Pancreatic Neoplasms
Neoplasms
Neoplasms, Cystic, Mucinous, and Serous
Neoplasms, Multiple Primary
Neoplasms, Second Primary
Bronchoscopic therapy for mucosa-associated lymphoid tissue lymphoma of the trachea. (1/201)
The tracheal tumor of a 74-year-old female was detected on bronchoscopy and histologically diagnosed as mucosa-associated lymphoid tissue (MALT) lymphoma. We successfully treated the tumor with endoscopic neodyminum-yttruim-aluminium-garnet (Nd-YAG) laser photoresection followed by local ethanol injection. This is the first case in which tracheal MALT lymphoma was successfully treated with bronchoscopy. Bronchoscopic therapy seems to be one of the most valuable strategies for treatment of MALT lymphomas of the central airway. (+info)Bronchial capillary hemangioma in adults. (2/201)
Two cases with capillary hemangioma of the trachea and the left upper lobe bronchus are presented. The adult patients were referred to the hospital because of hemoptysis and cough. The chest radiographs were normal in both cases. The bronchoscopic examination revealed circumscribed lesions with a capillarized surface protruding into the lumen of the trachea and the left upper lobe bronchus, respectively. The lesions were excised in toto with flexible bronchoscopic forceps. The specimens contained typical capillary hemangiomas without any signs of malignancy. Capillary hemangioma in the bronchial tree is an extremely rare benign lesion in adults. Nevertheless, it should be considered as a possible cause of hemoptysis and cough. (+info)A case of thyroid cancer involving the trachea: treatment by partial tracheal resection and repair with a latissimus dorsi musculocutaneous flap. (3/201)
A 65 year-old man had undergone left thyroidectomy for thyroid cancer. The cancer had directly invaded the cervical esophagus and trachea and the patient was referred to our hospital for radical resection and reconstruction. Cervical computed tomography showed a mass at the left-posterior wall of the trachea. Cervical esophagectomy, resection of the left half of the trachea (6 x 3 cm) including seven rings and cervical lymph node dissection were performed. The tracheal defect was covered by a latissimus dorsi musculocutaneous flap. The patient did not lose vocal function and remains alive and well 3 years after surgery without any evidence of recurrence. Latissimus dorsi muscle flap coverage of tracheal defects seems to be a useful technique in the combined resection of the trachea. (+info)Airway stenting for tracheal stenosis. (4/201)
Patients with upper airway obstruction from malignant disease are difficult to manage. A 62 year old patient presented with stridor and was found to have an upper tracheal tumour. Bronchoscopy, dilatation and stenting were performed successfully. The techniques and indications for the use of dynamic airway stent are discussed. (+info)Importance of physical properties of benzo(a)pyrene-ferric oxide mixtures in lung tumor induction. (5/201)
Three mixtures of benzo(alpha)(a)pyrene (BP) and ferric oxide with different physical properties were given intratracheally to Syrian golden hamsters for an examination of their neoplastic potential. Hamsters treated with a preparation containing large aggregates of BP and ferric oxide resulting from nucleation of BP on the particles showed an earlier onset and higher incidence of respiratory tract tumors than animals given a mixture containing smaller aggregates prepared by hand-grinding. The greatest number of tumors were present in the trachea and the predominant type was the squamous carcinoma. A third preparation in which the carcinogen was not attached to the ferric oxide showed a low tumor incidence similar to that present after intratracheal intubation of BP in gelatin without a carrier particle. For this model system of respiratory carcinogenesis, the physical attachment of BP and the carrier dust is necessary for a high tumor yield. (+info)Predictors of tracheobronchial invasion of suprabifurcal oesophageal cancer. (6/201)
