1
|
Hadjigeorgiou GF, Strouthou EM, Koulousakis D, Patsouris V, Neff F, Lumenta CB, Schul DB. Olfactory schwannomas – an enigmatic clinical entity. Br J Neurosurg 2019. [DOI: 10.1080/02688697.2019.1661968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Georgios F. Hadjigeorgiou
- Department of Neurosugery, Klinikum Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
- School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | | | - Dimitri Koulousakis
- Department of Neurosugery, Klinikum Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | | | - Frauke Neff
- Department of Pathology, Klinikum Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | - Christianto B. Lumenta
- Department of Neurosugery, Klinikum Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | - David B. Schul
- Department of Neurosugery, Klinikum Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| |
Collapse
|
2
|
Taha MM, AlBakry A, ElSheikh M, AbdelBary TH. Olfactory Nerve Schwannoma: A Case Report and Review of the Literature. Surg J (N Y) 2018; 4:e164-e166. [PMID: 30206542 PMCID: PMC6131093 DOI: 10.1055/s-0038-1669991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/09/2018] [Indexed: 12/01/2022] Open
Abstract
Schwannomas are benign tumors, which arise from the Schwann cells of the central or peripheral nerves. They form 8% of all intracranial tumors and most of the cases arise from vestibular division of the 8
th
cranial nerve. Rare cases are shown to arise from the olfactory or optic nerve, being devoid of myelin sheath. Up to date and according to our best of knowledge, 66 cases have been reported till now. Here we present a review of the literature and a case report of a 56-year-old male with an accidently discovered anterior cranial fossa schwannoma, following a road traffic accident. Tumor was completely excised, using a right frontal approach. Histopathology revealed Antoni-A cellular pattern. Although rare, but olfactory nerve schwannomas should be included in the differential diagnosis in anterior cranial fossa space occupying lesions, and the approach should be designed taking into consideration, this rare entity.
Collapse
Affiliation(s)
- Mahmoud M Taha
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | - Amr AlBakry
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | - Magdy ElSheikh
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | | |
Collapse
|
3
|
Esquivel-Miranda M, De la O Ríos E, Vargas-Valenciano E, Moreno-Medina E. Schwannoma de base anterior de cráneo. Neurocirugia (Astur) 2017; 28:298-305. [DOI: 10.1016/j.neucir.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
|
4
|
Bohoun CA, Terakawa Y, Goto T, Tanaka S, Kuwae Y, Ohsawa M, Morisako H, Nakajo K, Sato H, Ohata K, Yokoo H. Schwannoma-like tumor in the anterior cranial fossa immunonegative for Leu7 but immunopositive for Schwann/2E. Neuropathology 2016; 37:265-271. [PMID: 27925298 DOI: 10.1111/neup.12357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Abstract
Schwannoma arising from the olfactory system, often called olfactory groove schwannoma (OGS), is rare, as the olfactory bulb and tract, belonging to the central nervous system, should lack Schwann cells. Another rare entity called olfactory ensheathing cell tumor (OECT) has been reported, which mimics clinical and radiological characteristics of OGS. Here, we report two rare cases of schwannoma-like tumor in the anterior cranial fossa that showed negative staining for Leu7, but positive staining for Schwann/2E, and discuss their origin. Two cases of mass lesions in the anterior cranial fossa in a 26-year-old man and a 24-year-old woman were successfully removed. Morphological examination of these tumors was compatible with a diagnosis of schwannoma. Immunohistochemically, both cases were negative for Leu7, yielding a diagnosis of OECT, but were positive for the schwannoma-specific marker, Schwann/2E. Immunohistochemical staining results in our two cases question the current assumption that OGS and OECT can be distinguished only by Leu7 staining pattern. In conclusion, the origins of OGS and OECT remain to be determined, and further studies in larger numbers of cases are needed to characterize these rare tumors in the anterior cranial fossa.
