Browse publications by year: 2018

  1. Mohd Iskandar BJ, William T, Daisy Vanitha J
    Med J Malaysia, 2018 04;73(2):106-109.
    PMID: 29703874 MyJurnal
    BACKGROUND: Leptospirosis is a zoonotic disease with symptoms ranging from a mild, febrile illness to a severe form with multiorgan failure. Severe leptospirosis may require medical interventions in the form of dialysis and/or mechanical ventilation and often leads to mortality. An exaggerated host immune response-in particular, a "cytokine storm"-that causes endothelial and organ damage is associated with the disease severity and mortality.

    METHODS: Microscopic agglutination test (MAT)-positive and MAT-negative human serum samples (n=30) from patients with leptospirosis were obtained from the Public Health Laboratory, Kota Kinabalu, Sabah, Malaysia and control serum samples (n=10) were obtained from healthy student volunteers. We estimated the levels of IL-1β, IL-6, IL-8, IL-10, and TNF-α in serum samples by a Luminex assay.

    RESULTS: The levels of IL-6, IL-8, and IL1-β were significantly higher in 13% of the patients with leptospirosis compared to the healthy controls, while the levels of IL-10 and TNF-α were not elevated in either group.

    CONCLUSION: Our data suggest that elevated levels of IL-6, IL- 8, and IL1-β may be associated with leptospirosis disease severity, which requires patient follow-up for confirmation.

