Scientific letter
Pituitary apoplexy as presentation of atypical teratoid/rhabdoid tumor in an adult
Apoplejía hipofisaria como forma de presentación de un tumor teratoide/rabdoide atípico en el adulto
Read
3778
Timeswas read the article
732
Total PDF
3046
Total HTML
Share statistics
array:24 [ "pii" => "S2173509316300678" "issn" => "21735093" "doi" => "10.1016/j.endoen.2016.08.007" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "805" "copyright" => "SEEN" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Endocrinol Nutr. 2016;63:364-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 989 "formatos" => array:2 [ "HTML" => 766 "PDF" => 223 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1575092216300729" "issn" => "15750922" "doi" => "10.1016/j.endonu.2016.05.004" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "805" "copyright" => "SEEN" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Endocrinol Nutr. 2016;63:364-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1170 "formatos" => array:2 [ "HTML" => 861 "PDF" => 309 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Apoplejía hipofisaria como forma de presentación de un tumor teratoide/rabdoide atípico en el adulto" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "364" "paginaFinal" => "365" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pituitary apoplexy as presentation of atypical teratoid/rhabdoid tumor in an adult" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 990 "Ancho" => 990 "Tamanyo" => 86116 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">TAC craneal con contraste. Corte sagital. Día 30 de ingreso, 20 días después de la resección parcial de la lesión mediante abordaje transesfenoidal.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Larrán-Escandón, Isabel Mateo-Gavira, Francisco Javier Vilchez-López, Efraim Gómez Cárdenas, Manuel Aguilar Diosdado" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Larrán-Escandón" ] 1 => array:2 [ "nombre" => "Isabel" "apellidos" => "Mateo-Gavira" ] 2 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Vilchez-López" ] 3 => array:2 [ "nombre" => "Efraim" "apellidos" => "Gómez Cárdenas" ] 4 => array:2 [ "nombre" => "Manuel" "apellidos" => "Aguilar Diosdado" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173509316300678" "doi" => "10.1016/j.endoen.2016.08.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509316300678?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092216300729?idApp=UINPBA00004N" "url" => "/15750922/0000006300000007/v1_201607200626/S1575092216300729/v1_201607200626/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173509316300666" "issn" => "21735093" "doi" => "10.1016/j.endoen.2016.08.006" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "800" "copyright" => "SEEN" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Endocrinol Nutr. 2016;63:366-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1229 "formatos" => array:2 [ "HTML" => 971 "PDF" => 258 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Synchronous malignant struma ovarii and papillary thyroid carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "366" "paginaFinal" => "367" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estruma ovárico maligno y cáncer papilar de tiroides sincrónicos" ] ] "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" => 742 "Ancho" => 990 "Tamanyo" => 135651 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological image of mature cystic teratoma showing the typical nuclear characteristics of papillary thyroid cancer, as well as positive TTF1 (thyroid transcription factor-1).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo Fernández Catalina, Antonia Rego Iraeta, Mónica Lorenzo Solar, Paula Sánchez Sobrino" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pablo" "apellidos" => "Fernández Catalina" ] 1 => array:2 [ "nombre" => "Antonia" "apellidos" => "Rego Iraeta" ] 2 => array:2 [ "nombre" => "Mónica" "apellidos" => "Lorenzo Solar" ] 3 => array:2 [ "nombre" => "Paula" "apellidos" => "Sánchez Sobrino" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1575092216300535" "doi" => "10.1016/j.endonu.2016.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092216300535?