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Fine Needle Aspiration Biopsy (FNAB) in the Diagnosis of Hepatocellular Carcinoma: A Review

Romanian Journal of Internal Medicine
Volume 53 (2015): Issue 3 (September 2015)
By:
Open Access
|Oct 2015

References

  1. 1. HYTIROGLOU P, PARK YN, KRINSKY G, THEISE ND. Hepatic precancerous lesions and small hepatocellular carcinoma. Gastroenteroly Clinics of North America. 2007; 36(4):867-87.10.1016/j.gtc.2007.08.010
    Search in Google Scholar
  2. 2. KOJIRO M, WANLESS IR, ALVES V, et al. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 2009; 49(2):658-64.10.1002/hep.22709
    Search in Google Scholar
  3. 3. BRUIX J, SHERMAN M, LLOVET JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001; 35:421-30.10.1016/S0168-8278(01)00130-1
    Search in Google Scholar
  4. 4. BRUIX J, SHERMAN M. Management of hepatocellular carcinoma. Hepatology. 2005; 42:1208-36.10.1002/hep.20933
    Search in Google Scholar
  5. 5. WANG P, MENG ZQ, CHEN Z. Diagnostic value and complications of fine needle aspiration for primary liver cancer and its influence on the treatment outcome-a study based on 3011 patients in China. Eur J Surg Oncol. 2008; 34:541-6.10.1016/j.ejso.2007.07.013
    Search in Google Scholar
  6. 6. PARKIN DM, BRAY F, FERLAY J, PISANI P. Global cancer statistics, 2002. CA Cancer Journal of Clinicians 2005; 55(2):74-108.10.3322/canjclin.55.2.74
    Search in Google Scholar
  7. 7. HERTZ G, REDDY VB, GREEN L. Fine-needle aspiration biopsy of the liver: a multicenter study of 602 radiologically guided FNA. Diagnostic Cytopathology 2000; 23(5):326-8.10.1002/1097-0339(200011)23:5<;326::AID-DC8>3.0.CO;2-1
    Search in Google Scholar
  8. 8. KUO FY, CHEN WJ, LU SN, WANG JH, ENG HL. Fine needle aspiration cytodiagnosis of liver tumors. Acta Cytologica 2004; 48(2):142-8.10.1159/000326307
    Search in Google Scholar
  9. 9. CHHIENG DC. Fine needle aspiration biopsy of liver – an update. World J Surg Oncol. 2004; 2: 5.10.1186/1477-7819-2-5
    Search in Google Scholar
  10. 10. BALANI S, MALIK R, MALIK R, KAPOOR N. Cytomorphological variables of hepatic malignancies in fine needle aspiration smears with special reference to grading of hepatocellular carcinoma. J Cytol. 2013 Apr; 30(2):116-20.10.4103/0970-9371.112655
    Search in Google Scholar
  11. 11. KAÇAR ÖZKARA S, OZÖVER TUNELI I. Fine needle aspiration cytopathology of liver masses: 101 cases with cyto-/histopathological analysis. Acta Cytol. 2013; 57(4):332-6.10.1159/000351169
    Search in Google Scholar
  12. 12. 1SINGH P, MUKHOPADHYAY P, BHATT B, et al. Endoscopic ultrasound versus CT scan for detection of the metastases to the liver: results of a prospective comparative study. Journal of Clinical Gastroenterology 2009; 43(4):367-73.10.1097/MCG.0b013e318167b8cc
    Search in Google Scholar
  13. 13. 1AWAD SS, FAGAN S, ABUDAYYEH S, et al. Preoperative evaluation of hepatic lesions for the staging of hepatocellular and metastatic liver carcinoma using endoscopic ultrasonography. American Journal of Surgery 2002; 184(6):601-5.10.1016/S0002-9610(02)01092-9
    Search in Google Scholar
  14. 14. 1MAHESHWARI A, KANTSEVOY S, JAGANNATH S, THULUVATH PJ. Endoscopic ultrasound and fine-needle aspiration for the diagnosis of hepatocellular carcinoma. Clinics in Liver Disease 2010; 14(2):325-32.10.1016/j.cld.2010.03.014
    Search in Google Scholar
  15. 15. CROWE DR, ELOUBEIDI MA, CHHIENG DC, JHALA NC, JHALA D, ELTOUM IA. Fine-needle aspiration biopsy of hepatic lesions: computerized tomographic-guided versus endoscopic ultrasound-guided FNA. Cancer. 2006; 108(3):180-5.10.1002/cncr.21912
    Search in Google Scholar
  16. 16. 1DEWITT J, LEBLANC J, MCHENRY L, et al. Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: a large single-center experience. American Journal of Gastroenterology 2003; 98(9):1976-81.
