Scientific letter
Carcinoid tumor on cystic ovarian teratoma
Tumor carcinoide sobre teratoma ovárico quístico
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They may develop carcinoid syndrome in the absence of liver metastases by avoiding enterohepatic circulation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 59-year-old female patient with history of high blood pressure controlled with enalapril and gastroesophageal reflux on long-term treatment with omeprazole and cinitapride who <span class="elsevierStyleItalic">reported</span> almost daily episodes of facial flushing starting two years before. Episodes were self-limited, lasted approximately 5–10<span class="elsevierStyleHsp" style=""></span>min, followed no time pattern, and were not related to drug or food intake. They were not associated to high or low blood pressure, headache, diarrhea, or bronchospasm, but patient reported palpitations during them. Patient differentiated these episodes from the vasomotor symptoms she had previously experienced after menopause at 52 years of age. These symptoms included a generalized hot sensation not associated to sweating or facial erythema which spontaneously resolved at 55 years (two years before the start of current symptoms). The patient reported no associated constitutional symptoms. Physical examination findings were normal. Measurement of calcitonin levels in blood and metanephrines, normetanephrines and 5-hydroxyindoleacetic acid in urine was requested. Repeatedly high 5-hydroxyindoleacetic acid levels were found, together with a mild, discontinuous elevation in normetanephrines (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Calcitonin levels were normal. Based on these findings, chromogranin A was tested in plasma, and a value of 265<span class="elsevierStyleHsp" style=""></span>ng/mL (No.<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>134) was reported. Based on the suspicion of a carcinoid tumor, a computed tomography (CT) scan and magnetic resonance imaging of the chest and abdomen were performed, showing a 6<span class="elsevierStyleHsp" style=""></span>cm right adnexal lesion reported as a possible teratoma. On the other hand, transabdominal pelvic ultrasonography revealed a 3.5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm tumor related to the left ovary. Because of heterogeneity of the results, a <span class="elsevierStyleSup">111</span>In-Pentetreotide scan (Octreoscan<span class="elsevierStyleSup">®</span>) was requested, showing a tracer hyperuptake site in the left paramedial pelvic region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In order to relieve symptoms while planning surgery, treatment was started with a somatostatin analogue (lanreotide 60<span class="elsevierStyleHsp" style=""></span>mg every 28 days by the deep subcutaneous route), which decreased the frequency and severity of episodes. After ruling out cardiac valve involvement by echocardiography, bilateral adnexectomy was performed. Histological examination found a low-grade (G1) insular carcinoid tumor on a mature cystic teratoma in left adnexum with Ki-67 1–2%, low mitotic index, and positive staining for chromogranin and synaptophysin in immunohistochemistry. The right ovary had a mature teratoma with no associated carcinoid tumor. After surgery, <span class="elsevierStyleItalic">flushing</span> episodes disappeared, and 5-hydroxyindoleacetic acid and normetanephrine levels normalized. Octreoscan<span class="elsevierStyleSup">®</span> and CT performed six months after surgery were normal. Although serum chromogranin A levels markedly decreased, values remained slightly elevated (150–154<span class="elsevierStyleHsp" style=""></span>ng/dL; No<span class="elsevierStyleItalic">.</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>134). Since all other supplemental tests did not suggest tumor recurrence, such increased levels were attributed to a drug interaction. Omeprazole treatment was therefore discontinued three weeks before control laboratory tests, and chromogranin A levels normalized (63.3 and 37<span class="elsevierStyleHsp" style=""></span>ng/mL; No.: 19.4–98.1). Three years after surgery, patient continues to be symptom-free, and results of supplemental tests have been normal to date.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Carcinoid tumors are uncommon, with an annual incidence of approximately 8 cases per 100,000 population.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Only 1–2% of these tumors originate in ovarian tissue,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> where they often seat, as in the reported case, on a cystic teratoma or dermoid tumor.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> According to some studies, this confers them a better prognosis as compared to tumors not occurring on a germ cell tumor.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although symptoms of carcinoid syndrome are highly characteristic, the syndrome only occurs in a small proportion of carcinoid tumors. Insular ovarian carcinoid tumor, the histological subtype of our patient, is most common and is the only one that is associated to carcinoid syndrome in one-third of cases.