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1.
Gut and Liver ; : 426-433, 2024.
Article in English | WPRIM | ID: wpr-1042964

ABSTRACT

Background/Aims@#Papillary adenocarcinoma is classified to differentiated-type gastric cancer and is indicated for endoscopic submucosal dissection. However, due to its rare nature, there are limited studies on it. The purpose of this study was to determine the outcome of endoscopic submucosal dissection in patients with papillary-type early gastric cancer and to find the risk factors of lymph node metastasis. @*Methods@#Patients diagnosed with papillary-type early gastric cancer at eight medical centers, who underwent endoscopic submucosal dissection or surgical treatment, were retrospectively reviewed. The clinical results and long-term outcomes of post-endoscopic submucosal dissection were evaluated, and the risk factors of lymph node metastasis in the surgery group were analyzed. @*Results@#One-hundred and seventy-six patients with papillary-type early gastric cancer were enrolled: 44.9% (n=79) in the surgery group and 55.1% (n=97) in the endoscopic submucosal dissection group. As a result of endoscopic submucosal dissection, the en bloc resection and curative resection rates were 91.8% and 86.6%, respectively. The procedure-related complication rate was 4.1%, and local recurrence occurred in 3.1% of patients. Submucosal invasion (odds ratio, 3.735; 95% confidence interval, 1.026 to 12.177; p=0.047) and lymphovascular invasion (odds ratio, 7.636; 95% confidence interval, 1.730 to 22.857; p=0.004) were the risk factors of lymph node metastasis in papillary-type early gastric cancer patients. @*Conclusions@#The clinical results of endoscopic submucosal dissection in papillary-type early gastric cancer were relatively favorable, and endoscopic submucosal dissection is considered safe if appropriate indications are confirmed by considering the risk of lymph node metastasis.

2.
Article in English | WPRIM | ID: wpr-918973

ABSTRACT

Background/Aims@#Several conditions may cause difficulties with oral feeding. Percutaneous endoscopic gastrostomy (PEG) is commonly performed on patients who require enteral feeding for >2-3 weeks. This study examined the nutritional state of patients who required enteral feeding and underwent PEG to quantify the benefits of the procedure. @*Methods@#This retrospective study included patients who underwent PEG at the Chungnam National University Hospital between January 2013 and December 2018. A gastroenterologist performed all PEG procedures using the pull technique, and all patients were followed up for >3 weeks postoperatively. The BMI and lymphocyte count, along with the levels of hemoglobin, total protein, albumin, total cholesterol, BUN, and creatinine pre-PEG and between 3 weeks and 6 months post-PEG were evaluated. @*Results@#Overall, 151 patients (116 males; mean age 64.92 years) were evaluated. Of these patients, 112 (74.2%), 34 (22.5%), and five (3.3%) underwent PEG tube insertion because of neurological diseases, malignancy, and other conditions, respectively. The BMI and the hemoglobin, total protein, albumin, and total cholesterol levels were significantly higher post-PEG than pre-PEG. @*Conclusions@#These findings highlight the usefulness of PEG in the management of nutritionally poor patients with difficulties in feeding orally.

3.
Annals of Coloproctology ; : S18-S23, 2021.
Article in English | WPRIM | ID: wpr-896759

ABSTRACT

Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

4.
Annals of Coloproctology ; : S18-S23, 2021.
Article in English | WPRIM | ID: wpr-889055

ABSTRACT

Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

5.
Article in Korean | WPRIM | ID: wpr-786618

ABSTRACT

Gastric schwannoma, a rare mesenchymal tumor originating from the schwann cells of peripheral nerves, rarely occurs in the gastrointestinal tract. It accounts for only 0.2% of all gastric tumors and 2~6% of gastric mesenchymal tumors. Gastric schwannoma is observed as a subepithelial tumor on endoscopy; it is covered with normal mucosa, rendering its preoperative differential diagnosis difficult. An asymptomatic 43-year-old woman visited our hospital after a 7-cm ulcerofungating mass was detected in the lesser curvature of the gastric body on gastroscopy. Abdominal CT revealed multiple enlarged lymph nodes, and ¹⁸F-fluorodeoxyglucose (FDG) PET demonstrated a subtle uptake of FDG, suggestive of advanced gastric cancer. After three failed attempts of endoscopic biopsy, the patient underwent total gastrectomy with lymphadenectomy and was subsequently diagnosed with gastric schwannoma. Herein, we report this case with a literature review.