    Search in Google Scholar
  17. 17. SINGH P, ERICKSON RA, MUKHOPADHYAY P, et al. EUS for detection of the hepatocellular carcinoma: results of a prospective study. Gastrointestinal Endoscopy 2007; 66(2):265-73.10.1016/j.gie.2006.10.053
    Search in Google Scholar
  18. 18. DURAND F, REGIMBEAU JM, BELGHITI J, et al. Assessment of the benefits and risks of percutaneous biopsy before surgical resection of hepatocellular carcinoma. J Hepatol. 2001; 35(2):254-8.10.1016/S0168-8278(01)00108-8
    Search in Google Scholar
  19. 19. STIGLIANO R, MARELLI L, YU D, et al. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev. 2007; 33:437-47.10.1016/j.ctrv.2007.04.00117512669
    Search in Google Scholar
  20. 20. SABORIDO BP, DÍAZ JC, DE LOS GALANES SJ, et al. Does preoperative fine needle aspiration-biopsy produce tumor recurrence in patients following liver transplantation for hepatocellular carcinoma? Transplant Proc. 2005; 37:3874-7.
    Search in Google Scholar
  21. 21. FORNARI F, CIVARDI G, CAVANNA L, et al. Complications of ultrasonically guided fine-needle abdominal biopsy. Results of a multicenter Italian study and review of the literature. The Cooperative Italian Study Group. Scand J Gastroenterol. 1989; 24:949-55.10.3109/003655289090892392688068
    Search in Google Scholar
  22. 22. TORZILLI G, MINAGAWA M, TAKAYAMA T, et al. Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy. Hepatology 1999; 30:889-93.10.1002/hep.51030041110498639
    Search in Google Scholar
  23. 23. TUNG WC, HUANG YJ, LEUNG SW, et al. Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma post radiotherapy. Liver Int 2007; 27:192-200.10.1111/j.1478-3231.2006.01399.x17311613
    Search in Google Scholar
  24. 24. CHAPOUTOT C, PERNEY P, FABRE D, et al. Needle-tract seeding after ultrasound-guided puncture of hepatocellular carcinoma. A study of 150 patients. Gastroenterol Clin Biol. 1999; 23:552-6.
    Search in Google Scholar
  25. 25. NG KK, POON RT, LO CM, et al. Impact of preoperative fine-needle aspiration cytologic examination on clinical outcome in patients with hepatocellular carcinoma in a tertiary referral center. Arch Surg. 2004; 139:193-200.10.1001/archsurg.139.2.19314769580
    Search in Google Scholar
  26. 26. .HEMMING AW, CATTRAL MS, REED AI, et al. Liver transplantation for hepatocellular carcinoma. Ann Surg. 2001; 233:652-9.10.1097/00000658-200105000-00009142130511323504
    Search in Google Scholar
  27. 27. STIGLIANO R, BURROUGHS AK. Should we biopsy each liver mass suspicious for HCC before liver transplantation?--no, please don't. J Hepatol. 2005; 43:563-8.10.1016/j.jhep.2005.07.01516120469
    Search in Google Scholar
  28. 28. DURAND F, BELGHITI J, PARADIS V. Liver transplantation for hepatocellular carcinoma: role of biopsy. Liver Transpl. 2007; 13(11):S17-23.10.1002/lt.2132617969095
    Search in Google Scholar
  29. 29. WEE A. Fine needle aspiration biopsy of the liver: Algorithmic approach and current issues in the diagnosis of hepatocellular carcinoma. Cytojournal. 2005; 2:7.10.1186/1742-6413-2-7117797415941489
    Search in Google Scholar
  30. 30. LONGCHAMPT E, PATRIARCHE C, FABRE M. Accuracy of cytology vs. microbiopsy for the diagnosis of well-differentiated hepatocellular carcinoma and macroregenerative nodule. Definition of standardized criteria from a study of 100 cases. Acta Cytol. 2000; 44:515-23.10.1159/00032852310934942
    Search in Google Scholar
  31. 31. SOLE M, CALVET X, CUBERES T, MADERUELO F, BRUIX J, BRU C, et al. Value and limitations of cytologic criteria for the diagnosis of hepatocellular carcinoma by fine needle aspiration biopsy. Acta Cytol. 1993; 37:309-16.
