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Stage IAE Follicular Lymphoma of the Breast: Case Report and Review of the Literature

Stage IAE Follicular Lymphoma of the Breast: Case Report and Review of the Literature Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 597527, 3 pages http://dx.doi.org/10.1155/2013/597527 Case Report Stage IAE Follicular Lymphoma of the Breast: Case Report and Review of the Literature 1 2 Raymon Patron and Edward F. Miles Department of Internal Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA Division of Radiation Oncology, Department of Radiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA Correspondence should be addressed to Raymon Patron; raymon.patron@med.navy.mil Received 20 March 2013; Accepted 13 April 2013 Academic Editors: A. Goodman, J. I. Mayordomo, B. I. Razzouk, and G. P. Vandoros Copyright © 2013 R. Patron and E. F. Miles. 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. Primary lymphoma of the breast is a rare entity in the field of oncological medicine and represents <0.5% of all breast malignancies. A definitive diagnosis is obtained by excisional biopsy as the clinic al and radiographical presentation is similar to the more common primary breast carcinoma. Unlike primary breast carcinoma, localized radiation therapy is the mainstay of treatment. We report on a case of primary follicular lymphoma of the breast in a 67-year-old Caucasian woman treated with localized radiation as well as coinciding literature review regarding outcomes of different treatment modalities. 1. Introduction the right breast. Her screening mammogram was normal eight months before. Ultrasound evaluation demonstrated a Follicular lymphoma is the second most common lymphoma mixed density lesion measuring 1 cm in greatest dimension, diagnosed in the United States, comprising 20% of all non- directly overlying the pectoralis muscle. She underwent Hodgkin lymphomas and 70% of all indolent lymphomas [1]. excisional biopsy which demonstrated Grade 2 follicular Median age at diagnosis is 60 years with a slight female pre- lymphoma (Figures 1 and 2). Due to the unusual diagnosis, dominance [2, 3]. Most patients present with asymptomatic her case was reviewed at a multidisciplinary tumor board and lymphadenopathy, and more than 90% present with Stage discussed in detail with radiology, pathology, general surgery, III or IV disease [4]. Primary breast lymphoma is much less radiation oncology, and medical oncology specialists. common and represents 1% of all non-Hodgkin lymphomas She subsequently underwent a complete workup per the [5]and<0.5% of all breast malignancies [6]. national comprehensive cancer network (NCCN) guidelines, Management of follicular lymphoma depends on the [8] including a bone marrow biopsy which was normal stage; for early stage disease (I and II), current guidelines rec- and a positron emission tomography/computed tomography ommend the consideration of 2,400–3,000 centiGray (cGy) (PET/CT) study which demonstrated nither regional or involved-field radiation therapy for nodal sites and involved- distant adenopathy nor residual PET-avid disease in the right organ radiation therapy for extranodal sites [7]. breast. She denied fevers, night sweats, or significant weight We report a case of successful local control of an inciden- loss and was staged with Stage IAE follicular lymphoma of talfollicularlymphomaofthe breast diagnosedatexcisional the right breast. Radiation therapy was oeff red to limit the biopsy. risk of local recurrence with close monitoring for systemic recurrence. 2. Case Report Standard breast tangents were used with the medial bor- The patient was a 67-year-old Caucasian female who self- der at the sternal notch, the lateral border at the midaxillary palpated a 1 cm rfi m nodule in the midsuperior portion of line, the inferior border two centimeters below ipsilateral 2 Case Reports in Oncological Medicine Figure 1: Follicular lymphoma of the breast at 4x magnification in Figure 3: Anterior light field markings for right breast tangents with hematoxylin and eosin stain. separate supraclavicular field. Figure 2: Follicular lymphoma of the breast at 40x magnification in Figure 4: Supraclavicular light field with central scar from tumor hematoxylin and eosin stain. resection. axillary lymph nodes [10]. Primary follicular lymphoma of breast tissue, and the superior border placed at the inferior the breast as described in this case is the second or third most border of the clavicular head. Due to the location