Subject(s)
Adult , Female , Humans , Biopsy , Diagnosis, Differential , Endoscopy , Gastrectomy , Gastrointestinal Tract , Gastroscopy , Lymph Node Excision , Lymph Nodes , Mucous Membrane , Neurilemmoma , Peripheral Nerves , Schwann Cells , Stomach Neoplasms , Tomography, X-Ray Computed
6.
Article in English | WPRIM | ID: wpr-787286

ABSTRACT

Despite its declining incidence, gastric cancer is globally, still, the third most common cause of cancer-related mortality. Gastric cancer is a heterogeneous disease with diverse pathogenesis and molecular backgrounds. Therefore several systems have been proposed to aid in the classification of gastric adenocarcinoma based on the macroscopic, microscopic and anatomical features of the tumor. However, these classifications did not reflect the pathogenesis of the disease. Recently, genomic analysis has identified several subtypes of gastric adenocarcinoma and a detailed understanding of the molecular biology behind the neoplastic phenotype is possible to develop of more effective therapies. We will describe the existing various classification of gastric cancer and the recently introduced molecular biology and immunological classification.


Subject(s)
Adenocarcinoma , Classification , Incidence , Molecular Biology , Mortality , Phenotype , Stomach Neoplasms
7.
Clinical Endoscopy ; : 289-293, 2018.
Article in English | WPRIM | ID: wpr-714591

ABSTRACT

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.


Subject(s)
Humans , Endoscopy , Gastrectomy , Gastric Stump , Ischemia , Mortality , Necrosis , Risk Factors , Splenic Infarction , Stomach , Vascular Diseases
8.
Article in English | WPRIM | ID: wpr-718629

ABSTRACT

Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure.


Subject(s)
Humans , Middle Aged , Anesthesia, Local , Angiography , Anti-Bacterial Agents , Consciousness , Deglutition Disorders , Eating , Endoscopy , Gastrostomy , Hemoperitoneum , Hemorrhage , Hypotension , Mesenteric Artery, Superior , Needles , Nutritional Support , Pancreatitis , Pneumonia , Punctures , Tracheostomy
9.
Article in English | WPRIM | ID: wpr-713358

ABSTRACT

BACKGROUND: Timely intervention in the treatment of bloodstream infection is important for prescription of appropriate antimicrobials. With prompt determination of the antimicrobial susceptibility of a causative agent, rapid antimicrobial susceptibility test (AST) can help select the appropriate antimicrobial therapy. This clinical study is for evaluation of the clinical performance of the QMAC-dRAST for rapid AST directly from positive blood culture (PBC)s with Gram-positive cocci. METHODS: A total of 115 PBC samples with Gram-positive organisms (76 Staphylococcus spp. and 39 Enterococcus spp.) were evaluated by the QMAC-dRAST system, and their pure culture isolates were evaluated by the MicroScan WalkAway (Beckman Coulter, USA) as the comparative AST system. Thirteen antimicrobial agents were included, and the agreement and discrepancy rates of the QMAC-dRAST system (Quantamatrix Inc., Republic of Korea) compared to the MicroScan WalkAway were calculated. To resolve discrepancies, the broth microdilution method was performed. RESULTS: The QMAC-dRAST system exhibited a categorical agreement rate of 94.9% (1,126/1,187) and an essential agreement rate of 98.3% (1,167/1,187). The QMAC-dRAST system yielded very major (false-susceptible) errors at 1.0% (5/485), major (false-resistant) errors at 1.3% (9/693), and minor errors at 4.0% (47/1,187) compared to the MicroScan WalkAway. The QMAC-dRAST system significantly eliminated 30 hours of total turnaround time by combination of direct inoculation of PBC and an image-based approach. CONCLUSION: The results of the QMAC-dRAST system were highly accurate. Thereby, the QMAC-dRAST may provide essential information to accelerate therapeutic decisions for earlier and adequate antibiotic treatment and patient management in clinical settings.


Subject(s)
Humans , Anti-Infective Agents , Bacteremia , Bioengineering , Clinical Study , Drug Resistance, Microbial , Enterococcus , Gram-Positive Cocci , Methods , Microbial Sensitivity Tests , Prescriptions , Staphylococcus
11.
Article in English | WPRIM | ID: wpr-33735

ABSTRACT

For inflammatory bowel disease (IBD), antitumor necrosis factor treatment offers a new direction for both patients and medical doctors. This treatment has dramatically improved the quality of life for patients with ulcerative colitis and Crohn disease (CD). However, with increasing usage and longer follow-up periods, a wider range of possible adverse effects may be encountered. We report an unusual case of pulmonary sarcoidosis developed during the treatment of a patient with CD by using infliximab. A 30-year-old male who had been treated for CD with infliximab for 18 months was admitted due to abnormal opacities on chest radiography. Chest computed tomography displayed clustered small nodules in both lobes and enlarged multiple lymph nodes. The patient was diagnosed with sarcoidosis from the results of a biopsy of the subcarinal lymph node. Lung lesions were improved five months after infliximab was stopped.


