Case report
A massive pleural-based tumour: The challenge of diagnosis
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(B) Goretex patch repair of fenestrations.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Nwiloh" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Nwiloh" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911000705?idApp=UINPBA00004E" "url" => "/08732159/0000001700000006/v2_201509041318/S0873215911000705/v2_201509041318/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0873215911000663" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2011.06.002" "estado" => "S300" "fechaPublicacion" => "2011-11-01" "aid" => "30" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Pneumol. 2011;17:272-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8950 "formatos" => array:3 [ "EPUB" => 289 "HTML" => 7560 "PDF" => 1101 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "<span class="elsevierStyleItalic">Haemophilus influenzae</span> pneumonia and immunodeficiency in association with thymoma—A presentation of Good's Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "272" "paginaFinal" => "274" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 738 "Ancho" => 900 "Tamanyo" => 58530 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph at presentation suggestive of consolidation at the both lung bases (predominantly on the left side).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Fahim, M. Abuzakouk, S.P. Hart" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Fahim" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Abuzakouk" ] 2 => array:2 [ "nombre" => "S.P." "apellidos" => "Hart" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911000663?idApp=UINPBA00004E" "url" => "/08732159/0000001700000006/v2_201509041318/S0873215911000663/v2_201509041318/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "A massive pleural-based tumour: The challenge of diagnosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "275" "paginaFinal" => "277" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "H. Elsayed, J. Gosney" "autores" => array:2 [ 0 => array:4 [ "nombre" => "H." "apellidos" => "Elsayed" "email" => array:1 [ 0 => "drhany.elsayed@yahoo.co.uk" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Gosney" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Cardiothoracic Department, Liverpool Heart and Chest Hospital, United Kingdom" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Thoracic Surgery Department, Ain Shams University, Cairo, Egypt" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Histopathology Department, Royal Liverpool University Hospital Trust, Liverpool, United Kingdom" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 628 "Ancho" => 900 "Tamanyo" => 89320 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A large mass in the right hemi-thorax with low density suggestive of a lipoma/liposarcoma.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Liposarcoma most commonly arises in the retro peritoneum or thigh, but can also involve numerous other anatomical sites, such as the inguinal area, popliteal fossa, buttock, shoulder, arm, neck, back, and scalp, as well as the genitourinary and aerodigestive tracts.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Liposarcomas of the mediastinum and chest wall have been previously described; however, primary pleural liposarcoma is very rare and only a few isolated cases have been reported. We report an exceedingly rare case of a well-differentiated sclerosing liposarcoma in a 47-year-old male, which has been only reported once in the English literature.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 47-year-old gentleman was referred by his general practioner. He had been complaining of non-specific chest pain for the past 2 years. Over the past 2 months, the pain had become more frequent and sharp in nature. Additionally, he had begun to complain of shortness of breath with a NYHA classification of 2. Apart from that, he was fit with no significant past medical history apart from a fractured elbow and whiplash injury after a road traffic accident in 2002. His current medications included only painkillers on demand. He was a current smoker with a history of 20 packs per year. He drinks no alcohol.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A chest X-ray was done which was commented on as suspicious of diaphragmatic hernia, and hence was referred to the thoracic surgeons.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On presentation, this gentleman was fit and well. Cardio-respiratory revealed decreased air entry on the right basal lung field. The rest of examination was normal. We performed a CT-scan (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), which confirmed the presence of a huge mass of an unidentified nature occupying the right hemi thorax. Its measurements were 17<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm. A PET FDG confirmed the mass to be of normal activity with no other abnormal uptake elsewhere.