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Mede A, Chotai PN, Huh WJ, Tan M. Intra-abdominal Cystic Lymphangiomas: The Vanderbilt Experience. J Surg Res 2023; 285:197-204. [PMID: 36696706 DOI: 10.1016/j.jss.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/21/2022] [Accepted: 12/24/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Lymphangiomas are rare, cystic tumors that represent congenital malformation of the lymphatic vessels. We reviewed our institution's experience treating abdominal lymphangiomas with the purpose of describing the clinical features, management, and outcomes of this rare pathology. METHODS This is a single-institution, institutional review board-approved retrospective review of abdominal lymphangiomas presenting between January 2010 and February 2021. The diagnosis of lymphangioma was made on histopathology from either endoscopic or excisional biopsy of the lesion. Demographics, diagnostic imaging, histopathologic characteristics, and outcomes were analyzed. RESULTS We identified 48 patients, of whom 29 (60%) were female, >18 y (38; 79%), with a mean age of 43 y at the time of diagnosis (range, 4 d-87 y). Tumors ranged in size from <1 cm to 30 cm. Only 1/3 were symptomatic, most commonly with abdominal pain (9; 19%) On preoperative imaging, mural nodules or thickened walls were present in one case, in which pathology was consistent with benign lymphangioma. The majority of lymphangiomas were associated with the small bowel or its mesentery (31; 65%), followed by the colon/omentum (7; 15%). Most patients underwent surgical excision (29; 60%) with incomplete excision in one patient due to extensive local invasion, and three (10%) patients required multivisceral resection. The median duration of the follow-up was 13 mo (range, 1-105 mo), during which time, none of the patients developed malignancy. CONCLUSIONS Most abdominal lymphangiomas arise from the small bowel and are found incidentally and have a favorable prognosis. Resection should be reserved for symptomatic lesions or when there is a diagnostic uncertainty.
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Affiliation(s)
- Annmarie Mede
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pranit N Chotai
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Won Jae Huh
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus Tan
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Chenin M, Paisant A, Lebigot J, Bazeries P, Debbi K, Ronot M, Laurent V, Aubé C. Cystic liver lesions: a pictorial review. Insights Imaging 2022; 13:116. [PMID: 35838923 PMCID: PMC9287528 DOI: 10.1186/s13244-022-01242-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Hepatic cysts (HC) are sac-like structures mainly filled with liquid and showing a distinct membrane. They are usually found incidentally through imaging. A wide spectrum of imaging patterns may be observed for common and uncommon, neoplastic and non-neoplastic diseases. While simple hepatic cysts occur frequently and do not require any treatment or follow-up, non-typical cysts should be carefully analysed to avoid misdiagnosing a lesion that would require appropriate management. Therefore, adequate knowledge of all the relevant imaging patterns is critical to secure an accurate diagnosis. The aim of this review is to describe the imaging features of the different types of hepatic cysts.
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Affiliation(s)
- Mégane Chenin
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.
| | - Anita Paisant
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.,HIFIH Laboratory, EA 3859, UNIV Angers, 49045, Angers, France
| | - Jérôme Lebigot
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.,HIFIH Laboratory, EA 3859, UNIV Angers, 49045, Angers, France
| | - Paul Bazeries
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France
| | - Kawtar Debbi
- Department of Radiology, La Timone Children Hospital of Marseille, 264 rue St Pierre, 13385, Marseille Cedex 05, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, APHP.Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France.,Université de Paris, Paris, France
| | - Valérie Laurent
- Department of Radiology, University Hospital of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Christophe Aubé
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49 933, Angers Cedex 09, France.,HIFIH Laboratory, EA 3859, UNIV Angers, 49045, Angers, France
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Gatti M, Maino C, Tore D, Carisio A, Darvizeh F, Tricarico E, Inchingolo R, Ippolito D, Faletti R. Benign focal liver lesions: The role of magnetic resonance imaging. World J Hepatol 2022; 14:923-943. [PMID: 35721295 PMCID: PMC9157713 DOI: 10.4254/wjh.v14.i5.923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/07/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Liver lesions are common findings in radiologists' daily routine. They are a complex category of pathology that range from solitary benign lesions to primary liver cancer and liver metastases. Benign focal liver lesions can arise from different liver cell types: Epithelial (hepatocytes and biliary cells) and nonepithelial (mesenchymal cells). Liver magnetic resonance imaging (MRI) is a fundamental radiological method in these patients as it allows with its multiparametric approach optimal non-invasive tissue characterization. Furthermore, advanced liver MRI techniques such as diffusion-weighted imaging and hepatobiliary contrast agents have improved the detection of focal liver lesions and can be highly effective in differentiating pseudotumor from tumors, as well as benign from malignant lesions, and can also be used for differential diagnosis. Although histological examination can be useful in making a definitive diagnosis, MRI is an important modality in the diagnosis of liver lesions with a significant impact on patient care. This aim of this review is to provide a comprehensive overview of benign liver lesions on MRI.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy.
