Scientific letter
Leiomyosarcoma of the colon. A very uncommon condition with poor prognosis
Leiomiosarcoma de colon. Una entidad muy infrecuente con mal pronóstico
Read
711
Timeswas read the article
201
Total PDF
510
Total HTML
Share statistics
array:24 [ "pii" => "S2444382420300389" "issn" => "24443824" "doi" => "10.1016/j.gastre.2019.11.002" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1468" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Gastroenterol Hepatol. 2020;43:200-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210570519302614" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2019.11.002" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1468" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Gastroenterol Hepatol. 2020;43:200-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Leiomiosarcoma de colon. Una entidad muy infrecuente con mal pronóstico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "200" "paginaFinal" => "201" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Leiomyosarcoma of the colon. A very uncommon condition with poor prognosis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mireia Merichal Resina, Carlos Cerdan Santacruz, Enrique Sierra Grañón, Jordi Antoni Tarragona Foradada, Jorge Juan Olsina Kissler" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Mireia" "apellidos" => "Merichal Resina" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Cerdan Santacruz" ] 2 => array:2 [ "nombre" => "Enrique" "apellidos" => "Sierra Grañón" ] 3 => array:2 [ "nombre" => "Jordi Antoni" "apellidos" => "Tarragona Foradada" ] 4 => array:2 [ "nombre" => "Jorge Juan" "apellidos" => "Olsina Kissler" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2444382420300389" "doi" => "10.1016/j.gastre.2019.11.002" "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/S2444382420300389?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570519302614?idApp=UINPBA00004N" "url" => "/02105705/0000004300000004/v1_202003250614/S0210570519302614/v1_202003250614/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2444382420300377" "issn" => "24443824" "doi" => "10.1016/j.gastre.2019.10.007" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1464" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Gastroenterol Hepatol. 2020;43:201-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Black oesophagus (acute oesophageal necrosis)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "201" "paginaFinal" => "202" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Esófago negro (necrosis aguda esofágica)" ] ] "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" => 1549 "Ancho" => 3167 "Tamanyo" => 349114 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Endoscopic findings. (A) Mucosa of the medial oesophagus with blackish discolouration and longitudinal ulcerations. (B and C) Abrupt stop at the gastro-oesophageal junction. (D) Necrosis of the second duodenal segment. (E) Obstructive oesophageal stenosis shown on follow-up gastroscopy. (F) Course of oesophageal stenosis following several sessions of dilatation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Viviana Laredo, Mercedes Navarro, Enrique Alfaro, Pablo Cañamares, Daniel Abad, Gonzalo Hijos, Sandra García, Raúl Velamazán, José Manuel Blas, Ángel Ferrández" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Viviana" "apellidos" => "Laredo" ] 1 => array:2 [ "nombre" => "Mercedes" "apellidos" => "Navarro" ] 2 => array:2 [ "nombre" => "Enrique" "apellidos" => "Alfaro" ] 3 => array:2 [ "nombre" => "Pablo" "apellidos" => "Cañamares" ] 4 => array:2 [ "nombre" => "Daniel" "apellidos" => "Abad" ] 5 => array:2 [ "nombre" => "Gonzalo" "apellidos" => "Hijos" ] 6 => array:2 [ "nombre" => "Sandra" "apellidos" => "García" ] 7 => array:2 [ "nombre" => "Raúl" "apellidos" => "Velamazán" ] 8 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Blas" ] 9 => array:2 [ "nombre" => "Ángel" "apellidos" => "Ferrández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210570519302572" "doi" => "10.1016/j.gastrohep.2019.10.005" "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/S0210570519302572?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382420300377?idApp=UINPBA00004N" "url" => "/24443824/0000004300000004/v1_202004200614/S2444382420300377/v1_202004200614/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2444382420300407" "issn" => "24443824" "doi" => "10.1016/j.gastre.2019.10.008" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1471" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Gastroenterol Hepatol. 2020;43:193-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Comparison of scoring systems used in acute pancreatitis for predicting major adverse events" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "193" "paginaFinal" => "199" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación entre los sistemas de puntuación utilizados en la pancreatitis aguda para la predicción de acontecimientos adversos graves" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "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" => 2868 "Ancho" => 2926 "Tamanyo" => 370402 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Receiver operator characteristic curves of each scoring system for all end-points.