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On the basis of the patient's symptoms and the likelihood of resectability, we proceeded with a right thoractomy with single lung ventilation. A huge intrapleural mass measuring 18<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm and weighing 640<span class="elsevierStyleHsp" style=""></span>g was found attached to the inner surface of the chest wall by a 1<span class="elsevierStyleHsp" style=""></span>cm stalk. No other masses were found elsewhere. The mass was dissected and removed en bloc and was found to be partially encapsulated (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Routine haemostasis and closure were performed.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Postoperatively, the patient made an excellent recovery and was discharged home three days later. Histopathogy came back as a huge tumour with sheets of adipocytes of variable size with broad fibrous bands and extensive necrosis. A thick fibrous capsule surrounded the tumour. The appearance was consistent with a well-differentiated sclerosing liposarcoma with no areas of high-grade sarcoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>(a and b)). No immunohistochemistry was needed as morphology was diagnostic. On the basis of the pathology, our oncologist suggested the need for adjuvant radiotherapy.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Liposarcomas of the chest wall and mediastinum have been very rarely reported, and distinction from pleural liposarcoma with chest wall or mediastinal invasion requires careful radiographic evaluation, surgical evaluation, or both. In some cases it may be impossible to be certain where the tumour is arising but the main differentiating feature is whether the tumour is intra or extra-pleural in origin. In our case, the tumour appeared to be intrapleural, although there was a small stalk attached to the chest wall.</p><p id="par0040" class="elsevierStylePara elsevierViewall">After recognizing the diagnostic histologic features of a liposarcoma, one must exclude the possibility of metastases or spread from either the chest wall or mediastinum.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Other sarcomas that may be confused with liposarcoma include malignant fibrous histiocytoma, in which bizarre pleomorphic giant cells may be mistaken for pleomorphic liposarcoma. However, characteristic lipoblasts should be evident in liposarcoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">McGregor et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported the only recorded case of well-differentiated and pleomorphic liposarcoma of the pleural cavity that recurred 2 years following excision; the histologic pattern of this tumour resembled malignant fibrous histiocytoma.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The rarity of liposarcomas arising in the pleural cavity makes it difficult to identify prognostic factors that correlate with survival. The issue of surgical resectability is of paramount importance for patient survival, especially in low-grade sarcomas.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Based on the small number of pleural liposarcomas reported to date, it is difficult to know if there is clinical importance in separating resectable pleural liposarcomas from chest wall sarcomas. Whether complete resection with adequate surgical margins improves survival for pleural liposarcomas needs further evaluation with a larger number of cases. Our oncologist recommended adjuvant radiotherapy which is supported by other studies in which radiation therapy was instituted, later onset of recurrence and longer disease-free survival were more likely.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Of importance to the pathologist is the histopathologic subtype of liposarcoma. The classification of liposarcoma is based on 4 histologic categories that generally reflect the degree of differentiation, ranging from well-differentiated liposarcoma to myxoid/round cell, undifferentiated, and, finally, pleomorphic liposarcomas. Well-differentiated liposarcomas can be further sub-classified as lipoma-like, inflammatory, and sclerosing, based on features of similarity to lipomas, lymphoplasmacytic infiltrate, or areas of loose to dense fibrous stroma, respectively.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">It is very difficult to comment on the prognosis of the subtypes of well differentiated liposarcoma as this is the only second reported case in such an entity and this will require us to gather more cases with longer periods of follow up. Our case, as well as those identified in the literature, demonstrates that the most common histologic subtypes of liposarcoma in the pleura appear to be myxoid and well differentiated. All forms of liposarcoma contain lipoblasts in varying numbers and morphologic forms; however, the more poorly differentiated liposarcomas behave more aggressively and can produce widespread metastases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Liposarcomas of the pleura are very rare tumours diagnosed mainly via CT-scans with lipomas being the main differential diagnosis. The challenge of diagnosis remains in identifying its origin and it needs careful inspection from the surgeon before resection.