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509316300666?idApp=UINPBA00004N" "url" => "/21735093/0000006300000007/v2_201609300106/S2173509316300666/v2_201609300106/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173509316300745" "issn" => "21735093" "doi" => "10.1016/j.endoen.2016.09.004" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "802" "copyright" => "SEEN" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Nutr. 2016;63:354-63" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1050 "formatos" => array:2 [ "HTML" => 782 "PDF" => 268 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Thyroid dysfunction in the era of precision medicine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "354" "paginaFinal" => "363" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La disfunción tiroidea en la era de la medicina de precisión" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan C. Galofré, Juan J. Díez, David S. Cooper" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Juan C." "apellidos" => "Galofré" ] 1 => array:2 [ "nombre" => "Juan J." "apellidos" => "Díez" ] 2 => array:2 [ "nombre" => "David S." "apellidos" => "Cooper" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509316300745?idApp=UINPBA00004N" "url" => "/21735093/0000006300000007/v2_201609300106/S2173509316300745/v2_201609300106/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Pituitary apoplexy as presentation of atypical teratoid/rhabdoid tumor in an adult" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "364" "paginaFinal" => "365" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Larrán-Escandón, Isabel Mateo-Gavira, Francisco Javier Vilchez-López, Efraim Gómez Cárdenas, Manuel Aguilar Diosdado" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Laura" "apellidos" => "Larrán-Escandón" "email" => array:1 [ 0 => "laura.larran@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Isabel" "apellidos" => "Mateo-Gavira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Vilchez-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Efraim" "apellidos" => "Gómez Cárdenas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Manuel" "apellidos" => "Aguilar Diosdado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Neurociencia, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Apoplejía hipofisaria como forma de presentación de un tumor teratoide/rabdoide atípico en el adulto" ] ] "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" => 990 "Ancho" => 990 "Tamanyo" => 87100 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan of the head with contrast. Sagittal section. Day 30 of hospital stay, 20 days after partial lesion resection through a transsphenoidal approach.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although pituitary apoplexy usually occurs in a pituitary adenoma, it may also occur in other less common types of tumors. The atypical teratoid/rhabdoid tumor (ATRT) is a very aggressive malignant tumor of the central nervous system usually occurring in children under three years of age and has a poor prognosis despite chemotherapy and/or radiotherapy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 43-year-old female patient admitted to hospital for suspected pituitary apoplexy due to pituitary macroadenoma. She complained of headaches over the previous three months. In the two weeks prior to admission, the patient progressively experienced malaise, vomiting, lower limb weakness, diplopia and, finally, eyelid ptosis. There were no clinical signs suggesting hormone dysfunction, urinary frequency, or polydipsia, and her menstrual cycles were maintained. A physical examination showed an acceptable general condition with a score of 15 on the Glasgow scale. The patient had normal blood pressure and no fever or signs of hypercorticism or acromegaly. Paresis of the third left cranial nerve was found. Supplemental tests revealed severe hyponatremia (123<span class="elsevierStyleHsp" style=""></span>mmol/L). CT of the brain and pituitary MRI: 20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>23<span class="elsevierStyleHsp" style=""></span>mm sellar tumor with suprasellar growth, consistent with an invasive pituitary adenoma with subacute bleeding. Campimetry: superior and inferior nasal and temporal field involvement, especially marked in the left eye. A hormone profile was consistent with partial hypopituitarism: prolactin 625.9<span class="elsevierStyleHsp" style=""></span>μIU/mL (normal: 102–496); basal cortisol: 6.12<span class="elsevierStyleHsp" style=""></span>μg/dL (normal: 6.2–19.4); TSH 0.29<span class="elsevierStyleHsp" style=""></span>μIU/mL (normal: 0.27–4.2); FT4: 0.74<span class="elsevierStyleHsp" style=""></span>ng/dL (normal: 0.93–1.7); FSH: 3.9<span class="elsevierStyleHsp" style=""></span>mIU/mL (normal: 3.54–12.5); LH 0.3<span class="elsevierStyleHsp" style=""></span>mIU/mL (normal: 2.4–12.6); HGH 0.45<span class="elsevierStyleHsp" style=""></span>ng/mL (normal: 0–7), and IGF-1 67<span class="elsevierStyleHsp" style=""></span>ng/mL (normal: 100–310).