Letter to the Editor
Primary malignant melanoma of the esophagus: A rare cause of dysphagia
Melanoma maligno primario esofágico: una causa infrecuente de disfagia
Read
1906
Timeswas read the article
501
Total PDF
1405
Total HTML
Share statistics
array:23 [ "pii" => "S244438241500005X" "issn" => "24443824" "doi" => "10.1016/j.gastre.2015.12.003" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "879" "copyright" => "Elsevier España, S.L.U. and AEEH y AEG" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2016;39:47-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 503 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 348 "PDF" => 154 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210570515000989" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2015.04.001" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "879" "copyright" => "Elsevier España, S.L.U. y AEEH y AEG" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2016;39:47-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 836 "formatos" => array:2 [ "HTML" => 588 "PDF" => 248 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al director</span>" "titulo" => "Melanoma maligno primario esofágico: una causa infrecuente de disfagia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "47" "paginaFinal" => "48" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Primary malignant melanoma of the esophagus: A rare cause of dysphagia" ] ] "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" => 714 "Ancho" => 950 "Tamanyo" => 105689 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tinción con hematoxilina-eosina de biopsia esofágica mediante endoscopia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Revilla Morato, Ana Mora Soler, A. Beatriz Prieto Bermejo, Concepción Piñero Pérez, Daniel Pérez Corte, Rosa Acosta Materán, Héctor Marcos Prieto, L. Ignacio Gimeno Mateos, Fernando Geijo Martínez, Antonio Rodriguez Pérez" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Revilla Morato" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Mora Soler" ] 2 => array:2 [ "nombre" => "A. Beatriz" "apellidos" => "Prieto Bermejo" ] 3 => array:2 [ "nombre" => "Concepción" "apellidos" => "Piñero Pérez" ] 4 => array:2 [ "nombre" => "Daniel" "apellidos" => "Pérez Corte" ] 5 => array:2 [ "nombre" => "Rosa" "apellidos" => "Acosta Materán" ] 6 => array:2 [ "nombre" => "Héctor" "apellidos" => "Marcos Prieto" ] 7 => array:2 [ "nombre" => "L. Ignacio" "apellidos" => "Gimeno Mateos" ] 8 => array:2 [ "nombre" => "Fernando" "apellidos" => "Geijo Martínez" ] 9 => array:2 [ "nombre" => "Antonio" "apellidos" => "Rodriguez Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S244438241500005X" "doi" => "10.1016/j.gastre.2015.12.003" "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/S244438241500005X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570515000989?idApp=UINPBA00004N" "url" => "/02105705/0000003900000001/v1_201601070045/S0210570515000989/v1_201601070045/es/main.assets" ] ] "itemAnterior" => array:18 [ "pii" => "S2444382416000122" "issn" => "24443824" "doi" => "10.1016/j.gastre.2015.04.001" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "889" "copyright" => "Elsevier España, S.L.U. and AEEH y AEG" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2016;39:45-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 464 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 351 "PDF" => 108 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Typical but less frequently recognized findings in laparoscopic adjustable gastric band slippage" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "45" "paginaFinal" => "46" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos típicos pero menos reconocibles en deslizamiento de banda gástrica ajustable laparoscópica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 552 "Ancho" => 1951 "Tamanyo" => 177992 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Endoscopic image revealing an enlarged gastric pouch with mucosal erosions; (B) endoscopic image revealing herniation of the distal stomach (arrow) proximal to a narrowed impression (arrowhead) in the distal gastric body secondary to band displacement; (C) endoscopic image after retroflexion of the scope in the antrum, showing an easily traversed angulated constriction in the distal gastric body.