BACKGROUND: Factors possibly predicting airway invasion of oesophageal cancer in the absence of frank oesophagotracheal fistulas have not been studied. OBJECTIVES: To identify possible predictors of airway invasion by oesophageal cancer that are readily accessible in the preoperative setting. METHODS: We prospectively investigated 148 patients with newly diagnosed oesophageal cancer located at or above the level of the tracheal bifurcation and without any evidence of oesophago-respiratory fistulas or distant metastases. Demographic variables, respiratory parameters, results of bronchoscopy and other staging procedures (oesophagoscopy, swallow oesophagography, endosonography, CT and histology) and findings at surgery were compared between the patients with (n = 30) and without (n = 118) proven airway invasion and entered into a stepwise logistic regression model to evaluate their independent predictive roles. RESULTS: Univariate analysis indicated that the incidence of airway invasion increased with the presence of suspect CT findings, the presence of respiratory symptoms, tumour length, T stage on endoscopic ultrasonography, and histopathologic grading of the primary cancer. A multivariate logistic regression model indicated that suspect CT findings (odds ratio, 4.4; 95% confidence interval 1.7-11.1, p = 0.002) and maximal tumour length >8 cm (odds ratio, 3.7; 95% confidence interval 1.4-9.6, p = 0.007) were associated independently with airway invasion. The accuracy of predicting airway invasion was 82.5% with both variables combined. CONCLUSIONS: The high incidence of airway involvement by oesophageal cancer and the difficulty to predict it accurately with clinical data or other staging procedures justifies the routine use of bronchoscopy in all patients with the tumour located at or above the level of the tracheal bifurcation. A particular effort to objectively prove or exclude airway invasion should be made in patients with tumours longer than 8 cm and/or with CT findings suggesting airway invasion. (+info)Tumor induction in rats by feeding heptamethyleneimine and nitrite in water. (7/201)
Groups of 15 males and 15 females Sprague-Dawley rats were given 20 ml of drinking water solution containing either 0.2% heptamethyleneimine hydrochloride or this salt together with 0.2% sodium nitrite, 5 days a week for 28 weeks. Another group of 17 male and 30 female rats was given 0.2% sodium nitrite solution for 104 weeks. Most of the animals given heptamethyleneimine hydrochloride or sodium nitrite alone survived 2 years or more after the beginning of the treatment, and no tumors attributable to the treatment were seen at death; tumors appearing were those of endocrine origin found commonly in untreated controls. In the group receiving the combined treatment, most females were dead at 50 weeks and most males were dead at 80 weeks, 27 of 30 having tumors not seen in either control group. A total of 16 had squamous carcinomas in the lung; 25 had tumors of the oropharynx, tongue, esophagus, and forestomach; and there were a few animals with tumors in the nasal cavity and trachea. The expericment showed that squamous tumors of the lung could be induced by ingestion an amine and sodium nitrite. (+info)Species differences in the effect of benzo(alpha)pyrene-ferric oxide on the respiratory tract of rats and hamsters. (8/201)
When given intratracheal injections of a suspension of benzo(alpha)pyrene-ferric oxide, rats and hamsters showed striking species differences in the response of their respiratory tracts to the carcinogen. Hamsters produced squamous metaplasia of the trachea and large bronchi; in contrast, squamous cell nodules of bronchioloalveolar origin developed in rats within a few weeks after carcinogen application. The different sites of the early proliferative and metaplastic responses correlated in their location with the sites of later tumor development. There were no obvious differences between the two species in retention of benzo(alpha)pyrene in the lungs or tracheas. A species difference was observed, however, in the localization of the benzo(alpha)pyrene in the tracheal tissues using ultraviolet fluorescence microscopy. Carcinogen was found to be present in the epithelium of hamsters but not in the epithelium of rats, suggesting a species difference in penetration of carcinogen from the lumen into the tracheal tissues. (+info)Pancreatic adenocarcinoma is the most common type of malignant pancreatic neoplasm and accounts for approximately 85% of all pancreatic cancers. It originates in the glandular tissue of the pancreas and has a poor prognosis, with a five-year survival rate of less than 10%.
Pancreatic neuroendocrine tumors (PNETs) are less common but more treatable than pancreatic adenocarcinoma. These tumors originate in the hormone-producing cells of the pancreas and can produce excess hormones that cause a variety of symptoms, such as diabetes or high blood sugar. PNETs are classified into two main types: functional and non-functional. Functional PNETs produce excess hormones and are more aggressive than non-functional tumors.
Other rare types of pancreatic neoplasms include acinar cell carcinoma, ampullary cancer, and oncocytic pancreatic neuroendocrine tumors. These tumors are less common than pancreatic adenocarcinoma and PNETs but can be equally aggressive and difficult to treat.