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Ten days after admission, partial tumor resection was performed using a transsphenoidal approach. Over the following days, the headaches persisted and the patient experienced fluctuations in consciousness. A CT scan of the head with no contrast, performed five days after surgery, showed a slightly hyperdense image as compared to the brain parenchyma, homogeneous and rounded and related to the already known pituitary lesion, despite surgery. Rapid clinical progression occurred, with the development of sphincter incontinence and complete bilateral amaurosis. While waiting for the histological results and because of a suspected actively growing malignant tumor, radiotherapeutic oncology was consulted to assess treatment. A CT scan performed before the start of radiotherapy (20 days after surgery) showed a big sellar isodense tumor, 7.2<span class="elsevierStyleHsp" style=""></span>cm in size that had infiltrated the sellar region and right cavernous, frontal and right temporal sinuses with a mass effect, strongly enhanced with intravenous contrast (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The final pathological report confirmed the suspected malignancy: ATRT grade IV of the WHO. Measurement of integrase interactor 1 (INI1), a marker whose absence in tumor cell nuclei establishes the final diagnosis of ATRT, was negative twice. Because of rapid disease progression, a conservative approach was adopted. Only palliative measures and replacement therapy with glucocorticoids and thyroxine for persistent hypopituitarism were used. Finally, the patient died 35 days after admission.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Pituitary apoplexy is defined as an ischemic or hemorrhagic event usually occurring in a pituitary adenoma, although it may also occur in other types of tumor and even in a normal pituitary gland.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> In our patient, the clinical presentation was highly suggestive, and initial imaging tests showed a tumor consistent with pituitary adenoma, the pituitary lesion most common in adults. However, the unfavorable and rapidly progressive course suggested a malignant condition, finally diagnosed as ATRT.</p><p id="par0025" class="elsevierStylePara elsevierViewall">ATRT of the central nervous system usually affects young children, and 94% of the patients reported have been younger than 5 years.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> Radiographic characteristics are not specific of this type of tumor. Histolologically, ATRT consists of rhabdoid cells, alone or combined with indistinguishable areas of primitive neuroectodermal tumor (PNET) and/or with a mesenchymal and/or epithelial component.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a> ATRT is the only tumor of the central nervous system in which a pathognomonic change has been found in a suppressor gene, INI1/hSNF5. The loss of INI1 expression is considered diagnostic of ATRT, and adequate immunohistochemical assessment is therefore essential in order to evaluate this tumor variant.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment protocols for adults have been extrapolated from the pediatric literature, and aggressive surgical resection followed by multidisciplinary treatment is indicated. In adults, craniospinal radiotherapy is a standard treatment, associated with different chemotherapy regimens, although this is not well defined for adults.</p><p id="par0035" class="elsevierStylePara elsevierViewall">ATRT is characterized by aggressive behavior in the majority of children, who usually die within seven months of diagnosis despite intensive treatment. In the literature review performed in adults, only nine cases have occurred in the sellar or suprasellar region. Survival is variable in the different cases reported in the literature, with a mean of 26 months (range, 2 weeks/17 years)<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,6,7</span></a>; in the reported case, the course was fulminant, as the patient died only 35 days after diagnosis, and the form of presentation was the most aggressive and most rapidly progressive among all the tumors occurring in the sella turcica.