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Ponte, Rolando Pinho, Joana Ferreira, Carlos Fernandes, Iolanda Ribeiro, Joana Silva, Jorge Carrapita, Antónia Póvoa, João Carvalho" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Ponte" ] 1 => array:2 [ "nombre" => "Rolando" "apellidos" => "Pinho" ] 2 => array:2 [ "nombre" => "Joana" "apellidos" => "Ferreira" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Fernandes" ] 4 => array:2 [ "nombre" => "Iolanda" "apellidos" => "Ribeiro" ] 5 => array:2 [ "nombre" => "Joana" "apellidos" => "Silva" ] 6 => array:2 [ "nombre" => "Jorge" "apellidos" => "Carrapita" ] 7 => array:2 [ "nombre" => "Antónia" "apellidos" => "Póvoa" ] 8 => array:2 [ "nombre" => "João" "apellidos" => "Carvalho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382416000122?idApp=UINPBA00004N" "url" => "/24443824/0000003900000001/v2_201602240048/S2444382416000122/v2_201602240048/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Primary malignant melanoma of the esophagus: A rare cause of dysphagia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "47" "paginaFinal" => "48" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cristina Revilla Morato, Ana Mora Soler, A. Beatriz Prieto Bermejo, Concepción Piñero Pérez, Daniel Pérez Corte, Rosa Acosta Materán, Héctor Marcos Prieto, L. Ignacio Gimeno Mateos, Fernando Geijo Martínez, Antonio Rodriguez Pérez" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Cristina" "apellidos" => "Revilla Morato" "email" => array:1 [ 0 => "cris_revi@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" => "Ana" "apellidos" => "Mora Soler" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A. Beatriz" "apellidos" => "Prieto Bermejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Concepción" "apellidos" => "Piñero Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Daniel" "apellidos" => "Pérez Corte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Rosa" "apellidos" => "Acosta Materán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Héctor" "apellidos" => "Marcos Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "L. Ignacio" "apellidos" => "Gimeno Mateos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Fernando" "apellidos" => "Geijo Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Antonio" "apellidos" => "Rodriguez Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Clínico Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Melanoma maligno primario esofágico: una causa infrecuente de disfagia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1070 "Ancho" => 800 "Tamanyo" => 104750 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Macroscopic image of the esophagus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary malignant melanoma of the esophagus (PMME) accounts for only 0.1–0.2% of all malignant esophageal tumours.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Symptoms are usually dysphagia and retrosternal pain.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 68-year-old man, who was seen for symptoms of dysphagia beginning one month previously. Upper endoscopy revealed a 3-cm lesion with a polypoid appearance, 35<span class="elsevierStyleHsp" style=""></span>cm from the dental arch. The surrounding mucosa had a bluish appearance, suggestive of increased vascularization at this level. The biopsy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed areas of melanosis and foci of activity at the junction, pointing to a primary esophageal origin. Skin and ophthalmological examination revealed no evidence of melanoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The thoracoabdominal computed tomography scan showed irregular thickening (2.5<span class="elsevierStyleHsp" style=""></span>cm) of a 6-cm segment of the distal esophagus (extending to the cardia from 5<span class="elsevierStyleHsp" style=""></span>cm distal to the carina) and mediastinal lymphadenopathies (right upper paratracheal, 0.9<span class="elsevierStyleHsp" style=""></span>cm; lower paratracheal, 1.2<span class="elsevierStyleHsp" style=""></span>cm and calcified; and para-esophageal, 1.1<span class="elsevierStyleHsp" style=""></span>cm). The patient underwent transhiatal esophagectomy and subsequent transmediastinal tubular gastroplasty with cervical esophagogastric anastomosis. Histological analysis of the surgical specimen (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) confirmed a diagnosis of primary melanoma with lymphatic invasion. Immunohistochemistry (IHC) staining was positive for S100, HMB45 and Ki67. The patient remained 22 days in intensive care, where he underwent a radiological swallowing study that revealed stenosis of the gastric plastica with pre-stenotic dilatation, requiring endoscopic dilatation. Following chemotherapy due to lymphatic invasion, the patient died from nosocomial respiratory infection 6 months after diagnosis.