malignancy and elevated 76%), extremities (38%), face (21%), and neck (13%) [9]. The levels of immunoreactive human growth hormone,” Clinical and lesions in our patient were predominantly distributed on the Experimental Dermatology,vol.1,no. 4, pp.363–368,1976. back and the neck. eTh skin lesions of this paraneoplastic [9] D.L.Ellis andR.A.Yates,“Sign of Leser-Trela ´ t,” Clinics in phenomenon are benign unto themselves and oen ft regress Dermatology, vol. 11, no. 1, pp. 141–148, 1993. upon treatment of underlying neoplasm. However, in our [10] J. J. Benn, R. G. Firth, and P. H. Son ¨ ksen, “Metabolic eeff cts of patient the skin lesions failed to regress even aer ft significant an insulin-like factor causing hypoglycaemia in a patient with shrinkage of tumor size upon radiation and chemotherapy. a haemangiopericytoma,” Clinical Endocrinology,vol.32, no.6, We report this case of sign of Leser-Tre´lat associated with pp. 769–780, 1990. esophageal squamous cell carcinoma to highlight that an [11] Y. Horiuchi, K. Katsuoka, S. Takezaki, and S. Nishiyama, “Study otherwise benign, asymptomatic and oeft n ignored presen- of epidermal growth activity in cultured human keratinocytes tation of eruptive seborrheic keratoses could be an ominous from peripheral-blood lymphocytes of a patient with Sezary syndrome associated with he Leser-Trelat sign,” Archives of sign that should prompt elicitation of detailed history and Dermatological Research,vol.278,no. 1, pp.74–76, 1985. thorough physical examination. Any alarm symptoms or signs should be followed up by correlative testing. [12] J. H. Cohen, S. R. Lessin, B. R. Vowels, B. Benoit, W. K. Witmer, andA.H.Rook, “es Th ignofLeser-Trelatinassociation with Sezary syndrome: simultaneous disappearance of seborrheic Disclosure keratoses and malignant T-cell clone during combined therapy with photopheresis and interferon alfa,” Archives of Dermatol- All authors have confirmed that the paper is not under ogy, vol. 129, no. 9, pp. 1213–1215, 1993. consideration for review at any other journal. [13] T. Chiba, T. Shitomi, O. Nakano et al., “The sign of Leser- Trelat associated with esophageal carcinoma,” American Journal of Gastroenterology,vol.91, no.4,pp. 802–804, 1996. Conflict of Interests eTh authorsofthepaperdonothaveadirectfinancialrelation with any of the commercial identities mentioned in the paper that mightleadtoaconflictofinterests. Authors’ Contribution All authors have made contributions to the paper and have reviewed it before submission. References [1] R. A. Schwartz, “Sign of Leser-Trela ´ t,” Journal of the American Academy of Dermatology, vol. 35, no. 1, pp. 88–95, 1996. [2] H. J. Rampen and L. E. Schwengle, “eTh sign of Leser-Tr ela ´ t: does it exist?” Journal of the American Academy of Dermatology, vol. 21,no. 1, pp.50–55,1989. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

Journal

Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: Feb 6, 2014

References