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elmas Biberci Keskin, Bahadır Taşlıdere, Koray Koçhan, Bedia Gülen, Ali Tüzün İnce, Hakan Şentürk" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Elmas" "apellidos" => "Biberci Keskin" ] 1 => array:2 [ "nombre" => "Bahadır" "apellidos" => "Taşlıdere" ] 2 => array:2 [ "nombre" => "Koray" "apellidos" => "Koçhan" ] 3 => array:2 [ "nombre" => "Bedia" "apellidos" => "Gülen" ] 4 => array:2 [ "nombre" => "Ali Tüzün" "apellidos" => "İnce" ] 5 => array:2 [ "nombre" => "Hakan" "apellidos" => "Şentürk" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382420300407?idApp=UINPBA00004N" "url" => "/24443824/0000004300000004/v1_202004200614/S2444382420300407/v1_202004200614/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Leiomyosarcoma of the colon. A very uncommon condition with poor prognosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "200" "paginaFinal" => "201" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mireia Merichal Resina, Carlos Cerdan Santacruz, Enrique Sierra Grañón, Jordi Antoni Tarragona Foradada, Jorge Juan Olsina Kissler" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Mireia" "apellidos" => "Merichal Resina" "email" => array:1 [ 0 => "mireiamerichal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carlos" "apellidos" => "Cerdan Santacruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Enrique" "apellidos" => "Sierra Grañón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Jordi Antoni" "apellidos" => "Tarragona Foradada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Jorge Juan" "apellidos" => "Olsina Kissler" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Arnau de Vilanova, Lleida, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Coloproctología, Hospital Universitario Arnau de Vilanova, Lleida, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Arnau de Vilanova, Lleida, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leiomiosarcoma de colon. Una entidad muy infrecuente con mal pronóstico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Gastrointestinal mesenchymal tumours are uncommon. The most common types are gastrointestinal stroma tumours (GISTs)<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a>; the rarest types are smooth muscle tumours (leiomyomas and leiomyosarcomas) and schwannomas. The most common types in the colon are leiomyomas and submucosal lipomas. A diagnosis of a GIST is rare in this anatomical location, and a diagnosis of a leiomyosarcoma is rarer still (<1% of cases<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>). Its incidence is 1 per 100,000 inhabitants, and it accounts for 0.12% of colon neoplasms. Leiomyosarcoma of the colon is an aggressive tumour associated with a poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 71-year-old male with a history of hypertension, COPD, dyslipidaemia and appendectomy. For the purpose of testing due to constipation with a one year period of progression, he underwent a complete colonoscopy which revealed a polypoid lesion in the transverse colon, 80<span class="elsevierStyleHsp" style=""></span>cm from the anal margin. Pathology diagnosed the lesion as a leiomyosarcoma. Testing was extended to include a CT scan of the chest, abdomen and pelvis; the results were negative for distant lesions. A small locoregional lymphadenopathy measuring 11<span class="elsevierStyleHsp" style=""></span>mm was discovered. Given these findings, a laparoscopic sub-total colectomy with ileo-sigmoid anastomosis was performed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The definitive pathology report described a polypoid and ulcerated lesion with a stenosing lumen measuring 4.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm, with no necrosis and a mitotic rate of 12 per 10 high-power fields, corresponding to a pT1N0M0 tumour with a histological grade of G2.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Leiomyosarcomas of the colon are aggressive tumours with a high rate of local recurrence and fundamentally haematogenous spread that are associated with a poor prognosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Unlike GISTs, leiomyosarcomas preferentially occur in the small bowel (45%) or the large bowel (38%); they are rarely found in the stomach or oesophagus.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> They may also present in the rectum. They most commonly affect males in their fifties and sixties.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Morphologically, they may be indistinguishable from GISTs; immunohistochemistry is required for their diagnosis. This explains why many mesenchymal tumours in the pre-immunohistochemistry era were diagnosed as leiomyosarcomas.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">They usually present as sub-mucosal polyps or intramural nodules arising from the <span class="elsevierStyleItalic">muscularis mucosae</span> or the muscularis propria; ulceration and necrosis are common.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Characteristically, they test positive for smooth muscle markers such as desmin and actin and often calponin and h-Caldesmon, and negative for GIST markers (c-kit, CD34 and Dog-1).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A proper differential diagnosis between the two diseases is essential, as they have radically different prognoses.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment is surgery with complete removal and suitable margins; even with this treatment, recurrence is seen in many cases.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,5</span></a> The role of lymphadenectomy is debated; however, the guidelines recommend performing conventional oncology procedures with complete excision of the mesocolon as in intestinal adenocarcinoma in this location.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As for adjuvant treatment, these tumours are usually insensitive to chemotherapy and do not respond to imatinib. sunitinib has very limited efficacy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Adjuvant therapy with anthracyclines is considered the first-line choice in patients with large tumours and high-grade tumours.