| | - Cesare Maino
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Davide Tore
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Andrea Carisio
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Japan
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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Parmeggiani A, Baldazzi M, Carfagnini F, Vivacqua D, Golfieri R, Lovato L, Greco L. Extensive solitary lymphatic malformation of the liver in a child: a case report and literature review. Radiol Case Rep 2022; 17:427-433. [PMID: 34917222 PMCID: PMC8666449 DOI: 10.1016/j.radcr.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Intrabdominal lymphatic malformations are rare benign congenital vascular anomalies that account for less than 5% of benign masses in childhood, with an extremely variable clinical presentation. For this reason, although their radiological appearance is usually typical, diagnosis can be challenging and not always immediate. This report describes a unique case of extensive solitary hepatic lymphatic malformation in a 10-year-old boy with both extra- and intraparenchymal development with no associated symptoms. A literature review of reported cases of solitary hepatic lymphatic malformation is also included.
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Affiliation(s)
- Anna Parmeggiani
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michelangelo Baldazzi
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Filomena Carfagnini
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Donatella Vivacqua
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luigi Lovato
- Cardio-Thoracic Radiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Laura Greco
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Long X, Zhang L, Cheng Q, Chen Q, Chen XP. Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review. World J Clin Cases 2020; 8:4633-4643. [PMID: 33083428 PMCID: PMC7559670 DOI: 10.12998/wjcc.v8.i19.4633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic lymphangioma, a malformation of the liver lymphatic system, is a rare benign neoplasm and usually coexists with other visceral lymphangiomas. Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.
CASE SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with, including Schistosome japonicum infection and jaundice, and also together with imaging results, which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase. The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation. Finally, the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation. The pathological examination indicated the mass as hepatic lymphangioma. The patient has been followed up for 30 mo without recurrence. To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future, we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms, imaging presentation, operative techniques, histology features and prognosis.
CONCLUSION Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult. Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.
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Affiliation(s)
- Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Qi Cheng
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Qian Chen
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Hattori A, Inoue H, Kurata K, Tsuboi J, Yamada R, Hamada Y, Katsurahara M, Tanaka K, Horiki N, Takei Y. Cystic lymphangioma of the hepatoduodenal ligament: a rare intra-abdominal tumor mimicking hematoma. Clin J Gastroenterol 2020; 14:212-217. [PMID: 32996113 DOI: 10.1007/s12328-020-01250-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Abstract
A 22-year-old man was referred for upper abdominal pain. Unenhanced computed tomography (CT) revealed a lesion of heterogeneous hypoattenuation, part of which showed slightly high-density in the porta hepatis. On magnetic resonance imaging (MRI), T1-weighted images showed a multiloculated hyperintense mass and part of the mass was hyperintense in T2-weighted images. Abdominal ultrasonography showed a 40 mm multilocular mass with septa, containing solid and small cystic components. In sonazoid-enhanced ultrasonography, the septa were enhanced but the solid components were not. Because of the location of tumor and the findings of CT/MRI, we suspected the lesion as hematoma of the liver. We could not exclude neoplastic disease, such as biliary cystadenoma or cystadenocarcinoma of the liver, so surgical resection was performed. The mass was a multilocular cyst arising from the hepatoduodenal ligament. Pathological examination revealed aggregation of lymph vessels and endothelial-like cells with no atypia, which were positive for the specific markers D2-40 and CD31. The histological diagnosis was abdominal lymphangioma. Intra-abdominal lymphangiomas, which originate from the hepatoduodenal ligament, are extremely rare, benign tumors. We are mindful that lymphangioma should be considered in the differential diagnosis of tumors in the abdominal cavity, mimicking a hematoma of the liver and with a cystic appearance.