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, it should be borne in mind that pituitary apoplexy commonly occurs in pituitary adenomas, although other primary tumors affecting the sella turcica should always be taken into consideration. ATRT is a tumor of the central nervous system which is exceptional in adults and in a pituitary location, which may make diagnosis difficult. Diagnosis requires adequate immunohistochemical assessment, because the loss of INI1 expression is pathognomonic of this type of tumor. Because of the low incidence of ATRT, there are no specific therapeutic management protocols for the adult population, and the tumor is associated with a gloomy prognosis within a variable time period. The case reported demonstrates the rapid progression of the disease, and is one of the cases of ATRT in adults with the most aggressive behavior and shortest survival time among the diagnoses reported to date in the literature.</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: Larrán-Escandón L, Mateo-Gavira I, Vilchez-López FJ, Gómez Cárdenas E, Aguilar Diosdado M. Apoplejía hipofisaria como forma de presentación de un tumor teratoide/rabdoide atípico en el adulto. Endocrinol Nutr. 2016;63:364–365.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 990 "Ancho" => 990 "Tamanyo" => 87100 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan of the head with contrast. Sagittal section. Day 30 of hospital stay, 20 days after partial lesion resection through a transsphenoidal approach.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía clínica del diagnóstico y tratamiento de la apoplejía hipofisaria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Català" 1 => "A. Picó" 2 => "F. Tortosa" 3 => "C. Varela" 4 => "A. Gilsanz" 5 => "T. Lucas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Endocrinol Nutr" "fecha" => "2006" "volumen" => "53" "paginaInicial" => "19" "paginaFinal" => "24" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical teratoid/rhabdoid tumors: imaging findings of two cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Tez" 1 => "A. Köktener" 2 => "G. Güler" 3 => "P. Ozişik" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Turk Neurosurg" "fecha" => "2008" "volumen" => "18" "paginaInicial" => "30" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18382974" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case report. Atypical teratoid/rhabdoid tumour in sella turcica in an adult" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Arita" 1 => "K. Sugiyama" 2 => "T. Sano" 3 => "H. Oka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Neurochir (Wien)" "fecha" => "2008" "volumen" => "150" "paginaInicial" => "491" "paginaFinal" => "496" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical teratoid/rhabdoid tumor of the central nervous system in adult: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Umredkar" 1 => "A. Bal" 2 => "R.K. Vashista" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02688697.2010.496877" "Revista" => array:6 [ "tituloSerie" => "Br J Neurosurg" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "699" "paginaFinal" => "704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21070155" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of atypical teratoid/rhabdoid tumor in an adult, with long survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kenta" 1 => "N. Hiroshi" 2 => "K. Masahito" 3 => "Y. Tomoaki" 4 => "M. Roshan" 5 => "K. Hiromi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10014-010-0008-y" "Revista" => array:7 [ "tituloSerie" => "Brain Tumor Pathol" "fecha" => "2011" "volumen" => "28" "paginaInicial" => "71" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21181449" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109700011165" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical teratoid/rhabdoid tumors in adults: a case report an treatment-focused review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.A. Shonka" 1 => "T.S. Armstrong" 2 => "S.S. Prabhu" 3 => "A. Childress" 4 => "S. Choi" 5 => "L.A. Langford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4021/jocmr535w" "Revista" => array:6 [ "tituloSerie" => "J Clin Med Res" "fecha" => "2011" "volumen" => "3" "paginaInicial" => "85" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21811535" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of atypical teratoid/rhabdoid tumor in the internal auditory canal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Yamaguchi" 1 => "H. Oka" 2 => "C. Kijima" 3 => "H. Sano" 4 => "H. Watanabe" 5 => "M. Okamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anl.2014.09.005" "Revista" => array:6 [ "tituloSerie" => "Auris Nasus Larynx" "fecha" => "2015" "volumen" => "42" "paginaInicial" => "163" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25450856" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult-onset sellar and suprasellar atypical teratoid rhabdoid tumor treated with multimodal approach: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.G. Park" 1 => "J.H. Yoon" 2 => "S.H. Kim" 3 => "K.H. Cho" 4 => "H.J. Park" 5 => "S.