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Primary melanoma of the esophagus is a rare disease with high mortality. It presents between the sixth and seventh decades of life, predominantly in men (2:1 ratio).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Cases have occasionally been described in young people and even children. The disorder usually involves the lower two thirds of the esophagus (86% of cases),<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> and manifests clinically with dysphagia, weight loss, retrosternal pain and, occasionally, upper gastrointestinal bleeding. Macroscopically the tumour is polypoid, intraluminal, lobulated and usually pigmented.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a> It is often diagnosed–as in our case–via endoscopic biopsy, although diagnosis for lesions with no pigment granules may be complicated; in these cases, IHC with HMB45 and S100 positive staining is useful. Around 40% of patients present lymphatic spread at diagnosis; the first organ affected is the liver, followed by the mediastinum, lung and brain in that order.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,4</span></a> Primary melanoma is defined according to the criteria described by Allen and Spitz,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> namely, that the lesion should have the structure of a melanoma and contain melanin pigment, present an area with junctional activity on the squamous epithelium and with melanocytes in the adjacent epithelium, and have a polypoid configuration. Although the most common form of presentation at diagnosis is a protruding mass, primary melanoma has also been described in the form of flat lesions.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> This fact, together with the rare nature of the condition, results in a high percentage of initial diagnostic error and poor prognosis. Melanoma should be ruled out in at least the skin, eye, anus and vagina. Surgical resection is the treatment of choice and is the only treatment that affects survival. Five-year post-operative survival is 37%.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> In some patients with inoperable tumours, intraluminal brachytherapy, radiotherapy, chemotherapy, immunotherapy or metal stenting may relieve the dysphagia. Nonetheless, prognosis for this type of tumour is poor, essentially due to its metastatic capacity.</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: Revilla Morato C, Mora Soler A, Prieto Bermejo AB, Piñero Pérez C, Pérez Corte D, Acosta Materán R, et al. Melanoma maligno primario esofágico: una causa infrecuente de disfagia. Gastroenterol Hepatol. 2016;39:47–48.</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" => 714 "Ancho" => 950 "Tamanyo" => 108130 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Haematoxylin–eosin staining of the endoscopic esophageal biopsy.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1070 "Ancho" => 800 "Tamanyo" => 104750 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Macroscopic image of the esophagus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary malignant melanoma of the esophagus: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.H. Li" 1 => "X. Li" 2 => "X.P. Zou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v20.i10.2731" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "2731" "paginaFinal" => "2734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24627611" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary malignant melanoma of the esophagus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Yonal" 1 => "D. Ibrisim" 2 => "Y. Songur" 3 => "Y. Cakaloglu" 4 => "K. Tuncer" 5 => "H. Kirimlioglu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000353637" "Revista" => array:6 [ "tituloSerie" => "Case Rep Gastroenterol" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "272" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23898233" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current status of primary malignant melanoma of the esophagus: clinical features, pathology, management and prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Iwanuma" 1 => "N. Tomita" 2 => "T. Amano" 3 => "F. Isayama" 4 => "M. Tsurumaru" 5 => "T. Hayashi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00535-011-0490-y" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol" "fecha" => "2012" "volumen" => "47" "paginaInicial" => "21" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22048255" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of