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the reported case, menopause had to be included in differential diagnosis of flushing because of <span class="elsevierStyleItalic">patient</span> age. Although hot flashes spontaneously disappear in most women a few years after the start of menopause, they may persist in up to 30% of women older than 60 years, and in 9% of those over 70 years of age.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, hot flashes had disappeared in our patient three years after menopause, and had never been associated to facial erythema as the one she subsequently experienced in the setting of carcinoid syndrome.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Chromogranin A is a protein found in neurosecretory vesicles of neuroendocrine tumor cells. It is currently considered to be the best biochemical marker for follow-up of these tumors because of its high sensitivity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It is however less specific, and there are various conditions where slight chromogranin A elevations may occur, such as kidney or liver insufficiency. Long-term use of proton pump inhibitors is considered the main cause of increased chromogranin A levels unrelated to a neuroendocrine tumor. Decreased acidity leads to increased gastrin release and enterochromaffin cell hyperplasia, with a resultant increase in chromogranin A. In the case reported, long-term omeprazole treatment hindered interpretation of chromogranin A during follow-up. As recommended by the literature, omeprazole was discontinued to obtain a reliable value of the marker.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tomé Fernández-Ladreda M, Martínez de Pinillos Gordillo G, Pichardo López de Haro F, Cózar León MV. Tumor carcinoide sobre teratoma ovárico quístico. Endocrinol Nutr. 2014;61:434–436.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 766 "Ancho" => 1600 "Tamanyo" => 83248 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole body Octreoscan<span class="elsevierStyleSup">®</span>/abdominal SPECT-CT.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Surgery performed on October 2010.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">February 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">June 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">November 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">March 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">December 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">March 2011 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metanephrines; nmol/mgCr(No.: 0–0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5-OH-indoleacetic acid; nmol/mgCr(No.: 0–34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normetanephrines; nmol/mgCr(No.: 0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab568011.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Metanephrine, normetanephrine, and 5-hydroxyindoleacetic acid levels in urine.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary insular carcinoid of the ovary with carcinoid heart disease: unfavourable outcome of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Buda" 1 => "D. Giuliani" 2 => "N. Montano" 3 => "P. Perego" 4 => "R. Milani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijscr.2011.10.014" "Revista" => array:6 [ "tituloSerie" => "Int J Surg Case Rep" "fecha" => "2012" "volumen" => "3" "paginaInicial" => "59" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22288046" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Updated population-based review of carcinoid tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Maggard" 1 => "J.B. O’Connell" 2 => "C.Y. Ko" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2004" "volumen" => "240" "paginaInicial" => "117" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15213627" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary ovary carcinoid tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.P. Davis" 1 => "L.K. Hartmann" 2 => "G.L. Kenney" 3 => "H. Shapiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1006/gyno.1996.0136" "Revista" => array:6 [ "tituloSerie" => "Gynecol Oncol" "fecha" => "1996" "volumen" => "61" "paginaInicial" => "259" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8626144" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoids of the ovary: an analysis of 329 reported cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Soga" 1 => "M. Osaka" 2 => "Y. Yakuwa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Exp Clin Cancer Res" "fecha" => "2000" "volumen" => "19" "paginaInicial" => "271" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11144518" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strumal carcinoid of the ovary: report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Lenicek" 1 => "D. Tomas" 2 => "H. Soljacić-Vranes" 3 => "Z. Kraljević" 4 => "P. Klarić" 5 => "M. Kos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Clin Croat" "fecha" => "2012" "volumen" => "51" "paginaInicial" => "649" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23540174" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoid tumors of the ovary" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Talerman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cancer Res Clin Oncol" "fecha" => "1984" "volumen" => "107" "paginaInicial" => "125" "paginaFinal" => "135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6715397" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistent hot flushes in older postmenopausal women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Huang" 1 => "D. Grady" 2 => "V.L. Jacoby" 3 => "T.L. Blackwell" 4 => "D.C. Bauer" 5 => "G.F. Sawaya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.168.8.840" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2008" "volumen" => "168" "paginaInicial" => "840" "paginaFinal" => "846" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18443259" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical significance of blood chromogranin A measurement in neuroendocrine tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Seregni" 1 => "L. Ferrari" 2 => "E. Bajetta" 3 => "A. Martinetti" 4 => "E. Bombardieri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Ann Oncol" "fecha" => "2001" "volumen" => "12" "numero" => "Suppl. 2" "paginaInicial" => "S69" "paginaFinal" => "S72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11762355" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discontinuation of proton pump inhibitors during assessment of chromogranin A levels in patients with neuroendocrine tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.M. Korse" 1 => "M. Muller" 2 => "B.G. Taal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/bjc.2011.380" "Revista" => array:6 [ "tituloSerie" => "Br J Cancer" "fecha" => "2011" "volumen" => "105" "paginaInicial" => "1173" "paginaFinal" => "1175" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21989216" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735093/0000006100000008/v1_201410080024/S2173509314001421/v1_201410080024/en/main.assets" "Apartado" => array:4 [ "identificador" => "5823" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735093/0000006100000008/v1_201410080024/S2173509314001421/v1_201410080024/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001421?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 1 | 23 |
| 2024 October | 70 | 7 | 77 |
| 2024 September | 119 | 1 | 120 |
| 2024 August | 80 | 7 | 87 |
| 2024 July | 94 | 10 | 104 |
| 2024 June | 70 | 8 | 78 |
| 2024 May | 54 | 4 | 58 |
| 2024 April | 75 | 13 | 88 |
| 2024 March | 81 | 4 | 85 |
| 2024 February | 65 | 5 | 70 |
| 2024 January | 84 | 9 | 93 |
| 2023 December | 74 | 23 | 97 |
| 2023 November | 70 | 11 | 81 |
| 2023 October | 105 | 25 | 130 |
| 2023 September | 57 | 12 | 69 |
| 2023 August | 66 | 6 | 72 |
| 2023 July | 77 | 7 | 84 |
| 2023 June | 95 | 9 | 104 |
| 2023 May | 159 | 5 | 164 |
| 2023 April | 135 | 12 | 147 |
| 2023 March | 125 | 10 | 135 |
| 2023 February | 81 | 13 | 94 |
| 2023 January | 95 | 10 | 105 |
| 2022 December | 98 | 9 | 107 |
| 2022 November | 93 | 12 | 105 |
| 2022 October | 78 | 21 | 99 |
| 2022 September | 86 | 27 | 113 |
| 2022 August | 103 | 32 | 135 |
| 2022 July | 66 | 16 | 82 |
| 2022 June | 73 | 19 | 92 |
| 2022 May | 70 | 31 | 101 |
| 2022 April | 70 | 16 | 86 |
| 2022 March | 103 | 19 | 122 |
| 2022 February | 87 | 11 | 98 |
| 2022 January | 113 | 16 | 129 |
| 2021 December | 87 | 14 | 101 |
| 2021 November | 79 | 26 | 105 |
| 2021 October | 102 | 19 | 121 |
| 2021 September | 86 | 18 | 104 |
| 2021 August | 88 | 13 | 101 |
| 2021 July | 65 | 16 | 81 |
| 2021 June | 43 | 11 | 54 |
| 2021 May | 88 | 22 | 110 |
| 2021 April | 142 | 17 | 159 |
| 2021 March | 108 | 19 | 127 |
| 2021 February | 67 | 8 | 75 |
| 2021 January | 34 | 15 | 49 |
| 2020 December | 35 | 18 | 53 |
| 2020 November | 56 | 10 | 66 |
| 2020 October | 40 | 9 | 49 |
| 2020 September | 40 | 10 | 50 |
| 2020 August | 31 | 10 | 41 |
| 2020 July | 50 | 18 | 68 |
| 2020 June | 39 | 11 | 50 |
| 2020 May | 47 | 15 | 62 |
| 2020 April | 25 | 3 | 28 |
| 2020 March | 39 | 10 | 49 |
| 2020 February | 33 | 7 | 40 |
| 2020 January | 49 | 18 | 67 |
| 2019 December | 37 | 11 | 48 |
| 2019 November | 29 | 6 | 35 |
| 2019 October | 61 | 8 | 69 |
| 2019 September | 34 | 5 | 39 |
| 2019 August | 21 | 13 | 34 |
| 2019 July | 32 | 19 | 51 |
| 2019 June | 51 | 25 | 76 |
| 2019 May | 146 | 20 | 166 |
| 2019 April | 75 | 17 | 92 |
| 2019 March | 17 | 6 | 23 |
| 2019 February | 20 | 11 | 31 |
| 2019 January | 14 | 5 | 19 |
| 2018 December | 15 | 5 | 20 |
| 2018 November | 19 | 5 | 24 |
| 2018 October | 15 | 5 | 20 |
| 2018 September | 12 | 4 | 16 |
| 2018 August | 21 | 5 | 26 |
| 2018 July | 15 | 10 | 25 |
| 2018 June | 17 | 2 | 19 |
| 2018 May | 11 | 6 | 17 |
| 2018 April | 6 | 2 | 8 |
| 2018 March | 10 | 3 | 13 |
| 2018 February | 54 | 2 | 56 |
| 2018 January | 9 | 0 | 9 |
| 2017 December | 52 | 1 | 53 |
| 2017 November | 12 | 3 | 15 |
| 2017 October | 9 | 2 | 11 |
| 2017 September | 20 | 3 | 23 |
| 2017 August | 18 | 4 | 22 |
| 2017 July | 15 | 2 | 17 |
| 2017 June | 30 | 12 | 42 |
| 2017 May | 42 | 15 | 57 |
| 2017 April | 27 | 5 | 32 |
| 2017 March | 50 | 17 | 67 |
| 2017 February | 46 | 7 | 53 |
| 2017 January | 22 | 3 | 25 |
| 2016 December | 32 | 5 | 37 |
| 2016 November | 26 | 10 | 36 |
| 2016 October | 71 | 3 | 74 |
| 2016 September | 24 | 4 | 28 |
| 2016 August | 11 | 10 | 21 |
| 2016 July | 20 | 2 | 22 |
| 2016 June | 14 | 4 | 18 |
| 2016 May | 15 | 11 | 26 |
| 2016 April | 10 | 9 | 19 |
| 2016 March | 13 | 8 | 21 |
| 2016 February | 22 | 10 | 32 |
| 2016 January | 11 | 5 | 16 |
| 2015 December | 18 | 6 | 24 |
| 2015 November | 10 | 6 | 16 |
| 2014 October | 0 | 1 | 1 |
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