of the tumor prevalent primary breast lymphoma preceded by diffuse large bed in this position (Figure 3), a separate supraclavicular cell lymphoma (DLCL) and marginal zone lymphoma (MZL) field, matched to the nondivergent superior border of the [11–13]. We reviewed three studies examining the outcome of tangents, was required to ensure the coverage of this area, treatment modalities regarding this specific primary breast which included the tumor bed (Figure 4). A separate axillary malignancy. field was not used, but the tangent fields were noted to cover Martinelli et al. report on a multicentered study of 36 levels one and a portion of two in the ipsilateral axilla. eTh casesoffollicularprimary breast lymphoma over 23 years. tumor bed and adjacent critical structures including the lungs Patients were resected with surgery, chemotherapy, and radi- and heart were contoured on a slice-by-slice basis. ation therapy alone or in combination. Data collected showed A eld-in-field fi technique with dual energy photons (6 14 patients outofthe population relapsed aeft r amedian and10 MV)delivered200 cGyfractionsperdaytothetangent interval of 26 months. Eight patients with local disease treated fields, while a 6 MV photon beam was used to treat the with radiation as a first-line treatment showed no recurrence supraclavicular efi ld. Both fields received a total dose of in irradiated fields. Median followup at approximately 44 3,000 cGy over 19 days. She completed the treatment as months showed 8/36 died from the disease with cause- planned and experienced only Grade 1 radiation dermatitis. specific survival for follicular primary breast lymphoma: 84% A PET/CT scan performed four years aeft r completion of at 3 years, 79% at 5 years, and 66% at 10 years [11]. her lymphoma therapy demonstrated no evidence of recur- Ganjoo et al. report on a case study involving 37 cases of rent lymphoma. breast lymphoma including DLBCL, MZL, and SLL. Seven out of 37 demonstrated follicular lymphoma by biopsy. Of 3. Discussion the7,one case of follicular lymphoma staged IE,similar Primarybreastlymphoma(PBL)isararediseaseprocesssim- to the case presented, was treated with localized radiation ilar clinically and radiologically to common primary breast therapy alone, receiving 3600–5040 cGy including the breast carcinoma [9]. The patient must meet certain diagnostic cri- and axilla. The remaining 6 cases of follicular lymphoma with teria to make the diagnosis of PBL including lymphomatous IIIE, IV were treated with a combination of radiation and infiltrateofbreasttissuewithnootherorganornodalinvolve- CHOP/CVP or Rituximab. The patient treated for localized ment at the time of diagnosis with the exception of ipsilateral disease remained NED aer ft a median followup of 5.8 years. Case Reports in Oncological Medicine 3 The 5-year overall survival rate for patients with indolent [8] A. D. Zelenetz and R. T. Hoppe, “Non-Hodgkin’s lymphoma,” Cancer Control,vol.8,no. 6, pp.102–113,2001. lymphomas treated with CHOP/CVP or Rituximab was foundtobe92% [12]. [9] V. E. Duncan, V. V. B. Reddy, N. C. Jhala, D. C. Chhieng, and D. N. Jhala, “Non-Hodgkin’s lymphoma of the breast: a review of 18 Talwalkar et al. described 106 cases of lymphomas involv- primary and secondary cases,” Annals of Diagnostic Pathology, ing the breast. Of the 106, 15 were documented as disseminat- vol. 10,no. 3, pp.144–148,2006. ed follicular lymphoma. Of the forty-five patients, received [10] C. Wiseman and K. T. Liao, “Primary lymphoma of the breast,” chemotherapy 38 alone, 4 with adjuvant radiation therapy Cancer,vol.29, no.6,pp. 1705–1712, 1972. and 3 with combination chemotherapy, lumpectomy and [11] G. Martinelli, G. Ryan, J. F. Seymour et al., “Primary follicular radiation therapy. eTh 15 documented cases of follicular lym- and marginal-zone lymphoma of the breast: clinical features, phoma, showed a median overall survival of only 24 months. prognostic factors and outcome: a study by the International However, the cases described in this study were those of Extranodal Lymphoma Study Group,” Annals of Oncology,vol. disseminated disease involving the breast not necessarily the 20, no. 12, pp. 1993–1999, 2009. primary breast lymphoma described in this case [13]. [12] K. Ganjoo, R. Advani, M. R. Mariappan, A. McMillan, and S. In conclusion, most patients with follicular lymphoma Horning, “Non-Hodgkin lymphoma of the breast,” Cancer,vol. of the breast who present with early stage local disease 110, no. 1, pp. 25–30, 2007. responded very well to definitive radiation therapy [ 11, 12]. [13] S.S.Talwalkar,R.N.Miranda,J.R.Valbuena, M. J. Routbort, Thispatient’s tumorbed wasinthe superior breast and A. W. Martin, and L. J. Medeiros, “Lymphomas involving the required a separate supraclavicular field to treat the entire breast: a study of 106 cases comparing localized and dissemi- involved organ and tumor bed. er Th e is no evidence of disease nated neoplasms,” American Journal of Surgical Pathology,vol. 4 years aer ft completion of definitive therapy. 