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres547609" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec565489" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres547608" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec565488" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-12-10" "fechaAceptado" => "2011-06-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565489" "palabras" => array:3 [ 0 => "Liposarcoma" 1 => "Pleural based tumours" 2 => "Rare tumours" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565488" "palabras" => array:3 [ 0 => "Lipossarcoma" 1 => "Tumores na pleura" 2 => "Tumores raros" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Liposarcomas of the mediastinum and chest wall have been previously described; however, primary pleural liposarcoma is extremely rare.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report an exceedingly rare case of a well-differentiated sclerosing pleural liposarcoma in a 47-year-old male that was resected. We emphasise the importance of careful inspection of the origin of these tumours to allow accurate diagnosis.</p></span>" ] "es" => array:2 [ "titulo" => "Resumo" "resumen" => "<span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Os lipossarcomas do mediastino e da parede torácica foram descritos anteriormente; no entanto, o lipossarcoma pleural primário é extremamente raro.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Registamos um caso extremamente raro de um lipossarcoma esclerosante da pleura bem diferenciado num homem de 47 anos que foi reseccionado. Enfatizamos a importância da verificação cuidada da origem destes tumores, para permitir um diagnóstico preciso.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 628 "Ancho" => 900 "Tamanyo" => 89320 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A large mass in the right hemi-thorax with low density suggestive of a lipoma/liposarcoma.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 758 "Ancho" => 917 "Tamanyo" => 108132 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Gross appearance of the excised mass after removal from the chest.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 555 "Ancho" => 1500 "Tamanyo" => 233564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(a) Medium power photomicrograph showing mature adipocytes separated by collagenous fibrous tissue (sclerosing feature). An occasional lipoblast with an enlarged hyper chromatic nucleus is evident within the fat. (b) High power view showing an atypical lipoblast, the presence of which indicates malignant well differentiated sclerosing liposarcoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soft tissue tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.M. Enzinger" 1 => "S.W. Weiss" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1995" "editorial" => "Mosby-Year Book" "editorialLocalizacion" => "St Louis, MO" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural liposarcoma presenting with respiratory distress and suspected diaphragmatic hernia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Carroll" 1 => "M.D. Kramer" 2 => "A.J. Acinapura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1992" "volumen" => "54" "paginaInicial" => "1212" "paginaFinal" => "1213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1449314" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary pleural liposarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Evans" 1 => "R. Wolstenholme" 2 => "S. Shettar" 3 => "H. 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Kanabe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Clin Lab Sci" "fecha" => "1987" "volumen" => "17" "paginaInicial" => "83" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3034132" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liposarcoma of the pleura" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.W. Wong" 1 => "J.R. Pluth" 2 => "G.L. Grado" 3 => "S.E. Schild" 4 => "D.R. Sanderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "1994" "volumen" => "69" "paginaInicial" => "882" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8065192" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liposarcoma of the pleura: report of a case with a review of the literature and views on histogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.K. Gupta" 1 => "F.A. Paolini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/arrd.1967.95.2.298" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1967" "volumen" => "95" "paginaInicial" => "298" "paginaFinal" => "304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6017048" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variability of histologic pattern in recurrent soft tissue sarcomas originally diagnosed as liposarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.C. Snover" 1 => "H.W. Sumner" 2 => "L.P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 8 | 22 |