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> The efficacy of radiotherapy is also a matter of debate, although it has been suggested that, as an adjuvant therapy, it may reduce local recurrence in sarcomas of the rectum. Given this low sensitivity to adjuvant therapy, in cases of local recurrence and/or metastasis, the recommended treatment is surgical resection.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">With regard to follow-up, for tumours with an intermediate to high histological grade, it is recommended that a CT scan of the chest and abdomen be performed every 3–4 months in the first 2 years, then 2 times per year up to 5 years and then once per year after the first 5 years have elapsed. For low-grade tumours, it is recommended that a CT scan of the chest and abdomen be performed every 4–6 months in the first 5 years, then once per year.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The most common sites of metastasis are the liver and the peritoneum, followed by the lungs.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Given that spread to the lymph nodes is rare, the most important prognostic indicator is a size ≥5<span class="elsevierStyleHsp" style=""></span>cm; mitotic rate has no prognostic value.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Overall five-year survival following radical surgery is 51.6%.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> The primary cause of death is secondary to liver and lung metastases. Age over 40 years, tumour necrosis, distant disease and large tumour size have been identified as poor prognostic factors.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">No support in the form of grants was received for the preparation of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Merichal Resina M, Cerdan Santacruz C, Sierra Grañón E, Tarragona Foradada JA, Olsina Kissler JJ. Leiomiosarcoma de colon. Una entidad muy infrecuente con mal pronóstico. Gastroenterol Hepatol. 2020;43:200–201.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This manuscript was presented at the 23rd Spanish Coloproctology Association Foundation National Meeting in Valladolid, Spain, from 16 to 18 May 2019.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary leiomyosarcoma of the colon" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kono" 1 => "N. Tsuji" 2 => "N. Ozaki" 3 => "N. Matsumoto" 4 => "T. Takaba" 5 => "N. Okumura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12328-015-0584-9" "Revista" => array:6 [ "tituloSerie" => "Clin J Gastroenterol" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "217" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26208828" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of leiomyosarcoma of colon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Kiran" 1 => "P.M. Shiny" 2 => "K.S. Dhanya" 3 => "K.P. Aravindan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0973-1482.155980" "Revista" => array:5 [ "tituloSerie" => "J Cancer Res Ther" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "1035" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26881639" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary leiomyosarcoma of the colon: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Devriendt" 1 => "G. Leman" 2 => "F. Vanrykel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Chir Belg" "fecha" => "2019" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "4" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leiomyosarcoma: a 45 year review at Charity Hospital, New Orleans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Hill" 1 => "R. Mera" 2 => "E.A. Levine" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Surg" "fecha" => "1998" "volumen" => "64" "paginaInicial" => "53" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9457038" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ESMO Guidelines Committee and EURACAN" "etal" => true "autores" => array:6 [ 0 => "P.G. Casali" 1 => "N. Abecassis" 2 => "H.T. Aro" 3 => "S. Bauer" 4 => "R. Biagini" 5 => "S. Bielack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/annonc/mdy321" "Revista" => array:7 [ "tituloSerie" => "Ann Oncol" "fecha" => "2018" "volumen" => "29" "numero" => "Suppl. 4" "paginaInicial" => "iv268" "paginaFinal" => "iv269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30285214" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004300000004/v1_202004200614/S2444382420300389/v1_202004200614/en/main.assets" "Apartado" => array:4 [ "identificador" => "77930" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004300000004/v1_202004200614/S2444382420300389/v1_202004200614/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382420300389?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 24 | 8 | 32 |
| 2024 September | 21 | 13 | 34 |
| 2024 August | 25 | 12 | 37 |
| 2024 July | 18 | 13 | 31 |
| 2024 June | 14 | 9 | 23 |
| 2024 May | 13 | 2 | 15 |
| 2024 April | 20 | 11 | 31 |
| 2024 March | 4 | 4 | 8 |
| 2024 February | 10 | 2 | 12 |
| 2024 January | 13 | 2 | 15 |
| 2023 December | 21 | 6 | 27 |
| 2023 November | 13 | 2 | 15 |
| 2023 October | 16 | 4 | 20 |
| 2023 September | 11 | 7 | 18 |
| 2023 August | 10 | 3 | 13 |
| 2023 July | 9 | 3 | 12 |
| 2023 June | 15 | 3 | 18 |
| 2023 May | 53 | 5 | 58 |
| 2023 April | 37 | 4 | 41 |
| 2023 March | 10 | 1 | 11 |
| 2023 February | 18 | 8 | 26 |
| 2023 January | 19 | 5 | 24 |
| 2022 December | 13 | 3 | 16 |
| 2022 November | 14 | 8 | 22 |
| 2022 October | 14 | 8 | 22 |
| 2022 September | 10 | 4 | 14 |
| 2022 August | 10 | 9 | 19 |
| 2022 July | 11 | 7 | 18 |
| 2022 June | 6 | 8 | 14 |
| 2022 May | 10 | 7 | 17 |
| 2022 April | 22 | 19 | 41 |
| 2022 March | 1 | 0 | 1 |
| 2022 January | 1 | 0 | 1 |
Show all