32,no. 9, pp.1299–1309,2008. Conflict of Interests eTh authorsdeclaresthatthere is no conflictofinterests. Disclaimer eTh views expressed in this paper are those of the authors and do not necessarily reflect the ocia ffi l policy or position of the Department of the Navy, Department of Defense, or the United States Government. References [1] J. O. Armitage, “A clinical evaluation of the International Lym- phoma Study Group classification of non-Hodgkin’s lympho- ma,” Blood,vol.89, no.11, pp.3909–3918,1997. [2] J.O.ArmitageandD.D.Weisenburger,“Newapproachtoclassi- fying non-Hodgkin’s lymphomas: clinical features of the major histologic subtypes,” Journal of Clinical Oncology,vol.16, no.8, pp. 2780–2795, 1998. [3] N.L.Harris, E. S. Jaeff ,J.Diebold et al., “World health organi- zation classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the clinical advisory committee meeting—airlie house, Virginia, November 1997,” Journal of Clinical Oncology,vol.17, no.12, pp.3835–3849,1999. [4] A. Freedman, “Follicular lymphoma: 2011 update on diagnosis and management,” American Journal of Hematology,vol.86, pp. 768–775, 2011. [5] C.S.Ha, P. Dubey, L. K. Goyal, M. Hess,F.Cabanillas,and J. D. Cox, “Localized primary non-Hodgkin lymphoma of the breast,” American Journal of Clinical Oncology,vol.21, no.4,pp. 376–380, 1998. [6] R. Giardini, C. Piccolo, and F. Rilke, “Primary non-Hodgkin’s lymphomas of the female breast,” Cancer,vol.69, no.3,pp. 725– 735, 1992. [7] A.D.Zelenetz, J. S. Abramson,R.H.Advanietal.,“NCCN Clinical Practice Guidelines in Oncology: non-Hodgkin’s lym- phomas,” Journal of the National Comprehensive Cancer Net- work, vol. 8, pp. 288–334, 2010. 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

Stage IAE Follicular Lymphoma of the Breast: Case Report and Review of the Literature

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Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 597527, 3 pages http://dx.doi.org/10.1155/2013/597527 Case Report Stage IAE Follicular Lymphoma of the Breast: Case Report and Review of the Literature 1 2 Raymon Patron and Edward F. Miles Department of Internal Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA Division of Radiation Oncology, Department of Radiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA Correspondence should be addressed to Raymon Patron; raymon.patron@med.navy.mil Received 20 March 2013; Accepted 13 April 2013 Academic Editors: A. Goodman, J. I. Mayordomo, B. I. Razzouk, and G. P. Vandoros Copyright © 2013 R. Patron and E. F. Miles. 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. Primary lymphoma of the breast is a rare entity in the field of oncological medicine and represents <0.5% of all breast malignancies. A definitive diagnosis is obtained by excisional biopsy as the clinic al and radiographical presentation is similar to the more common primary breast carcinoma. Unlike primary breast carcinoma, localized radiation therapy is the mainstay of treatment. We report on a case of primary follicular lymphoma of the breast in a 67-year-old Caucasian woman treated with localized radiation as well as coinciding literature review regarding outcomes of different treatment modalities. 1. Introduction the right breast. Her screening mammogram was normal eight months before. Ultrasound evaluation demonstrated a Follicular lymphoma is the second most common lymphoma mixed density lesion measuring 1 cm in greatest dimension, diagnosed in the United States, comprising 20% of all non- directly overlying the pectoralis muscle. She underwent Hodgkin lymphomas and 70% of all indolent lymphomas [1]. excisional biopsy which demonstrated Grade 2 follicular Median age at diagnosis is 60 years with a slight female pre- lymphoma (Figures 1 and 2). Due to the unusual diagnosis, dominance [2, 3]. Most patients present with asymptomatic her case was reviewed at a multidisciplinary tumor board and lymphadenopathy, and more than 90% present with Stage discussed in detail with radiology, pathology, general surgery, III or IV disease [4]. Primary breast lymphoma is much less radiation oncology, and medical oncology specialists. common and represents 1% of all non-Hodgkin lymphomas She subsequently underwent a complete workup per the [5]and<0.5% of all breast malignancies [6]. national comprehensive cancer network (NCCN) guidelines, Management of follicular lymphoma depends on the [8] including a bone marrow biopsy which was normal stage; for early stage disease (I and II), current guidelines rec- and a positron emission tomography/computed tomography ommend the consideration of 2,400–3,000 centiGray (cGy) (PET/CT) study which demonstrated nither regional or involved-field radiation therapy for nodal sites and involved- distant adenopathy nor residual PET-avid disease in the right organ radiation therapy for extranodal sites [7]. breast. She denied fevers, night sweats, or significant weight We report a case of successful local control of an inciden- loss and was staged with Stage IAE follicular lymphoma of talfollicularlymphomaofthe breast diagnosedatexcisional the right breast. Radiation therapy was oeff red to limit the biopsy. risk of local recurrence with close monitoring for systemic recurrence. 2. Case Report Standard breast tangents were used with the medial bor- The patient was a 67-year-old Caucasian female who self- der at the sternal notch, the lateral border at the midaxillary palpated a 1 cm rfi m nodule in the midsuperior portion of line, the inferior border two centimeters below ipsilateral 2 Case Reports in Oncological Medicine Figure 1: Follicular lymphoma of the breast at 4x magnification in Figure 3: Anterior light field markings for right breast tangents with hematoxylin and eosin stain. separate supraclavicular field. Figure 2: Follicular lymphoma of the breast at 40x magnification in Figure 4: Supraclavicular light field with central scar from tumor hematoxylin and eosin stain. resection. axillary lymph nodes [10]. Primary follicular lymphoma of breast tissue, and the superior border placed at the inferior the breast as described in this case is the second or third most border of the clavicular head. Due to the location of the tumor prevalent primary breast lymphoma preceded by diffuse large bed in this position (Figure 3), a separate supraclavicular cell lymphoma (DLCL) and marginal zone lymphoma (MZL) field, matched to the nondivergent superior border of the [11–13]. We reviewed three studies examining the outcome of tangents, was required to ensure the coverage of this area, treatment modalities regarding this specific primary breast which included the tumor bed (Figure 4). A separate axillary malignancy. field was not used, but the tangent fields were noted to cover Martinelli et al. report on a multicentered study of 36 levels one and a portion of two in the ipsilateral axilla. eTh casesoffollicularprimary breast lymphoma over 23 years. tumor bed and adjacent critical structures including the lungs Patients were resected with surgery, chemotherapy, and radi- and heart were contoured on a slice-by-slice basis. ation therapy alone or in combination. Data collected showed A eld-in-field fi technique with dual energy photons (6 14 patients outofthe population relapsed aeft r amedian and10 MV)delivered200 cGyfractionsperdaytothetangent interval of 26 months. Eight patients with local disease treated fields, while a 6 MV photon beam was used to treat the with radiation as a first-line treatment showed no recurrence supraclavicular efi ld. Both fields received a total dose of in irradiated fields. Median followup at approximately 44 3,000 cGy over 19 days. She completed the treatment as months showed 8/36 died from the disease with cause- planned and experienced only Grade 1 radiation dermatitis. specific survival for follicular primary breast lymphoma: 84% A PET/CT scan performed four years aeft r completion of at 3 years, 79% at 5 years, and 66% at 10 years [11]. her lymphoma therapy demonstrated no evidence of recur- Ganjoo et al. report on a case study involving 37 cases of rent lymphoma. breast lymphoma including DLBCL, MZL, and SLL. Seven out of 37 demonstrated follicular lymphoma by biopsy. Of 3. Discussion the7,one case of follicular lymphoma staged IE,similar Primarybreastlymphoma(PBL)isararediseaseprocesssim- to the case presented, was treated with localized radiation ilar clinically and radiologically to common primary breast therapy alone, receiving 3600–5040 cGy including the breast carcinoma [9]. The patient must meet certain diagnostic cri- and axilla. The remaining 6 