Subject(s)
Adult , Humans , Male , Biopsy , Colitis, Ulcerative , Crohn Disease , Follow-Up Studies , Inflammatory Bowel Diseases , Infliximab , Lung , Lymph Nodes , Necrosis , Quality of Life , Radiography , Sarcoidosis , Sarcoidosis, Pulmonary , Thorax , Tumor Necrosis Factor-alpha
12.
Article in English | WPRIM | ID: wpr-21597

ABSTRACT

Colonoscopy is a commonly performed endoscopic procedure. Although it is generally considered to be safe, serious complications, such as colorectal perforation, can occur. Most colonic perforations are intraperitoneal and cause pneumoperitoneum with acute abdominal pain as the initial symptom. However, extraperitoneal perforations with pneumoretroperitoneum may happen, albeit rarely, with atypical initial symptoms. We report a rare case of rectosigmoid perforation occurring after diagnostic colonoscopy that developed into pneumoretroperitoneum, pneumomediastinum, pneumothorax, and subcutaneous emphysema, with a change in voice and neck swelling as the initial symptoms. The patient was successfully treated with endoscopic closure of the perforation and conservative management.


Subject(s)
Humans , Abdominal Pain , Colon , Colonoscopy , Mediastinal Emphysema , Neck , Pneumoperitoneum , Pneumothorax , Retropneumoperitoneum , Subcutaneous Emphysema , Voice
13.
Article in English | WPRIM | ID: wpr-149529

ABSTRACT

Neuroendocrine tumors (NETs) of the esophagus are extremely rare, aggressive and have a poor prognosis. Combined therapy using chemotherapy, radiotherapy and/or surgery appear effective. Here, we present a patient with a complaint of dysphagia who was diagnosed with this rare tumor. Upper gastrointestinal endoscope of a 46-year-old female revealed a localized ulcerative lesion in the middle esophagus. Histologic exam of biopsy specimens indicated a neuroendocrine carcinoma. The tumor cells were arranged in microtubular structures, with small and round cells containing scanty cytoplasm. They were positive for synaptophysin and chromogranin A on immunohistochemical staining. A computed tomography scan showed an esophageal tumor with enlarged superior mediastinal lymph nodes and about 1.2 cm sized liver metastasis, similar to findings in PET-CT scanning. The patient was prescribed chemotherapy consisting of etoposide and cisplatin, which led to regression of disease on follow-up imaging study. She continues under clinical observation. We seek to increase awareness of this exceedingly rare but hazardous disease by sharing our unexpected finding.


Subject(s)
Female , Humans , Middle Aged , Biopsy , Carcinoma, Neuroendocrine , Chromogranin A , Cisplatin , Cytoplasm , Deglutition Disorders , Drug Therapy , Endoscopes, Gastrointestinal , Endoscopy , Esophageal Neoplasms , Esophagus , Etoposide , Follow-Up Studies , Liver , Lymph Nodes , Neoplasm Metastasis , Neuroendocrine Tumors , Prognosis , Radiotherapy , Synaptophysin , Ulcer
14.
Article in English | WPRIM | ID: wpr-149532

ABSTRACT

BACKGROUND/AIMS: In gastric cancer, the rate of recurrence and metastasis following radical resection is high, necessitating improvement in survival and cure rates. Neoadjuvant chemotherapy (NAC) has potential benefits for locally advanced gastric cancer; however, the surgical benefits and effects on survival are unclear. This study evaluates the effectiveness of NAC in locally advanced gastric cancer and compares clinical outcomes of doublet and triplet regimens. METHODS: We reviewed patient medical records of 383 patients who underwent NAC (n=41) or surgery only (n=342) for treatment of locally advanced gastric cancer. The baseline characteristics and clinical outcomes were compared between the groups. Chemotherapy patients were classified according to regimen, doublet (n=28) and triplet (n=13), and NAC-related clinical response, safety, and toxicity were analyzed. RESULTS: The baseline characteristics did not differ significantly between groups. After NAC, the tumor downstage rate was 51.2% (21/41); however, overall survival (p=0.205) and disease-free survival (p=0.415) were not significantly different between the groups. On subgroup analysis, no significant differences in drug toxicity (p=0.604) or clinical response (p=0.374) were found between outcomes of doublet and triplet chemotherapy regimens. CONCLUSIONS: In patients with locally advanced gastric cancer, NAC showed tolerable drug toxicity and increased tumor downstage, but NAC failed to increase the survival rate, which may be caused by a high D2-lymphadenectomy rate. Therefore, NAC was found to be a therapeutic option for select gastric cancer patients.