Collapse
Affiliation(s)
- Christian Aïssè Bohoun
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuzo Terakawa
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Neurosurgery, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Takeo Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Sayaka Tanaka
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuko Kuwae
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Nakajo
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Sato
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Gunma, Japan
| |
Collapse
|
5
|
Pereira MC, Peris-Celda M, Qian J, Kenning TJ, Pinheiro-Neto CD. Unilateral Endoscopic Endonasal Surgery for Resection of an Olfactory Schwannoma of the Anterior Cranial Base in a Patient with Hereditary Hemorrhagic Telangiectasia. World Neurosurg 2016; 89:729.e15-20. [DOI: 10.1016/j.wneu.2016.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/14/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
|
6
|
Nascimento LA, Settanni FAP, Filho JFDG, Sanchez IND, Cavalcante BB, Stávale JN. Isolated schwannoma of the olfactory groove: a case report. Int Arch Otorhinolaryngol 2015; 19:93-5. [PMID: 25992159 PMCID: PMC4392511 DOI: 10.1055/s-0033-1353368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/01/2013] [Indexed: 11/30/2022] Open
Abstract
Introduction Schwannoma of the olfactory groove is an extremely rare tumor that can share a differential diagnosis with meningioma or neuroblastoma. Objectives The authors present a case of giant schwannoma involving the anterior cranial fossa and ethmoid sinuses. Case Report The patient presented with a 30-month history of left nasal obstruction, anosmia, and sporadic ipsilateral bleeding. Computed tomography of the paranasal sinuses revealed expansive lesion on the left nasal cavity extending to nasopharynx up to ethmoid and sphenoid sinuses bilaterally with intraorbital and parasellar extension to the skull base. Magnetic resonance imaging scan confirmed the expansive tumor without dural penetration. Biopsy revealed no evidence of malignancy and probable neural cell. Bifrontal craniotomy was performed combined with lateral rhinotomy (Weber-Ferguson approach), and the lesion was totally removed. The tumor measured 8.0 × 4.3 × 3.7 cm and microscopically appeared as a schwannoma composed of interwoven bundles of elongated cells (Antoni A regions) mixed with less cellular regions (Antoni B). Immunohistochemical study stained intensively for vimentin and S-100. Conclusion Schwannomas of the olfactory groove are extremely rare, and the findings of origin of this tumor is still uncertain but recent studies point most probably to the meningeal branches of trigeminal nerve or anterior ethmoidal nerves.
Collapse
Affiliation(s)
- Luiz Augusto Nascimento
- Division of Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo, São Paulo/SP, Brazil
| | - Flávio Aurélio Parente Settanni
- Division of Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo, São Paulo/SP, Brazil
| | | | | | | | - João Noberto Stávale
- Department of Pathology, Universidade Federal de São Paulo, São Paulo/SP, Brazil
| |
Collapse
|
7
|
Sunaryo PL, Svider PF, Husain Q, Choudhry OJ, Eloy JA, Liu JK. Schwannomas of the sinonasal tract and anterior skull base: a systematic review of 94 cases. Am J Rhinol Allergy 2015; 28:39-49. [PMID: 24717879 DOI: 10.2500/ajra.2014.28.3978] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Schwannomas of the anterior skull base (ASB) and sinonasal tract are extremely rare. These lesions mimic other pathologies such as olfactory groove meningiomas, hemangiopericytomas, and esthesioneuroblastomas. Because of their low incidence, ASB and sinonasal tract schwannomas have not been well characterized. A systematic review of ASB and sinonasal tract schwannomas was conducted to further elucidate the presentation and surgical management of these lesions. METHODS A MEDLINE/PubMed search was performed, identifying 71 articles representing 94 cases of ASB and sinonasal schwannomas. Each case was analyzed for demographics, clinical presentation, anatomic location, radiographic features, and surgical treatment. RESULTS In 94 patients with ASB and sinonasal schwannomas, 44 (46.8%) were exclusively sinonasal, 30 cases (31.9%) were exclusively intracranial, 12 (12.8%) were primarily intracranial with extension into the paranasal sinuses, and 8 (8.5%) were primarily sinonasal with intracranial extension. Headaches and nasal obstruction were the most common presenting symptoms occurring in 30.9 and 29.8% of cases, respectively. Magnetic resonance imaging typically showed a hyperintense mass on T2-weighted imaging (70%) and hypointense (41%) on T1-weighted imaging. Most patients underwent surgical gross total resection via craniotomy, endoscopic endonasal approach, rhinotomy, or other sinonasal approaches. Recurrence occurred in three cases ranging from 4 months to 13 years. Postoperative complications included cerebral spinal fluid leakage, bacterial meningitis, epidural hematoma, and pneumocranium. CONCLUSION ASB and sinonasal schwannomas are rare lesions and should be considered in the differential diagnosis of ASB masses involving the cribriform plate with sinonasal extension. Gross total resection of these lesions should be considered the goal of operative management.
Collapse
Affiliation(s)
- Peter L Sunaryo
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | | | | | | | | |
Collapse
|
8
|
Rotondo M, Pascale M, Scuotto A. Giant frontal intraparenchymal schwannoma: unexpected diagnosis. BMJ Case Rep 2013; 2013:bcr-2013-010350. [PMID: 23833005 DOI: 10.1136/bcr-2013-010350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of an intraparenchymal frontal schwannoma, surgically resected in a middle-aged, otherwise healthy woman. Magnetic resonance imaging was ineffective for the definitive diagnosis and was instead afforded by histology. This case is unique because the rare lesion presented as a giant mass; to the best of our knowledge, such a finding has not been previously reported.