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.14791/btrt.2014.2.2.108" "Revista" => array:6 [ "tituloSerie" => "Brain Tumor Res Treat" "fecha" => "2014" "volumen" => "2" "paginaInicial" => "108" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25408935" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical teratoid rhabdoid tumour of the spine: report of a case and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Sinha" 1 => "M. Ahmad" 2 => "A. Varghese" 3 => "T. Parekh" 4 => "A. Ismail" 5 => "A. Chakrabarty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-014-3445-1" "Revista" => array:7 [ "tituloSerie" => "Eur Spine J" "fecha" => "2015" "volumen" => "24" "numero" => "Suppl 4" "paginaInicial" => "S472" "paginaFinal" => "S484" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25374299" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735093/0000006300000007/v2_201609300106/S2173509316300678/v2_201609300106/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/21735093/0000006300000007/v2_201609300106/S2173509316300678/v2_201609300106/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509316300678?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 20 | 1 | 21 |
| 2024 September | 39 | 5 | 44 |
| 2024 August | 31 | 7 | 38 |
| 2024 July | 25 | 3 | 28 |
| 2024 June | 24 | 4 | 28 |
| 2024 May | 30 | 4 | 34 |
| 2024 April | 24 | 3 | 27 |
| 2024 March | 48 | 6 | 54 |
| 2024 February | 42 | 6 | 48 |
| 2024 January | 52 | 5 | 57 |
| 2023 December | 48 | 5 | 53 |
| 2023 November | 47 | 6 | 53 |
| 2023 October | 50 | 13 | 63 |
| 2023 September | 23 | 1 | 24 |
| 2023 August | 49 | 3 | 52 |
| 2023 July | 30 | 5 | 35 |
| 2023 June | 46 | 6 | 52 |
| 2023 May | 71 | 5 | 76 |
| 2023 April | 59 | 6 | 65 |
| 2023 March | 32 | 3 | 35 |
| 2023 February | 50 | 12 | 62 |
| 2023 January | 22 | 3 | 25 |
| 2022 December | 42 | 14 | 56 |
| 2022 November | 34 | 17 | 51 |
| 2022 October | 29 | 8 | 37 |
| 2022 September | 41 | 16 | 57 |
| 2022 August | 43 | 11 | 54 |
| 2022 July | 41 | 9 | 50 |
| 2022 June | 49 | 5 | 54 |
| 2022 May | 69 | 9 | 78 |
| 2022 April | 46 | 15 | 61 |
| 2022 March | 76 | 11 | 87 |
| 2022 February | 59 | 8 | 67 |
| 2022 January | 64 | 4 | 68 |
| 2021 December | 51 | 17 | 68 |
| 2021 November | 55 | 13 | 68 |
| 2021 October | 31 | 16 | 47 |
| 2021 September | 28 | 12 | 40 |
| 2021 August | 24 | 15 | 39 |
| 2021 July | 24 | 9 | 33 |
| 2021 June | 22 | 7 | 29 |
| 2021 May | 43 | 15 | 58 |
| 2021 April | 78 | 15 | 93 |
| 2021 March | 50 | 13 | 63 |
| 2021 February | 40 | 15 | 55 |
| 2021 January | 37 | 12 | 49 |
| 2020 December | 35 | 14 | 49 |
| 2020 November | 40 | 11 | 51 |
| 2020 October | 38 | 7 | 45 |
| 2020 September | 32 | 16 | 48 |
| 2020 August | 46 | 9 | 55 |
| 2020 July | 22 | 5 | 27 |
| 2020 June | 20 | 6 | 26 |
| 2020 May | 39 | 22 | 61 |
| 2020 April | 27 | 11 | 38 |
| 2020 March | 25 | 8 | 33 |
| 2020 February | 37 | 5 | 42 |
| 2020 January | 35 | 13 | 48 |
| 2019 December | 25 | 6 | 31 |
| 2019 November | 15 | 6 | 21 |
| 2019 October | 21 | 4 | 25 |
| 2019 September | 20 | 6 | 26 |
| 2019 August | 20 | 2 | 22 |
| 2019 July | 21 | 30 | 51 |
| 2019 June | 36 | 21 | 57 |
| 2019 May | 113 | 36 | 149 |
| 2019 April | 35 | 8 | 43 |
| 2019 March | 11 | 2 | 13 |
| 2019 February | 12 | 8 | 20 |
| 2019 January | 10 | 2 | 12 |
| 2018 December | 7 | 11 | 18 |
| 2018 November | 11 | 3 | 14 |
| 2018 October | 8 | 4 | 12 |
| 2018 September | 14 | 4 | 18 |
| 2018 August | 10 | 2 | 12 |
| 2018 July | 5 | 2 | 7 |
| 2018 June | 10 | 2 | 12 |
| 2018 May | 11 | 1 | 12 |
| 2018 April | 13 | 0 | 13 |
| 2018 March | 11 | 1 | 12 |
| 2018 February | 11 | 0 | 11 |
| 2018 January | 14 | 1 | 15 |
| 2017 December | 10 | 0 | 10 |
| 2017 November | 18 | 0 | 18 |
| 2017 October | 18 | 2 | 20 |
| 2017 September | 12 | 1 | 13 |
| 2017 August | 13 | 2 | 15 |
| 2017 July | 13 | 3 | 16 |
| 2017 June | 17 | 4 | 21 |
| 2017 May | 40 | 3 | 43 |
| 2017 April | 25 | 3 | 28 |
| 2017 March | 37 | 23 | 60 |
| 2017 February | 42 | 4 | 46 |
| 2017 January | 3 | 0 | 3 |
Show all