The symptoms of pancreatic neoplasms vary depending on the type and location of the tumor, but they often include abdominal pain, weight loss, jaundice, and fatigue. Diagnosis is typically made through a combination of imaging tests such as CT scans, endoscopic ultrasound, and biopsy. Treatment options for pancreatic neoplasms depend on the type and stage of the tumor but may include surgery, chemotherapy, radiation therapy, or a combination of these.
Prognosis for patients with pancreatic neoplasms is generally poor, especially for those with advanced stages of disease. However, early detection and treatment can improve survival rates. Research into the causes and mechanisms of pancreatic neoplasms is ongoing, with a focus on developing new and more effective treatments for these devastating diseases.
Neoplasm refers to an abnormal growth of cells that can be benign (non-cancerous) or malignant (cancerous). Neoplasms can occur in any part of the body and can affect various organs and tissues. The term "neoplasm" is often used interchangeably with "tumor," but while all tumors are neoplasms, not all neoplasms are tumors.
Types of Neoplasms
There are many different types of neoplasms, including:
1. Carcinomas: These are malignant tumors that arise in the epithelial cells lining organs and glands. Examples include breast cancer, lung cancer, and colon cancer.
2. Sarcomas: These are malignant tumors that arise in connective tissue, such as bone, cartilage, and fat. Examples include osteosarcoma (bone cancer) and soft tissue sarcoma.
3. Lymphomas: These are cancers of the immune system, specifically affecting the lymph nodes and other lymphoid tissues. Examples include Hodgkin lymphoma and non-Hodgkin lymphoma.
4. Leukemias: These are cancers of the blood and bone marrow that affect the white blood cells. Examples include acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL).
5. Melanomas: These are malignant tumors that arise in the pigment-producing cells called melanocytes. Examples include skin melanoma and eye melanoma.
Causes and Risk Factors of Neoplasms
The exact causes of neoplasms are not fully understood, but there are several known risk factors that can increase the likelihood of developing a neoplasm. These include:
1. Genetic predisposition: Some people may be born with genetic mutations that increase their risk of developing certain types of neoplasms.
2. Environmental factors: Exposure to certain environmental toxins, such as radiation and certain chemicals, can increase the risk of developing a neoplasm.
3. Infection: Some neoplasms are caused by viruses or bacteria. For example, human papillomavirus (HPV) is a common cause of cervical cancer.
4. Lifestyle factors: Factors such as smoking, excessive alcohol consumption, and a poor diet can increase the risk of developing certain types of neoplasms.
5. Family history: A person's risk of developing a neoplasm may be higher if they have a family history of the condition.
Signs and Symptoms of Neoplasms
The signs and symptoms of neoplasms can vary depending on the type of cancer and where it is located in the body. Some common signs and symptoms include:
1. Unusual lumps or swelling
2. Pain
3. Fatigue
4. Weight loss
5. Change in bowel or bladder habits
6. Unexplained bleeding
7. Coughing up blood
8. Hoarseness or a persistent cough
9. Changes in appetite or digestion
10. Skin changes, such as a new mole or a change in the size or color of an existing mole.
Diagnosis and Treatment of Neoplasms
The diagnosis of a neoplasm usually involves a combination of physical examination, imaging tests (such as X-rays, CT scans, or MRI scans), and biopsy. A biopsy involves removing a small sample of tissue from the suspected tumor and examining it under a microscope for cancer cells.
The treatment of neoplasms depends on the type, size, location, and stage of the cancer, as well as the patient's overall health. Some common treatments include:
1. Surgery: Removing the tumor and surrounding tissue can be an effective way to treat many types of cancer.
2. Chemotherapy: Using drugs to kill cancer cells can be effective for some types of cancer, especially if the cancer has spread to other parts of the body.
3. Radiation therapy: Using high-energy radiation to kill cancer cells can be effective for some types of cancer, especially if the cancer is located in a specific area of the body.
4. Immunotherapy: Boosting the body's immune system to fight cancer can be an effective treatment for some types of cancer.
5. Targeted therapy: Using drugs or other substances to target specific molecules on cancer cells can be an effective treatment for some types of cancer.