superficial primary malignant melanoma of the esophagus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kato" 1 => "M. Harano" 2 => "S. Ono" 3 => "D. Sato" 4 => "Y. Choda" 5 => "T. Kanazawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gan To Kagaku Ryoho" "fecha" => "2013" "volumen" => "40" "paginaInicial" => "2109" "paginaFinal" => "2111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24394029" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary malignant melanoma of the esophagus. Brush cytology and histogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Aldovini" 1 => "C. Detassis" 2 => "F. Piscioli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Cytol" "fecha" => "1983" "volumen" => "27" "paginaInicial" => "65" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6573833" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant melanoma: a clinicopatohological analysis of the criteria for diagnosis and prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C. Allen" 1 => "S. Spitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2407-6-1" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1953" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16390557" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary malignant melanoma of the esophagus: misdiagnosis and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Lu" 1 => "H. Huang" 2 => "J. Chang" 3 => "W.H. Li" 4 => "G.F. Zhao" 5 => "H.Y. He" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2013" "volumen" => "105" "paginaInicial" => "488" "paginaFinal" => "489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24274447" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000003900000001/v2_201602240048/S244438241500005X/v2_201602240048/en/main.assets" "Apartado" => array:4 [ "identificador" => "48445" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000003900000001/v2_201602240048/S244438241500005X/v2_201602240048/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244438241500005X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 4 | 2 | 6 |
| 2024 September | 11 | 4 | 15 |
| 2024 August | 11 | 3 | 14 |
| 2024 July | 7 | 4 | 11 |
| 2024 June | 12 | 4 | 16 |
| 2024 May | 9 | 5 | 14 |
| 2024 April | 10 | 4 | 14 |
| 2024 March | 13 | 2 | 15 |
| 2024 February | 14 | 2 | 16 |
| 2024 January | 17 | 5 | 22 |
| 2023 December | 20 | 2 | 22 |
| 2023 November | 14 | 2 | 16 |
| 2023 October | 16 | 3 | 19 |
| 2023 September | 13 | 5 | 18 |
| 2023 August | 10 | 1 | 11 |
| 2023 July | 11 | 7 | 18 |
| 2023 June | 13 | 3 | 16 |
| 2023 May | 19 | 4 | 23 |
| 2023 April | 16 | 2 | 18 |
| 2023 March | 9 | 2 | 11 |
| 2023 February | 66 | 6 | 72 |
| 2023 January | 15 | 6 | 21 |
| 2022 December | 18 | 5 | 23 |
| 2022 November | 22 | 7 | 29 |
| 2022 October | 12 | 5 | 17 |
| 2022 September | 11 | 7 | 18 |
| 2022 August | 20 | 5 | 25 |
| 2022 July | 15 | 7 | 22 |
| 2022 June | 16 | 6 | 22 |
| 2022 May | 21 | 9 | 30 |
| 2022 April | 19 | 4 | 23 |
| 2022 March | 31 | 7 | 38 |
| 2022 February | 20 | 4 | 24 |
| 2022 January | 39 | 3 | 42 |
| 2021 December | 18 | 11 | 29 |
| 2021 November | 18 | 7 | 25 |
| 2021 October | 28 | 17 | 45 |
| 2021 September | 7 | 23 | 30 |
| 2021 August | 13 | 5 | 18 |
| 2021 July | 38 | 3 | 41 |
| 2021 June | 23 | 7 | 30 |
| 2021 May | 19 | 4 | 23 |
| 2021 April | 32 | 19 | 51 |
| 2021 March | 32 | 10 | 42 |
| 2021 February | 15 | 8 | 23 |
| 2021 January | 38 | 16 | 54 |
| 2020 December | 32 | 8 | 40 |
| 2020 November | 33 | 7 | 40 |
| 2020 October | 25 | 3 | 28 |
| 2020 September | 11 | 6 | 17 |
| 2020 August | 25 | 8 | 33 |
| 2020 July | 14 | 6 | 20 |
| 2020 June | 13 | 12 | 25 |
| 2020 May | 18 | 8 | 26 |
| 2020 April | 13 | 7 | 20 |
| 2020 March | 12 | 4 | 16 |
| 2020 February | 11 | 1 | 12 |
| 2020 January | 10 | 5 | 15 |
| 2019 December | 13 | 2 | 15 |
| 2019 November | 11 | 10 | 21 |
| 2019 October | 6 | 3 | 9 |
| 2019 September | 14 | 2 | 16 |
| 2019 August | 7 | 3 | 10 |
| 2019 July | 13 | 11 | 24 |
| 2019 June | 28 | 28 | 56 |
| 2019 May | 102 | 47 | 149 |
| 2019 April | 27 | 12 | 39 |
| 2019 March | 7 | 1 | 8 |
| 2019 February | 13 | 6 | 19 |
| 2019 January | 9 | 2 | 11 |
| 2018 December | 4 | 1 | 5 |
| 2018 November | 10 | 2 | 12 |
| 2018 October | 3 | 5 | 8 |
| 2018 September | 7 | 4 | 11 |
| 2018 August | 5 | 1 | 6 |
| 2018 July | 9 | 1 | 10 |
| 2018 June | 6 | 0 | 6 |
| 2018 May | 8 | 5 | 13 |
| 2018 April | 5 | 2 | 7 |
| 2018 March | 11 | 0 | 11 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 8 | 1 | 9 |
Show all