    Search in Google Scholar
  32. 32. SOYUER I, EKINCI C, KAYA M, GENÇ Y, BAHAR K. Diagnosis of hepatocellular carcinoma by fine needle aspiration cytology. Cellular features. Acta Cytol. 2003; 47:581-9.10.1159/00032657212920750
    Search in Google Scholar
  33. 33. WEE A, NILSSON B, CHAN-WILDE C, YAP I. Fine needle aspiration biopsy of hepatocellular carcinoma. Some unusual features. Acta Cytol. 1991; 35:661-70.
    Search in Google Scholar
  34. 34. WEE A. Fine needle aspiration biopsy of hepatocellular carcinoma and hepatocellular nodular lesions: role, controversies and approach to diagnosis. Cytopathology. 2011; 22:287-305.10.1111/j.1365-2303.2011.00882.x21762411
    Search in Google Scholar
  35. 35. WEE A. Fine-needle aspiration biopsy of hepatocellular carcinoma and related hepatocellular nodular lesions in cirrhosis: controversies, challenges, and expectations. Patholog Research Int. 2011; 1-17.10.4061/2011/587936313513421789263
    Search in Google Scholar
  36. 36. BERGMAN S, GRAEME-COOK F, PITMAN MB. The usefulness of the reticulin stain in the differential diagnosis of liver nodules on fine-needle aspiration biopsy cell block preparations. Modern Pathology 1997; 10(12):1258-64.
    Search in Google Scholar
  37. 37. WEE A AND SAMPATANKUL P. Fine needle aspiration cytology of the liver: Diagnostic algorithm a Southeast Asian perspective. Year Book Publisher, Bangkok, Thailand, 2004.
    Search in Google Scholar
  38. 38. LIN CC, LIN CJ, HSU CW, CHEN YC, CHEN WT, LIN SM. Fine-needle aspiration cytology to distinguish dysplasia from hepatocellular carcinoma with different grades. J Gastroenterol Hepatol. 2008; 23(7 Pt 2):e146-52.10.1111/j.1440-1746.2007.04924.x
    Search in Google Scholar
  39. 39. BOSMAN FT, CARNEIRO F, HRUBAN RH, THEISE N.D. WHO classification of tumours of the digestive system. IARC, Lyon, France, 2010.
    Search in Google Scholar
  40. 40. ZEPPA P, ANNICIELLO A, VETRANI A, PALOMBINI L. Fine needle aspiration biopsy of hepatic focal fatty change. A report of two cases. Acta Cytologica 2002; 46(3):567-70.10.1159/000326879
    Search in Google Scholar
  41. 41. GUPTA SK, DAS DK, RAJWANSHI A, BHUSNURMATH SR. Cytology of hepatocellular carcinoma. Diagn Cytopathol. 1986; 2:290-4.10.1002/dc.2840020405
    Search in Google Scholar
  42. 42. SINGH HK, SILVERMAN JF, GEISINGER KR. Fine-needle aspiration cytomorphology of clear-cell hepatocellular carcinoma. Diagn Cytopathol. 1997; 17(4):306-10.10.1002/(SICI)1097-0339(199710)17:4<;306::AID-DC13>3.0.CO;2-S
    Search in Google Scholar
  43. 43. PIATTI B, CASPANI B, GIUDICI C, FERRARIO D. Fine needle aspiration biopsy of hepatocellular carcinoma resembling neuroendocrine tumor. A case report. Acta Cytol. 1997 Mar-Apr; 41(2):583-6.10.1159/000332561
    Search in Google Scholar
  44. 44. WEE A, NILSSON B, YAP I. Fine needle aspiration biopsy of small/intermediate cell tumors in the liver. Considerations in a southeast Asian population. Acta Cytol. 1996; 40(5):937-47.10.1159/000334005
    Search in Google Scholar
  45. 45. MAEDA T, ADACHI E, KAJIYAMA K, TAKENAKA K, SUGIMACHI K, TSUNEYOSHI M. Spindle cell hepatocellular carcinoma. A clinicopathologic and immunohistochemical analysis of 15 cases. Cancer. 1996; 77:51-7.10.1002/(SICI)1097-0142(19960101)77:1<;51::AID-CNCR10>3.0.CO;2-7
    Search in Google Scholar
  46. 46. WU PC, FANG JW, LAU VK, LAI CL, LO CK, LAU JY. Classification of hepatocellular carcinoma according to hepatocellular and biliary differentiation markers. Clinical and biological implications. Am J Pathol. 1996; 149:1167-75.