Collapse
|
9
|
Sauvaget F, François P, Ben Ismail M, Thomas C, Velut S. Anterior fossa schwannoma mimicking an olfactory groove meningioma: case report and literature review. Neurochirurgie 2013; 59:75-80. [PMID: 23587626 DOI: 10.1016/j.neuchi.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/30/2012] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
Abstract
Intracranial schwannomas not associated with cranial nerves account for less than 1% of surgically treated schwannomas of the central and peripheral nervous system. With only 45 cases reported to date, subfrontal schwannomas are very rare tumors, leaving the issue of their origin controversial. A 66-year-old woman presented with a 1-year history of progressive headaches. Clinical examination revealed hypoesthesia of the nasal tip. CT-scan and MRI studies revealed a large subfrontal tumor thought preoperatively to be a meningioma. Intraoperatively, a large extra-axial tumor arising from the floor of the right frontal fossa was encountered. Histopathology identified the tumor as a schwannoma. This current case gives strong clinical presumption of an origin from the anterior ethmoidal nerve. We reviewed the literature in order to establish the epidemiology of these tumors, from which there appear to be divergent profiles depending on tumor origin and histology. Despite close similarities with olfactory groove meningiomas, patient history and radiological findings provide substantial evidence for differential diagnosis.
Collapse
Affiliation(s)
- F Sauvaget
- Department of Neurosurgery, François-Rabelais University, 10, boulevard Tonnellé, 37044 Tours, France.
| | | | | | | | | |
Collapse
|
10
|
Figueiredo EG, Soga Y, Amorim RLO, Oliveira AMP, Teixeira MJ. The puzzling olfactory groove schwannoma: a systematic review. Skull Base 2012; 21:31-6. [PMID: 22451797 DOI: 10.1055/s-0030-1262945] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We systematically reviewed the literature concerning the anterior cranial fossa schwannomas to understand their pathogenesis, determine their origin, and standardize the terminology. We performed a MEDLINE, EMBASE, and Science Citation Index Expanded search of the literature; age, gender, clinical presentation, presence or absence of hyposmia, radiological features, and apparent origin were analyzed and tabulated. Cases in a context of neurofibromatosis and nasal schwannomas with intracranial extension were not included. Age varied between 14 and 63 years (mean = 30.9). There were 22 male and 11 female patients. The clinical presentation included seizures (n = 15), headache (n = 16), visual deficits (n = 7), cognitive disturbances (n = 3), and rhinorrhea (n = 1). Hyposmia was present in 14 cases, absent in 13 cases (39.3%), and unreported in five. Homogeneous and heterogeneous contrast enhancement was observed in 14 and 15 cases, respectively. The region of the olfactory groove was the probable site in 96.5%. Olfactory tract could be identified in 39.3%. The most probable origin is the meningeal branches of trigeminal nerve or anterior ethmoidal nerves. Thus, olfactory groove schwannoma would better describe its origin and pathogenesis and should be the term preferentially used to name it.
Collapse
|
11
|
Olfactory ensheathing cell tumor arising from the olfactory mucosa. Case Rep Med 2012; 2012:426853. [PMID: 22685468 PMCID: PMC3368184 DOI: 10.1155/2012/426853] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/25/2012] [Accepted: 03/26/2012] [Indexed: 11/17/2022] Open
Abstract
We report a rare case of olfactory ensheathing cell tumor. A female presented a large soft mass extending medially to the olfactory cleft and laterally to the middle meatus in the left nasal cavity. Imaging studies confirmed a cystic mass extending superiorly into the frontal lobe, indicating that the tumor arouse from the olfactory mucosa. A subtotal resection was achieved through an endoscopic endonasal approach without operative complications. Immunohistochemically constituent cells were diffusely positive for S-100 protein, but olfactory ensheathing cell tumor was diagnosed by negative staining for Leu7 (CD57). This case indicates that olfactory ensheathing cell tumor should be included in differential diagnoses for the olfactory cleft tumors.