Prevention of Neoplasms
While it is not always possible to prevent neoplasms, there are several steps that can reduce the risk of developing cancer. These include:
1. Avoiding exposure to known carcinogens (such as tobacco smoke and radiation)
2. Maintaining a healthy diet and lifestyle
3. Getting regular exercise
4. Not smoking or using tobacco products
5. Limiting alcohol consumption
6. Getting vaccinated against certain viruses that are associated with cancer (such as human papillomavirus, or HPV)
7. Participating in screening programs for early detection of cancer (such as mammograms for breast cancer and colonoscopies for colon cancer)
8. Avoiding excessive exposure to sunlight and using protective measures such as sunscreen and hats to prevent skin cancer.
It's important to note that not all cancers can be prevented, and some may be caused by factors that are not yet understood or cannot be controlled. However, by taking these steps, individuals can reduce their risk of developing cancer and improve their overall health and well-being.
Cystic neoplasms are fluid-filled sacs that grow in the body. They can be benign or malignant and can arise from a variety of tissues, including the ovaries, pancreas, and lungs. Mucinous neoplasms are tumors that produce mucin, a type of protein found in mucus. These tumors can occur in the breast, ovary, or colon, and are often benign.
Serous neoplasms are tumors that arise from the serous membranes, which are the thin layers of tissue that line the cavities of the body. Examples of serous neoplasms include ovarian cancer and mesothelioma. These tumors can be benign or malignant.
In summary, neoplasms, cystic, mucinous, and serous are different types of tumors that can occur in various organs and tissues throughout the body. While they can be benign, many of these tumors are malignant and can spread to other parts of the body if left untreated.
There are several types of skin neoplasms, including:
1. Basal cell carcinoma (BCC): This is the most common type of skin cancer, and it usually appears as a small, fleshy bump or a flat, scaly patch. BCC is highly treatable, but if left untreated, it can grow and invade surrounding tissue.
2. Squamous cell carcinoma (SCC): This type of skin cancer is less common than BCC but more aggressive. It typically appears as a firm, flat, or raised bump on sun-exposed areas. SCC can spread to other parts of the body if left untreated.
3. Melanoma: This is the most serious type of skin cancer, accounting for only 1% of all skin neoplasms but responsible for the majority of skin cancer deaths. Melanoma can appear as a new or changing mole, and it's essential to recognize the ABCDE signs (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving size, shape, or color) to detect it early.
4. Sebaceous gland carcinoma: This rare type of skin cancer originates in the oil-producing glands of the skin and can appear as a firm, painless nodule on the forehead, nose, or other oily areas.
5. Merkel cell carcinoma: This is a rare and aggressive skin cancer that typically appears as a firm, shiny bump on the skin. It's more common in older adults and those with a history of sun exposure.
6. Cutaneous lymphoma: This type of cancer affects the immune system and can appear as a rash, nodules, or tumors on the skin.
7. Kaposi sarcoma: This is a rare type of skin cancer that affects people with weakened immune systems, such as those with HIV/AIDS. It typically appears as a flat, red or purple lesion on the skin.
While skin cancers are generally curable when detected early, it's important to be aware of your skin and notice any changes or unusual spots, especially if you have a history of sun exposure or other risk factors. If you suspect anything suspicious, see a dermatologist for an evaluation and potential biopsy. Remember, prevention is key to avoiding the harmful effects of UV radiation and reducing your risk of developing skin cancer.
Multiple primary neoplasms can arise in different organs or tissues throughout the body, such as the breast, colon, prostate, lung, or skin. Each tumor is considered a separate entity, with its own unique characteristics, including size, location, and aggressiveness. Treatment for multiple primary neoplasms typically involves surgery, chemotherapy, radiation therapy, or a combination of these modalities.
The diagnosis of multiple primary neoplasms can be challenging due to the overlapping symptoms and radiological findings between the different tumors. Therefore, it is essential to have a thorough clinical evaluation and diagnostic workup to rule out other possible causes of the symptoms and confirm the presence of multiple primary neoplasms.
Multiple primary neoplasms are more common than previously thought, with an estimated prevalence of 2% to 5% in some populations. The prognosis for patients with multiple primary neoplasms varies depending on the location, size, and aggressiveness of each tumor, as well as the patient's overall health status.
It is important to note that multiple primary neoplasms are not the same as metastatic cancer, in which a single primary tumor spreads to other parts of the body. Multiple primary neoplasms are distinct tumors that arise independently from different primary sites within the body.