    Search in Google Scholar
  47. 47. DURNEZ A, VERSLYPE C, NEVENS F, et al. The clinicopathological and prognostic relevance of cytokeratin 7 and 19 expression in hepatocellular carcinoma. A possible progenitor cell origin. Histopathology. 2006; 49(2):138-51.10.1111/j.1365-2559.2006.02468.x
    Search in Google Scholar
  48. 48. JARNAGIN WR, WEBER S, TICKOO SK, KOEA JB, OBIEKWE S, FONG Y, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002; 94:2040-6.10.1002/cncr.10392
    Search in Google Scholar
  49. 49. KUNZ G JR, CHUNG J, ALI SZ. Hepatocellular carcinoma-fibrolamellar variant: cytopathology of an unusual case. Diagnostic Cytopathology 2002; 26(4):257-61.10.1002/dc.10088
    Search in Google Scholar
  50. 50. PÉREZ-GUILLERMO M, MASGRAU NA, GARCÍA-SOLANO J, SOLA-PÉREZ J, DE AGUSTÍN Y DE AGUSTÍN P. Cytologic aspect of fibrolamellar hepatocellular carcinoma in fine-needle aspirates. Diagn Cytopathol. 1999; 21(3):180-7.10.1002/(SICI)1097-0339(199909)21:3<;180::AID-DC7>3.0.CO;2-O
    Search in Google Scholar
  51. 51. DAVENPORT RD. Cytologic diagnosis of fibrolamellar carcinoma of the liver by fine-needle aspiration. Diagn Cytopathol. 1990; 6:275-9.10.1002/dc.2840060410
    Search in Google Scholar
  52. 52. GIBBONS D, DE LAS MORENAS A. Fine needle aspiration diagnosis of combined hepatocellular carcinoma and cholangiocarcinoma. A case report. Acta Cytol. 1997 Jul-Aug; 41(4 Suppl):1269-7210.1159/000333518
    Search in Google Scholar
  53. 53. WEE A, NILSSON B. Combined hepatocellular-cholangiocarcinoma. Diagnostic challenge in hepatic fine needle aspiration biopsy. Acta Cytol. 1999; 43:131-8.10.1159/000330966
    Search in Google Scholar
  54. 54. DUSENBERY D. Combined hepatocellular-cholangiocarcinoma. Cytologic findings in four cases. Acta Cytologica 1997; 41(3):903-9.10.1159/000332726
    Search in Google Scholar
  55. 55. DAS DK. Cytodiagnosis of hepatocellular carcinoma in fine-needle aspirates of the liver: its differentiation from reactive hepatocytes and metastatic adenocarcinoma. Diagn Cytopathol. 1999; 21:370-7.10.1002/(SICI)1097-0339(199912)21:6<;370::AID-DC2>3.0.CO;2-K
    Search in Google Scholar
  56. 56. LAU SK, PRAKASH S, GELLER SA, ALSABEH R. Comparative immunohistochemical profile of hepatocellular carcinoma, cholangiocarcinoma, and metastatic adenocarcinoma. Hum Pathol. 2002; 33:1175-81.10.1053/hupa.2002.130104
    Search in Google Scholar
  57. 57. WEE A, THAMBOO TP, THOMAS A. alpha-Fetoprotein-producing liver carcinomas of primary extrahepatic origin. Acta Cytol. 2003; 47:799-808.10.1159/000326610
    Search in Google Scholar
  58. 58. ISHIKURA H, KISHIMOTO T, ANDACHI H, KAKUTA Y, YOSHIKI T. Gastrointestinal hepatoid adenocarcinoma: venous permeation and mimicry of hepatocellular carcinoma, a report of four cases. Histopathology. 1997; 31:47-54.10.1046/j.1365-2559.1997.5740812.x
    Search in Google Scholar