Subject(s)
Humans , Adenocarcinoma , Disease-Free Survival , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Medical Records , Neoadjuvant Therapy , Neoplasm Metastasis , Recurrence , Stomach , Stomach Neoplasms , Survival Rate , Triplets
15.
Journal of Gastric Cancer ; : 221-229, 2016.
Article in English | WPRIM | ID: wpr-152745

ABSTRACT

PURPOSE: Dysregulated microRNAs (miRNAs) can contribute to cancer development by leading to abnormal proliferation of cells, apoptosis, and differentiation. Although several miRNAs that are related to gastric cancer have been identified, the reported results have been inconsistent. The aim of this study was to determine miRNA expression profiles and validate miRNAs up- and down-regulated in gastric cancer. MATERIALS AND METHODS: We evaluated 34 primary gastric cancer tissues and paired adjacent nontumorous gastric tissues. Total RNA was extracted, and low-molecular-weight RNAs (<200 nucleotides) were isolated for further analysis. Two pairs of tissues were processed for GeneChip microarray analysis, and the identified up- and down-regulated miRNAs were validated by real-time quantitative polymerase chain reaction (qPCR). RESULTS: In the set of differentially expressed miRNAs, 5 were overexpressed by more than 2 fold, and 5 were reduced by 2 fold or less in gastric cancer tissues compared with normal gastric tissues. Four of these miRNAs (miR-196b-5p, miR-375, miR-483-5p, and miR-486-5p) were then validated by qPCR, and the relative expression levels of 2 miRNAs (miR-196b-5p and miR-375) were significantly different between cancer and normal tissues. CONCLUSIONS: Our results revealed that the expression of miR-196b-5p and miR-375 significantly correlates with gastric cancer. These miRNAs could therefore serve as diagnostic biomarkers of gastric cancer.


Subject(s)
Apoptosis , Biomarkers , Microarray Analysis , MicroRNAs , Polymerase Chain Reaction , RNA , Stomach , Stomach Neoplasms
16.
Journal of Gastric Cancer ; : 182-190, 2016.
Article in English | WPRIM | ID: wpr-216432

ABSTRACT

PURPOSE: This study aimed to establish a large-scale database of patients with gastric cancer to facilitate the development of a national-cancer management system and a comprehensive cancer control policy. MATERIALS AND METHODS: An observational prospective cohort study on gastric cancer was initiated in 2010. A total of 14 cancer centers throughout the country and 152 researchers were involved in this study. Patient enrollment began in January 2011, and data regarding clinicopathological characteristics, life style-related factors, quality of life, as well as diet diaries were collected. RESULTS: In total, 4,963 patients were enrolled until December 2014, and approximately 5% of all Korean patients with gastric cancer annually were included. The mean age was 58.2±11.5 years, and 68.2% were men. The number of patients in each stage was as follows: 3,394 patients (68.4%) were in stage IA/B; 514 patients (10.4%), in stage IIA/B; 469 patients (9.5%), in stage IIIA/B/C; and 127 patients (2.6%), in stage IV. Surgical treatment was performed in 3,958 patients (79.8%), endoscopic resection was performed in 700 patients (14.1%), and 167 patients (3.4%) received palliative chemotherapy. The response rate for the questionnaire on the quality of life was 95%; however, diet diaries were only collected for 27% of patients. CONCLUSIONS: To provide comprehensive information on gastric cancer for patients, physicians, and government officials, a large-scale database of Korean patients with gastric cancer was established. Based on the findings of this cohort study, an effective cancer management system and national cancer control policy could be developed.