Symptoms of Kidney Neoplasms can include blood in the urine, pain in the flank or abdomen, weight loss, fever, and fatigue. Diagnosis is made through a combination of physical examination, imaging studies such as CT scans or ultrasound, and tissue biopsy. Treatment options vary depending on the type and stage of the neoplasm, but may include surgery, ablation therapy, targeted therapy, or chemotherapy.
It is important for individuals with a history of Kidney Neoplasms to follow up with their healthcare provider regularly for monitoring and check-ups to ensure early detection of any recurrences or new tumors.
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NIH Clinical Center Search the Studies: Study Number, Study Title
PMID- 5097483
Malignant7
- Primary tracheal tumors are rare, constituting approximately 0.1-0.4% of malignant diseases. (nih.gov)
- 2. Primary tracheal malignant neoplasms: the University of Texas MD Anderson Cancer Center experience. (nih.gov)
- 17. The use of radiation therapy appears to improve outcome in patients with malignant primary tracheal tumors: a SEER-based analysis. (nih.gov)
- Case report and review of the literature on malignant tracheal tumors]. (nih.gov)
- Malignant C4258 Pleomorphic Rhabdomyosarcoma An aggressive malignant mesenchymal neoplasm with skeletal muscle differentiation, occurring in adults and rarely in children. (nih.gov)
- Malignant C27273 Poroma Eccrine Poroma A benign, well circumscribed sweat gland neoplasm with eccrine or apocrine differentiation. (nih.gov)
- The team of ENT doctors at the medical facility successfully copes with the treatment of malignant head and neck neoplasms. (bookinghealth.com)
Stenosis5
- Tracheal stenosis is also a recognized complication of tracheostomy. (medscape.com)
- Congenital tracheal stenosis is often identified by characteristic wheezes and cyanosis in childhood, but asymptomatic progression to adulthood is rare. (medscape.com)
- The sequence of events that leads to laryngeal and upper tracheal stenosis in adults involves ulceration of the mucosa and cartilage, inflammatory reactions with associated granulation tissue, fibrous tissue formation, and contraction of fibrous scar tissue. (medscape.com)
- The linear tomogram demonstrates tracheal stenosis. (medscape.com)
- This linear tomogram was obtained from a patient with a respiratory scleroma and tracheal stenosis in the cervical trachea (double-headed red arrow). (medscape.com)
Tumors are rare1
- Tracheal tumors are rare, accounting for 0.1% of all malignancies. (bvsalud.org)
Diseases2
- Tracheal chondrosarcoma are rare diseases, with only 15 cases previously described in the literature between 1959 and 2008. (nih.gov)
- These cells provide excellent model systems to study all aspects of bronchial/tracheal cells' functions and diseases, particularly those related to airway viral infections, as well as tissue repair mechanisms, signaling changes and potential treatments relevant to lung injuries, mechanical and oxidative stress, inflammation, pulmonary diseases and smoking. (creative-bioarray.com)
Lung3
- Lung carcinoids (LC) comprise neuroendocrine lung tumors of low (typical carcinoid) and intermediate (atypical carcinoid) grade of malignancy accounting for less than 2% of all lung neoplasms. (bvsalud.org)
- tracheal, bronchus and lung (TBL) cancer was the leading cause of cancer deaths for men. (oneradionetwork.com)
- Lung, bronchus, and tracheal cancer tended to stabilize, while stomach cancer decreased among males in the Southeast Region. (bvsalud.org)
Epithelial5
- Bronchial/Tracheal cells are responsible for producing lubricating mucus to keep the airways functional and they are a type of epithelial cell, a term used generally to refer to cells lining the inside or outside of the body. (creative-bioarray.com)
- At Creative Bioarray, we provide 9 types of human bronchial/tracheal cells including Human Tracheal Fibroblasts, Human Small Airway Epithelial Cells, Human Bronchial Epithelial Cells (HBEpC), Lobar Bronchial Epithelial Cells, etc. (creative-bioarray.com)
- Description: Creative Bioarray's normal Human Bronchial/Tracheal Epithelial Cells, when grown. (creative-bioarray.com)
- Description: Human hypertension tracheal epithelial cells are isolated from the tracheal tissues. (creative-bioarray.com)