| 2024 October | 49 | 33 | 82 |
| 2024 September | 52 | 25 | 77 |
| 2024 August | 93 | 45 | 138 |
| 2024 July | 39 | 31 | 70 |
| 2024 June | 53 | 31 | 84 |
| 2024 May | 47 | 31 | 78 |
| 2024 April | 41 | 26 | 67 |
| 2024 March | 44 | 30 | 74 |
| 2024 February | 51 | 27 | 78 |
| 2024 January | 47 | 31 | 78 |
| 2023 December | 33 | 26 | 59 |
| 2023 November | 40 | 32 | 72 |
| 2023 October | 42 | 37 | 79 |
| 2023 September | 49 | 42 | 91 |
| 2023 August | 52 | 25 | 77 |
| 2023 July | 38 | 25 | 63 |
| 2023 June | 28 | 23 | 51 |
| 2023 May | 57 | 31 | 88 |
| 2023 April | 43 | 14 | 57 |
| 2023 March | 75 | 19 | 94 |
| 2023 February | 54 | 25 | 79 |
| 2023 January | 54 | 14 | 68 |
| 2022 December | 52 | 18 | 70 |
| 2022 November | 76 | 39 | 115 |
| 2022 October | 55 | 29 | 84 |
| 2022 September | 52 | 30 | 82 |
| 2022 August | 88 | 35 | 123 |
| 2022 July | 94 | 41 | 135 |
| 2022 June | 52 | 31 | 83 |
| 2022 May | 55 | 43 | 98 |
| 2022 April | 54 | 23 | 77 |
| 2022 March | 45 | 41 | 86 |
| 2022 February | 34 | 28 | 62 |
| 2022 January | 69 | 37 | 106 |
| 2021 December | 31 | 36 | 67 |
| 2021 November | 54 | 37 | 91 |
| 2021 October | 39 | 44 | 83 |
| 2021 September | 41 | 27 | 68 |
| 2021 August | 48 | 21 | 69 |
| 2021 July | 20 | 28 | 48 |
| 2021 June | 29 | 19 | 48 |
| 2021 May | 46 | 14 | 60 |
| 2021 April | 164 | 50 | 214 |
| 2021 March | 95 | 12 | 107 |
| 2021 February | 62 | 17 | 79 |
| 2021 January | 37 | 17 | 54 |
| 2020 December | 40 | 7 | 47 |
| 2020 November | 61 | 25 | 86 |
| 2020 October | 30 | 14 | 44 |
| 2020 September | 73 | 25 | 98 |
| 2020 August | 81 | 28 | 109 |
| 2020 July | 100 | 28 | 128 |
| 2020 June | 87 | 19 | 106 |
| 2020 May | 92 | 20 | 112 |
| 2020 April | 96 | 21 | 117 |
| 2020 March | 73 | 6 | 79 |
| 2020 February | 66 | 12 | 78 |
| 2020 January | 95 | 17 | 112 |
| 2019 December | 80 | 14 | 94 |
| 2019 November | 94 | 9 | 103 |
| 2019 October | 87 | 21 | 108 |
| 2019 September | 82 | 13 | 95 |
| 2019 August | 150 | 21 | 171 |
| 2019 July | 160 | 12 | 172 |
| 2019 June | 148 | 6 | 154 |
| 2019 May | 169 | 17 | 186 |
| 2019 April | 144 | 25 | 169 |
| 2019 March | 185 | 11 | 196 |
| 2019 February | 174 | 8 | 182 |
| 2019 January | 224 | 23 | 247 |
| 2018 December | 145 | 7 | 152 |
| 2018 November | 55 | 3 | 58 |
| 2018 October | 62 | 10 | 72 |
| 2018 September | 39 | 10 | 49 |
| 2018 August | 52 | 27 | 79 |
| 2018 July | 65 | 19 | 84 |
| 2018 June | 75 | 41 | 116 |
| 2018 May | 92 | 15 | 107 |
| 2018 April | 98 | 21 | 119 |
| 2018 March | 120 | 19 | 139 |
| 2018 February | 73 | 11 | 84 |
| 2018 January | 100 | 19 | 119 |
| 2017 December | 130 | 15 | 145 |
| 2017 November | 59 | 15 | 74 |
| 2017 October | 34 | 17 | 51 |
| 2017 September | 32 | 11 | 43 |
| 2017 August | 46 | 17 | 63 |
| 2017 July | 34 | 13 | 47 |
| 2017 June | 34 | 25 | 59 |
| 2017 May | 38 | 22 | 60 |
| 2017 April | 13 | 5 | 18 |
| 2017 March | 15 | 6 | 21 |
| 2017 February | 49 | 8 | 57 |
| 2017 January | 34 | 2 | 36 |
| 2016 December | 37 | 22 | 59 |
| 2016 November | 30 | 14 | 44 |
| 2016 October | 55 | 12 | 67 |
| 2016 September | 141 | 9 | 150 |
| 2016 August | 62 | 5 | 67 |
| 2016 July | 12 | 6 | 18 |
| 2016 June | 5 | 5 | 10 |
| 2016 May | 14 | 0 | 14 |
| 2016 April | 48 | 2 | 50 |
| 2016 March | 87 | 8 | 95 |
| 2016 February | 88 | 15 | 103 |
| 2016 January | 73 | 11 | 84 |
| 2015 December | 85 | 7 | 92 |
| 2015 November | 73 | 10 | 83 |
| 2015 October | 58 | 9 | 67 |
| 2015 September | 77 | 7 | 84 |
| 2015 August | 66 | 7 | 73 |
| 2015 July | 127 | 6 | 133 |
| 2015 June | 57 | 4 | 61 |
| 2015 May | 82 | 7 | 89 |
| 2015 April | 81 | 5 | 86 |
| 2015 March | 74 | 6 | 80 |
| 2015 February | 74 | 6 | 80 |
| 2015 January | 70 | 14 | 84 |
| 2014 December | 74 | 10 | 84 |
| 2014 November | 64 | 8 | 72 |
| 2014 October | 84 | 6 | 90 |
| 2014 September | 70 | 10 | 80 |
| 2014 August | 32 | 15 | 47 |
| 2014 July | 59 | 12 | 71 |
| 2014 June | 56 | 5 | 61 |
| 2014 May | 85 | 9 | 94 |
| 2014 April | 64 | 10 | 74 |
| 2014 March | 77 | 11 | 88 |
| 2014 February | 90 | 12 | 102 |
| 2014 January | 85 | 11 | 96 |
| 2013 December | 69 | 12 | 81 |
| 2013 November | 59 | 10 | 69 |
| 2013 October | 65 | 12 | 77 |
| 2013 September | 75 | 12 | 87 |
| 2013 August | 59 | 12 | 71 |
| 2013 July | 73 | 19 | 92 |
| 2013 June | 52 | 16 | 68 |
| 2013 May | 47 | 15 | 62 |
| 2013 April | 68 | 26 | 94 |
| 2013 March | 66 | 13 | 79 |
| 2013 February | 59 | 19 | 78 |
| 2013 January | 62 | 20 | 82 |
| 2012 December | 55 | 14 | 69 |
| 2012 November | 59 | 16 | 75 |
| 2012 October | 41 | 6 | 47 |
| 2012 September | 16 | 7 | 23 |
| 2012 January | 286 | 0 | 286 |
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