Collapse
|
12
|
Yamaguchi T, Fujii H, Dziurzynski K, Delashaw JB, Watanabe E. Olfactory ensheathing cell tumor: case report. Skull Base 2011; 20:357-61. [PMID: 21359000 DOI: 10.1055/s-0030-1249572] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Subfrontal schwannomas, sometimes referred to as olfactory groove schwannomas, are rare tumors (34 cases reported to date). Despite the name and several theories proposed in the literature, there is no officially recognized description of the tumor's cell origin. Yasuda proposed the concept of an olfactory ensheathing cell (OEC) tumor in 2006. Olfactory ensheathing cells are glial cells that ensheath the axons of the first cranial nerve. Microscopically, both olfactory ensheathing cells and Schwann cells have similar morphological and immunohistochemical features. However, immunohistochemically olfactory ensheathing cells are negative for Leu7 and Schwann cells positive. A 30-year-old woman presented with a subfrontal, extraaxial, enhancing tumor, and underwent gross total resection. Immunohistochemical reactivity data suggested a schwannoma (positive for S-100 and negative for epithelial membrane antigen). However, the tumor was negative for Leu7. Accordingly, our final diagnosis was that of an OEC tumor. Subfrontal schwannoma immunohistochemical staining, if negative for Leu7, is indicative of an OEC tumor. It is possible that schwannoma-like extraaxial tumors at the anterior skull base are OEC tumors, which negative Leu7 staining can confirm.
Collapse
Affiliation(s)
- Takashi Yamaguchi
- Department of Neurosurgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | | | | | | | | |
Collapse
|
13
|
Lin SC, Chen MH, Lin CF, Ho DMT. Olfactory ensheathing cell tumor with neurofibroma-like features: a case report and review of the literature. J Neurooncol 2009; 97:117-22. [DOI: 10.1007/s11060-009-9986-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 08/06/2009] [Indexed: 11/29/2022]
|
14
|
Figueiredo EG, Gomes MQ, Soga Y, Amorim RL, Rosemberg S, Teixeira MJ. A rare case of olfactory groove schwannoma. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:534-5. [DOI: 10.1590/s0004-282x2009000300034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
15
|
Choi YS, Sung KS, Song YJ, Kim HD. Olfactory schwannoma-case report-. J Korean Neurosurg Soc 2009; 45:103-6. [PMID: 19274121 DOI: 10.3340/jkns.2009.45.2.103] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 01/27/2009] [Indexed: 11/27/2022] Open
Abstract
Intracranial schwannomas preferentially arise from the vestibular branch of the eighth nerve, and rarely from the trigeminal nerve, facial nerve, and lower cranial nerves. Anterior cranial fossa schwannomas are extremely uncommon and few details about them have been reported. The patient was a 39-year-old woman whose chief complaints were anosmia and frontal headache for 2 years. The gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed an extra-axial mass from ethmoid sinus to right frontal base region near the midline, with solid enhancement in lower portion and multicystic formation in upper portion. The tumor was totally resected via basal subfrontal approach. At operation, the tumor had cystic portion with marginal calcification and the anterior skull base was destructed by the tumor. The olfactory bulb was involved, and the tumor capsule did not contain neoplastic cells. The histopathological diagnosis was schwannoma. We report a rare case of anterior cranial fossa schwannoma with literature review.
Collapse
Affiliation(s)
- Yu-Seok Choi
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| | | | | | | |
Collapse
|
16
|
Martínez-Soto L, Alfaro-Baca R, Torrecilla-Sardón M, Fernández-Vallejo B, Ferreira-Muñóz R, De Diego T. Un nuevo caso de “schwannoma del olfatorio”; presentación y revisión de la literatura. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70172-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
17
|
Borges A. Skull base tumours part I: imaging technique, anatomy and anterior skull base tumours. Eur J Radiol 2008; 66:338-47. [PMID: 18462901 DOI: 10.1016/j.ejrad.2008.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 01/11/2008] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
Abstract
Advances in cross-sectional imaging, surgical technique and adjuvant treatment have largely contributed to ameliorate the prognosis, lessen the morbidity and mortality of patients with skull base tumours and to the growing medical investment in the management of these patients. Because clinical assessment of the skull base is limited, cross-sectional imaging became indispensable in the diagnosis, treatment planning and follow-up of patients with suspected skull base pathology and the radiologist is increasingly responsible for the fate of these patients. This review will focus on the advances in imaging technique; contribution to patient's management and on the imaging features of the most common tumours affecting the anterior skull base. Emphasis is given to a systematic approach to skull base pathology based upon an anatomic division taking into account the major tissue constituents in each skull base compartment. The most relevant information that should be conveyed to surgeons and radiation oncologists involved in patient's management will be discussed.
Collapse
Affiliation(s)
- Alexandra Borges
- Instituto Português de Oncologia Francisco Gentil, Centro de Lisboa, Serviço de Radiologia, Rua Professor Lima Basto, 1093 Lisboa Codex, Portugal.
| |
Collapse
|