- Carcinomas or neoplasms of epithelial cell origin often yield sheets or clumps of cells of varying size, and nuclear/cytoplasmic ratio characteristic of the type of neoplasia. (dvm360.com)
TRACHEA2
- The linear tomogram shows the larynx and a long stenotic tracheal segment (double-headed red arrow) that begins above the tracheostomy site (black arrow) and extends to two thirds of the trachea. (medscape.com)
- Bronchial/Tracheal cells are from the lining of the bronchi/trachea, the network of tubes used to convey air to the lungs. (creative-bioarray.com)
Thyroid Neoplasms1
- Primary thyroid lymphoma (PTL) is a rare malignancy, accounting for less than 5% of all thyroid neoplasms. (bioscientifica.com)
Laryngeal Neoplasms3
- Laryngeal Neoplasms" is a descriptor in the National Library of Medicine's controlled vocabulary thesaurus, MeSH (Medical Subject Headings) . (umassmed.edu)
- This graph shows the total number of publications written about "Laryngeal Neoplasms" by people in this website by year, and whether "Laryngeal Neoplasms" was a major or minor topic of these publications. (umassmed.edu)
- Below are the most recent publications written about "Laryngeal Neoplasms" by people in Profiles. (umassmed.edu)
Deviation2
- The chest radiograph shows an intrathoracic goiter with tracheal compression and deviation (arrows). (medscape.com)
- A CT scan of the neck showed diffuse enlargement of the thyroid gland extending towards the anterior mediastinum with tracheal deviation and lymphadenopathy within levels VII and right II-IV. (bioscientifica.com)
Lumen2
- This image is a sagittal computed tomography scan reconstruction in a patient with a multinodular goiter that is compressing the tracheal lumen. (medscape.com)
- We report a novel single-stage tracheal reconstruction for a 6.5-cm long defect involving the anterior two thirds of the tracheal circumference in a patient with deeply infiltrative thyroid cancer into the tracheal lumen. (nih.gov)
Airway1
- Management of tracheal chondrosarcoma almost completely obstructing the airway: a case report. (nih.gov)
Incidence1
- 5. Incidence and treatment of tracheal cancer: a nationwide study in the Netherlands. (nih.gov)
Cancers3
- Despite most primary tracheal cancers being eligible for surgery and/or radiotherapy, unresectable, recurrent and metastatic tumors may require systemic treatments. (nih.gov)
- Squamous cell carcinoma and adenoid cystic carcinoma are the two most prevalent tracheal cancers. (bvsalud.org)
- The most common childhood cancers were leukemia, other neoplasms, non-Hodgkin lymphoma, and brain and nervous system cancers. (oneradionetwork.com)
Malignancy1
- Well, the key thing with the sternoclavicular joint is it has a relatively higher instance of nasty malignancy in terms of neoplasm. (sputters-target.com)
Malignancies2
Carcinoma1
- 1. Population based cancer registry analysis of primary tracheal carcinoma. (nih.gov)
Pathology1
- 11. Pathology of tracheal tumors. (nih.gov)
Tissue1
- Description: Human Primary Tracheal Fibroblasts are isolated from normal human tracheal tissue. (creative-bioarray.com)
Goiter1
- Goiter -associated tracheal compression is demonstrated in the images below. (medscape.com)
Radiotherapy1
- More experience is required to establish the definitive role of radiotherapy in low-grade tracheal chondrosarcoma. (nih.gov)
Tracheostomy1
- The linear tomogram shows a long stenotic tracheal segment (double-headed blue arrow) above a tracheostomy site (black arrow). (medscape.com)
Diagnosis1
- Neuroendocrine neoplasms (NENs) are a heterogeneous family of tumors of challenging diagnosis and clinical management. (bvsalud.org)
Primary4
Rare1
- Here we present a rare case of tracheal chondrosarcoma and a review of the literature. (nih.gov)
Clinical1
- Clinical and imaging investigation revealed a giant tracheal mass that was partially debulked by laser for symptomatic relief. (nih.gov)
Cells2
- Hereditary Wilms' Tumor Familial embryonal neoplasm derived from nephrogenic blastemal cells. (nih.gov)
- Round-cell neoplasms, such as lymphosarcoma, usually yield few individual round cells when aspirated. (dvm360.com)
Management1
- Tracheal chondrosarcoma and surgical management. (nih.gov)
Case1
- Tracheal chondrosarcoma: a case report. (nih.gov)