  59. 59. SAAD RS, LUCKASEVIC TM, NOGA CM, JOHNSON DR, SILVERMAN JF, LIU YL. Diagnostic value of HepPar1, pCEA, CD10, and CD34 expression in separating hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration cytology. Diagn Cytopathol. 2004; 30:1-6.10.1002/dc.10345
    Search in Google Scholar
  60. 60. STAHL J, VOYVODIC F. Biopsy diagnosis of malignant versus benign liver “nodules”: new helpful markers. An update. Adv Anat Pathol. 2000; 7:230-9.10.1097/00125480-200007040-00005
    Search in Google Scholar
  61. 61. NASSAR A, COHEN C, SIDDIQUI MT. Utility of glypican-3 and survivin in differentiating hepatocellular carcinoma from benign and preneoplastic hepatic lesions and metastatic carcinomas in liver fine-needle aspiration biopsies. Diagn Cytopathol. 2009; 37(9):629-35.10.1002/dc.21075
    Search in Google Scholar
  62. 62. SATO K, TANAKA M, KUSABA T, FUKUDA H, TANIKAWA K. Immunohistochemical demonstration of alpha-fetoprotein in small hepatocellular carcinoma. Oncol Rep. 1998; 5:355-8.10.3892/or.5.2.355
    Search in Google Scholar
  63. 63. WEE A, NILSSON B. pCEA canalicular immunostaining in fine needle aspiration biopsy diagnosis of hepatocellular carcinoma. Acta Cytol. 1997; 41:1147-55.10.1159/000332837
    Search in Google Scholar
  64. 64. BORSCHERI N, ROESSNER A, RÖCKEN C. Canalicular immunostaining of neprilysin (CD10) as a diagnostic marker for hepatocellular carcinomas. Am J Surg Pathol. 2001; 25:1297-303.10.1097/00000478-200110000-00011
    Search in Google Scholar
  65. 65. LIN F, ABDALLAH H, MESCHTER S. Diagnostic utility of CD10 in differentiating hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration biopsy (FNAB) of the liver. Diagn Cytopathol. 2004; 30:92-7.10.1002/dc.10419
    Search in Google Scholar
  66. 66. DE BOER WB, SEGAL A, FROST FA, STERRETT GF. Can CD34 discriminate between benign and malignant hepatocytic lesions in fine-needle aspirates and thin core biopsies? Cancer. 2000; 90:273-8.
    Search in Google Scholar
  67. 67. FAN Z, VAN DE RIJN M, MONTGOMERY K, ROUSE RV. Hep par 1 antibody stain for the differential diagnosis of hepatocellular carcinoma: 676 tumors tested using tissue microarrays and conventional tissue sections. Mod Pathol. 2003; 16:137-44.10.1097/01.MP.0000052103.13730.20
    Search in Google Scholar
  68. 68. CAPURRO M, WANLESS IR, SHERMAN M, et al. Glypican-3: a novel serum and histochemical marker for hepatocellular carcinoma. Gastroenterology. 2003; 125:89-97.10.1016/S0016-5085(03)00689-9
    Search in Google Scholar
  69. 69. COSTON WM, LOERA S, LAU SK, ISHIZAWA S, JIANG Z, et al. Distinction of hepatocellular carcinoma from benign hepatic mimickers using Glypican-3 and CD34 immunohistochemistry. Am J Surg Pathol. 2008; 32:433-44.10.1097/PAS.0b013e318158142f
    Search in Google Scholar
  70. 70. MAEDA T, KAJIYAMA K, ADACHI E, TAKENAKA K, SUGIMACHI K, TSUNEYOSHI M. The expression of cytokeratins 7, 19, and 20 in primary and metastatic carcinomas of the liver. Mod Pathol. 1996; 9:901-9.