cases of follicular lymphoma with teria to make the diagnosis of PBL including lymphomatous IIIE, IV were treated with a combination of radiation and infiltrateofbreasttissuewithnootherorganornodalinvolve- CHOP/CVP or Rituximab. The patient treated for localized ment at the time of diagnosis with the exception of ipsilateral disease remained NED aer ft a median followup of 5.8 years. Case Reports in Oncological Medicine 3 The 5-year overall survival rate for patients with indolent [8] A. D. Zelenetz and R. T. Hoppe, “Non-Hodgkin’s lymphoma,” Cancer Control,vol.8,no. 6, pp.102–113,2001. lymphomas treated with CHOP/CVP or Rituximab was foundtobe92% [12]. [9] V. E. Duncan, V. V. B. Reddy, N. C. Jhala, D. C. Chhieng, and D. N. Jhala, “Non-Hodgkin’s lymphoma of the breast: a review of 18 Talwalkar et al. described 106 cases of lymphomas involv- primary and secondary cases,” Annals of Diagnostic Pathology, ing the breast. Of the 106, 15 were documented as disseminat- vol. 10,no. 3, pp.144–148,2006. ed follicular lymphoma. Of the forty-five patients, received [10] C. Wiseman and K. T. Liao, “Primary lymphoma of the breast,” chemotherapy 38 alone, 4 with adjuvant radiation therapy Cancer,vol.29, no.6,pp. 1705–1712, 1972. and 3 with combination chemotherapy, lumpectomy and [11] G. Martinelli, G. Ryan, J. F. Seymour et al., “Primary follicular radiation therapy. eTh 15 documented cases of follicular lym- and marginal-zone lymphoma of the breast: clinical features, phoma, showed a median overall survival of only 24 months. prognostic factors and outcome: a study by the International However, the cases described in this study were those of Extranodal Lymphoma Study Group,” Annals of Oncology,vol. disseminated disease involving the breast not necessarily the 20, no. 12, pp. 1993–1999, 2009. primary breast lymphoma described in this case [13]. [12] K. Ganjoo, R. Advani, M. R. Mariappan, A. McMillan, and S. In conclusion, most patients with follicular lymphoma Horning, “Non-Hodgkin lymphoma of the breast,” Cancer,vol. of the breast who present with early stage local disease 110, no. 1, pp. 25–30, 2007. responded very well to definitive radiation therapy [ 11, 12]. [13] S.S.Talwalkar,R.N.Miranda,J.R.Valbuena, M. J. Routbort, Thispatient’s tumorbed wasinthe superior breast and A. W. Martin, and L. J. Medeiros, “Lymphomas involving the required a separate supraclavicular field to treat the entire breast: a study of 106 cases comparing localized and dissemi- involved organ and tumor bed. er Th e is no evidence of disease nated neoplasms,” American Journal of Surgical Pathology,vol. 4 years aer ft completion of definitive therapy. 32,no. 9, pp.1299–1309,2008. Conflict of Interests eTh authorsdeclaresthatthere is no conflictofinterests. Disclaimer eTh views expressed in this paper are those of the authors and do not necessarily reflect the ocia ffi l policy or position of the Department of the Navy, Department of Defense, or the United States Government. References [1] J. O. Armitage, “A clinical evaluation of the International Lym- phoma Study Group classification of non-Hodgkin’s lympho- ma,” Blood,vol.89, no.11, pp.3909–3918,1997. [2] J.O.ArmitageandD.D.Weisenburger,“Newapproachtoclassi- fying non-Hodgkin’s lymphomas: clinical features of the major histologic subtypes,” Journal of Clinical Oncology,vol.16, no.8, pp. 2780–2795, 1998. [3] N.L.Harris, E. S. Jaeff ,J.Diebold et al., “World health organi- zation classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the clinical advisory committee meeting—airlie house, Virginia, November 1997,” Journal of Clinical Oncology,vol.17, no.12, pp.3835–3849,1999. [4] A. Freedman, “Follicular lymphoma: 2011 update on diagnosis and management,” American Journal of Hematology,vol.86, pp. 768–775, 2011. [5] C.S.Ha, P. Dubey, L. K. Goyal, M. Hess,F.Cabanillas,and J. D. Cox, “Localized primary non-Hodgkin lymphoma of the breast,” American Journal of Clinical Oncology,vol.21, no.4,pp. 376–380, 1998. [6] R. Giardini, C. Piccolo, and F. Rilke, “Primary non-Hodgkin’s lymphomas of the female breast,” Cancer,vol.69, no.3,pp. 725– 735, 1992. [7] A.D.Zelenetz, J. S. Abramson,R.H.Advanietal.,“NCCN Clinical Practice Guidelines in Oncology: non-Hodgkin’s lym- phomas,” Journal of the National Comprehensive Cancer Net- work, vol. 8, pp. 288–334, 2010. 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

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Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: May 8, 2013

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