Subject(s)
Humans , Male , Cohort Studies , Diet , Drug Therapy , Korea , Occupational Groups , Prospective Studies , Quality of Life , Stomach Neoplasms
17.
Clinical Endoscopy ; : 294-297, 2016.
Article in English | WPRIM | ID: wpr-94066

ABSTRACT

The incidence of gastric band erosion has decreased to 1%. Gastric band erosion can manifest with various clinical symptoms, although some patients remain asymptomatic. We present a case of a mostly asymptomatic patient who was diagnosed with gastric band erosion during a routine health check-up. A 32-year-old man without any underlying diseases except for non-alcoholic fatty liver underwent laparoscopic adjustable gastric band surgery in 2010. He had no significant complications postoperatively. He underwent routine health check-ups with near-normal gastroduodenoscopic findings through 2014. However, in 2015, routine gastroduodenoscopy showed that the gastric band had eroded into the stomach. His gastric band was removed laparoscopically, and the remaining gastric ulcer perforation was repaired using an omental patch. Due to the early diagnosis, the infection was not serious. The patient was discharged on postoperative day 3 with oral antibiotics. This patient was fortunately diagnosed early by virtue of a routine health check-up; thus, eliminating the possibility of serious complications.


Subject(s)
Adult , Humans , Anti-Bacterial Agents , Bariatric Surgery , Cytochrome P-450 CYP1A1 , Early Diagnosis , Fatty Liver , Incidence , Obesity, Morbid , Stomach , Stomach Ulcer , Virtues
18.
Korean Journal of Medicine ; : 416-420, 2016.
Article in English | WPRIM | ID: wpr-96325

ABSTRACT

Most mucosa-associated lymphoid tissue (MALT) lymphomas are found in the gastrointestinal tract. The most common site is the stomach, whereas colon MALT lymphomas are rare. There are a few reports of simultaneously diagnosed stomach and colon MALT lymphomas. However, diagnosis of primary colonic MALT lymphoma after complete remission of gastric MALT lymphoma is extremely rare. Although the treatment protocol for gastric MALT lymphoma is well established, there is no consensus protocol for colonic MALT lymphoma owing to its rarity. Herein, we report a case of colonic MALT lymphoma incidentally diagnosed 6 months after completion of radiation therapy for gastric MALT lymphoma and treated via polypectomy, with no recurrence for 3 years.


Subject(s)
Clinical Protocols , Colon , Consensus , Diagnosis , Gastrointestinal Tract , Lymphoid Tissue , Lymphoma , Lymphoma, B-Cell, Marginal Zone , Recurrence , Stomach
19.
Korean Journal of Medicine ; : 217-223, 2016.
Article in Korean | WPRIM | ID: wpr-75766

ABSTRACT

Gastric adenoma is a precancerous lesion. While some adenomas regress spontaneously, others progress as invasive carcinomas. Simple follow-up of gastric adenoma may be possible considering the possibility of spontaneous regression. However, several studies have reported discrepancies between the results of endoscopic forceps biopsies and post-resection biopsies. These studies showed that the pathological findings are more severe in biopsies performed after endoscopic resections. We suggest that endoscopic resections should be planned for cases of gastric adenoma. After endoscopic resection, regular endoscopic surveillance and Helicobacter pylori eradication may reduce the occurrence of gastric cancer.


Subject(s)
Adenoma , Biopsy , Follow-Up Studies , Helicobacter pylori , Stomach , Stomach Neoplasms , Surgical Instruments
20.
Article in Korean | WPRIM | ID: wpr-76275

ABSTRACT

Many neoplasms, including lung cancer, breast cancer, melanoma, and gastrointestinal tract malignancy, possess potential for skin metastasis. Skin metastases can represent the first presentation of such malignancies and may be observed incidentally during routine exam. Skin metastases from gastric adenocarcinoma are uncommon, with a prevalence rate of 0.04-0.8%. Cutaneous metastases from gastric cancer are generally observed as the initial symptom of advanced gastric cancer. Early detection and treatment can increase patient survival. A 42-year-old woman visited our department with nodule about 1 cm in size on the right frontal scalp noticed incidentally after laparoscopy-assisted distal gastrectomy and adjuvant systemic chemotherapy for early gastric cancer about 16 months prior. The patient was diagnosed with skin metastasis from gastric adenocarcinoma. Complete excision of the skin lesion and additional chemotherapy were performed. Herein, we report a case of nodular tumor-like scalp metastasis from early gastric cancer with a brief review of the literature.


Subject(s)
Adult , Female , Humans , Adenocarcinoma , Breast Neoplasms , Drug Therapy , Gastrectomy , Gastrointestinal Tract , Lung Neoplasms , Melanoma , Neoplasm Metastasis , Prevalence , Scalp , Skin , Stomach Neoplasms
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