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Affiliation(s)
- Aiji Hattori
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Hiroyuki Inoue
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kazunari Kurata
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Junya Tsuboi
- Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Reiko Yamada
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yasuhiko Hamada
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | | | - Kyosuke Tanaka
- Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Noriyuki Horiki
- Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Yoshiyuki Takei
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Intraabdominal Lymphatic Malformations: Pearls and Pitfalls of Diagnosis and Differential Diagnoses in Pediatric Patients. AJR Am J Roentgenol 2017; 208:637-649. [DOI: 10.2214/ajr.16.17008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Liu Q, Sui CJ, Li BS, Gao A, Lu JY, Yang JM. Solitary hepatic lymphangioma: a one-case report. SPRINGERPLUS 2014; 3:314. [PMID: 25279280 PMCID: PMC4169228 DOI: 10.1186/2193-1801-3-314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/17/2014] [Indexed: 02/07/2023]
Abstract
Hepatic lymphangiomas, malformations of the liver lymphatic system, are extremely rare conditions in adults. A 41-year-old man presented with right upper abdominal pain for 6 months was introduced in this report. Ultrasound (US) and computed tomography (CT) scan demonstrated a giant cystictumor with a pedunculatedextrahepatic growth pattern. Due to diagnostic uncertainty, a partial hepatectomy was performed and pathological results confirmed the diagnosis of solitary hepatic lymphangioma. In this article, we reviewed the clinical and pathology features, preoperative diagnostic challenges, and treatments of hepaticlymphangiomas.
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Affiliation(s)
- Qu Liu
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China ; Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Cheng-Jun Sui
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
| | - Bao-Shan Li
- Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Ang Gao
- Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Jian-Yue Lu
- Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Jia-Mei Yang
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
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Watanabe M, Shiozawa K, Ikehara T, Sato A, Matsui D, Ogino Y, Igarashi Y, Okubo Y, Shibuya K, Sumino Y. A case of solitary bile duct hamartoma with advanced gastric carcinoma: findings in contrast-enhanced ultrasonography. J Med Ultrason (2001) 2014; 41:203-7. [PMID: 27277774 DOI: 10.1007/s10396-013-0480-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/21/2013] [Indexed: 12/11/2022]
Abstract
Bile duct hamartomas (BDH), which are also known as von Meyenburg complexes, are benign neoplasms that involve cystic dilatation of the bile duct surrounded by fibrous stroma. However, multiple lesions develop in most cases of BDH, whereas a solitary lesion, as seen in our case, is relatively rare. We report here the co-existence of gastric carcinoma and BDH mimicking metastasis in a 30-year-old woman. A lesion measuring 13 × 9 mm with the appearance of a hyperechoic nodule with no pulsatile blood flow signals was observed on US and Doppler US in S4 of the liver. On contrast-enhanced ultrasonography (CEUS), the septum-like structure in the tumor was weakly enhanced at 17 s after administration of Sonazoid. There has been no description of solitary BDH findings on CEUS in the literature. We present the US findings of BDH, including those yielded by CEUS using Sonazoid, along with the microscopic pathological correlation.
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Affiliation(s)
- Manabu Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Kazue Shiozawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Ikehara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Aya Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Daigo Matsui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yu Ogino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Youichiro Okubo
- Department of Surgical Pathology, Toho University Medical Center, Omori Hospital, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University Medical Center, Omori Hospital, Tokyo, Japan
| | - Yasukiyo Sumino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
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da Cunha Castro EC, Galambos C. Prox-1: a specific and sensitive marker for lymphatic endothelium in normal and diseased human tissues. Ann Thorac Surg 2011; 92:407; author reply 407-8. [PMID: 21718895 DOI: 10.1016/j.athoracsur.2011.01.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 11/20/2010] [Accepted: 01/26/2011] [Indexed: 12/27/2022]
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