    Search in Google Scholar
  71. 71. TORII A, NAKAYAMA A, HARADA A, NAKAO A, NONAMI T, SAKAMOTO J, et al. Expression of the CD15 antigen in hepatocellular carcinoma. Cancer. 1993, 15;71(12):3864-7.10.1002/1097-0142(19930615)71:12<;3864::AID-CNCR2820711212>3.0.CO;2-5
    Search in Google Scholar
  72. 72. KUANG DM, ZHAO Q, WU Y, PENG C, WANG J, XU Z, et al. Peritumoral neutrophils link inflammatory response to disease progression by fostering angiogenesis in hepatocellular carcinoma. J Hepatol. 2011; 54(5):948-55.10.1016/j.jhep.2010.08.04121145847
    Search in Google Scholar
  73. 73. ROTELLINI M, MESSERINI L, STOMACI N, RASPOLLINI MR. Hepatoid adenocarcinoma of the ureter: unusual case presenting hepatic and ovarian metastases. Appl Immunohistochem Mol Morphol. 2011;19(5):478-83.10.1097/PAI.0b013e318216af6321558843
    Search in Google Scholar
  74. 74. BERTINO G, NERI S, BRUNO CM, ARDIRI AM, CALVAGNO GS, MALAGUARNERA M, TORO A, et al. Diagnostic and prognostic value of alpha-fetoprotein, des-γ-carboxy prothrombin and squamous cell carcinoma antigen immunoglobulin M complexes in hepatocellular carcinoma. Minerva Med. 2011 Oct; 102(5):363-71.
    Search in Google Scholar
  75. 75. SOUDAH B, SCHIRAKOWSKI A, GEBEL M, POTTHOFF A, BRAUBACH P, SCHLUE J, et al. Overview and evaluation of the value of fine needle aspiration cytology in determining the histogenesis of liver nodules: 14 years of experience at Hannover Medical School. Oncol Rep. 2015 Jan; 33(1):81-7.10.3892/or.2014.355425333302
    Search in Google Scholar
  76. 76. WEN CH, LIN CH, TSAO SC, SU YC, TSAI MH, CHAI CY. Micronucleus scoring in liver fine needle aspiration cytology. Cytopathology. 2013 Dec; 24(6):391-5.10.1111/cyt.1200922974178
    Search in Google Scholar
  77. 77. WEE A. Cytopathology: SS06-1 a well-differentiated hepatocellular nodular lesion in the liver of a woman. Pathology. 2014 Oct; 46 Suppl 2:S9.10.1097/01.PAT.0000454075.48181.04
    Search in Google Scholar
  78. 78. KOUTSELINI H, LAZARIS AC, KAVANTZAS N, KIRITSI T, DAVARIS PS. Significance of nuclear morphometry as a diagnostic tool in fine-needle aspirates of the liver. Eur J Gastroenterol Hepatol 2000; 12:913-921.10.1097/00042737-200012080-0001110958219
    Search in Google Scholar
DOI: https://doi.org/10.1515/rjim-2015-0028 | Journal eISSN: 2501-062X | Journal ISSN: 1220-4749
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Language: English
Page range: 209 - 217
Submitted on: Apr 23, 2015
Published on: Oct 14, 2015
Published by: N.G. Lupu Internal Medicine Foundation
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year
Keywords:
Liver,
Hepatocellular carcinoma,
FNAB,
cytology,
immunocytochemistry
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Cardiology,
Gastroenterology,
Rheumatology

© 2015 Alexandra Kalogeraki, Georgios Z. Papadakis, Dimitrios Tamiolakis, Iliana Karvela-Kalogeraki, Mihailos Karvelas-Kalogerakis, John Segredakis, Eleni Moustou, published by N.G. Lupu Internal Medicine Foundation
This work is licensed under the Creative Commons Attribution 4.0 License.

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