    MeSH terms: Agglutination Tests; Animals; Follow-Up Studies; Renal Dialysis; Humans; Leptospirosis; Malaysia; Respiration, Artificial; Students; Tumor Necrosis Factor-alpha; Volunteers; Zoonoses; Interleukin-6; Cytokines; Interleukin-8; Interleukin-10; Interleukin-1beta
  2. Michael A, Narasimman S, Jasjit Singh N
    Med J Malaysia, 2018 04;73(2):110-111.
    PMID: 29703875 MyJurnal
    Intra-abdominal heterotopic ossification usually develops after abdominal surgery and can cause complications such as bowel obstruction and even intestinal perforation. Bisphosphonates, NSAIDs and even local radiation is used as prophylaxis or treatment. Surgeons must consider heterotopic ossification and its complications as a differential when managing complex polytrauma patients with suspicious radiographic densities.
    MeSH terms: Anti-Inflammatory Agents, Non-Steroidal; Diphosphonates; Humans; Intestinal Obstruction; Intestinal Perforation; Multiple Trauma; Ossification, Heterotopic; Abdominal Cavity; Surgeons
  3. Ariffuddin I, Arman Zaharil MS, Wan Azman WS, Ahmad Sukari H
    Med J Malaysia, 2018 04;73(2):112-113.
    PMID: 29703876 MyJurnal
    High failure rate for recurrent palatal fistulas closure pose a great challenge to plastic surgeons. Tongue and facial artery musculomucosal (FAMM) flaps are the more commonly used flaps for closure of these recurrent fistulas. We report a case of a formerly inset FAMM flap to effectively close a previously repaired oronasal fistula.
    MeSH terms: Arteries; Palate; Surgical Flaps; Tongue; Oral Fistula; Surgeons
  4. Lim CC, Chong HS, Yong DJ, Foong SK, Prepageran N
    Med J Malaysia, 2018 04;73(2):114-115.
    PMID: 29703877 MyJurnal
    Schwannoma of cervical sympathetic chain is a rare cause of neck swelling. We report a 73- year-old male presented with anterior neck triangle swelling mimicking a carotid body tumour. Surgical excision was done, and the histopathological examination reported as ancient schwannoma. We would like to discuss the important differential diagnoses and highlight the possibility of an ancient schwannoma of cervical sympathetic chain masquerading as carotid body tumour. Also, to emphasise the importance of imaging for pre-operative planning and counselling.
    MeSH terms: Carotid Body Tumor; Counseling; Diagnosis, Differential; Male; Neck; Neurilemmoma; Peripheral Nervous System Neoplasms; Sympathetic Nervous System
  5. Noor Khairiah AK, Mohamad Nazrulhisham MN, John G
    Med J Malaysia, 2018 04;73(2):116-118.
    PMID: 29703878 MyJurnal
    Primary osteosarcoma of the spine is indeed rare and only several sporadic cases have been reported. It tends to occur in a slightly older age group than those with appendicular skeleton tumours. We present here an unusual case of aggressive lumbosacral osteosarcoma in a young teenager complicated by extensive dural spread, skip lesions and intravascular extension. Although a histopathological examination is mandatory to establish the diagnosis, this case emphasises the need of imaging to ascertain the full extent of disease spread especially in deciding the type of treatment to be instituted and to evaluate the response to the treatment.
    MeSH terms: Adolescent; Bone and Bones; Bone Neoplasms; Humans; Osteosarcoma; Spine
  6. Norazah Z, Joyce Darshinee DS
    Med J Malaysia, 2018 04;73(2):119-120.
    PMID: 29703879 MyJurnal
    Pulmonary veins stenosis in a Down Syndrome infant with normal connection pulmonary vein is rare and precise incidence of this disease is unknown. We report a case of progressive multiple pulmonary vein stenosis in a Down Syndrome infant with congenital heart disease and transient myeloproliferative leukaemia. This case-report aims to improve awareness among physicians and sonographers of this disease and the importance of pulmonary vein assessment in congenital heart disease with unexplained pulmonary hypertension.
    MeSH terms: Constriction, Pathologic; Down Syndrome; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant; Leukemia; Leukemoid Reaction; Pulmonary Veins; Incidence; Stenosis, Pulmonary Vein
  7. Yatiee SL, Mohd Khairi MD, Md Salzihan MS, Ikmal HB
    Med J Malaysia, 2018 04;73(2):121-122.
    PMID: 29703880 MyJurnal
    The incidence of intradermal nevus in the external auditory canal is uncommon. We herein are describing a case of 60-year-old lady who presented with foreign body sensation in the right external ear canal (EAC) with mild discomfort and ear bleed during ear picking. Otoscopic examination revealed hyperpigmented mass on the floor of the outer two third of EAC. Complete excisional biopsy of the mass resulted in histopathology findings of intradermal nevus. Despite the fact that the disease is not alarming, the possibilities of benign melanocytic nevi transformation into malignant lesions such as melanoma need to be ruled out.
    MeSH terms: Biopsy; Ear Canal; Foreign Bodies; Melanoma; Nevus, Pigmented; Sensation; Skin Neoplasms; Incidence; Nevus, Intradermal; Otoscopes; Otoscopy
  8. Ashraf MI, Ong SK, Mujawar S, Pawar S, More P, Paul S, et al.
    Sci Rep, 2018 04 27;8(1):6669.
    PMID: 29703908 DOI: 10.1038/s41598-018-25042-2
    Identifying effective drug targets, with little or no side effects, remains an ever challenging task. A potential pitfall of failing to uncover the correct drug targets, due to side effect of pleiotropic genes, might lead the potential drugs to be illicit and withdrawn. Simplifying disease complexity, for the investigation of the mechanistic aspects and identification of effective drug targets, have been done through several approaches of protein interactome analysis. Of these, centrality measures have always gained importance in identifying candidate drug targets. Here, we put forward an integrated method of analysing a complex network of cancer and depict the importance of k-core, functional connectivity and centrality (KFC) for identifying effective drug targets. Essentially, we have extracted the proteins involved in the pathways leading to cancer from the pathway databases which enlist real experimental datasets. The interactions between these proteins were mapped to build an interactome. Integrative analyses of the interactome enabled us to unearth plausible reasons for drugs being rendered withdrawn, thereby giving future scope to pharmaceutical industries to potentially avoid them (e.g. ESR1, HDAC2, F2, PLG, PPARA, RXRA, etc). Based upon our KFC criteria, we have shortlisted ten proteins (GRB2, FYN, PIK3R1, CBL, JAK2, LCK, LYN, SYK, JAK1 and SOCS3) as effective candidates for drug development.
    MeSH terms: Antineoplastic Agents/adverse effects; Antineoplastic Agents/isolation & purification*; Antineoplastic Agents/pharmacology*; Humans; Neoplasms/drug therapy*; Neoplasms/pathology; Gene Regulatory Networks/drug effects; Drug Discovery/methods*; Protein Interaction Maps/drug effects; Drug-Related Side Effects and Adverse Reactions*
  9. Kamaluddin MR, Md Shariff NS, Mat Saat GA
    Malays J Pathol, 2018 Apr;40(1):1-10.
    PMID: 29704379 MyJurnal
    INTRODUCTION: Murder is an extreme form of violent crime which occurs across all social, cultural, and ethnic spheres. It is therefore, crucial to understand the nature and the extent of mechanical profiles of murder and murderers. The purpose of this article is to review such critical aspects of murder in a nutshell.

    METHODS: An archival research methodology was employed in this study where relevant search for literatures on these mechanical aspects related to murder was made across search engines such as Google Scholar and Elsevier with relevant articles selected for this review.

    RESULTS AND DISCUSSION: This review discusses in an in-depth manner, pivotal mechanical profiles which include motives, methods of killing, choice of weapon, settings, targeted body parts, and murder victim concealment. In-depth understanding of each mechanical aspect offers an opportunity to the public at large to expand their knowledge on murder prevention manners which is vital for crime prevention efforts in the future.

    MeSH terms: Homicide*; Humans
  10. Tan GC, Stalling M, Al-Rawabdeh S, Kahwash BM, Alkhoury RF, Kahwash SB
    Malays J Pathol, 2018 Apr;40(1):11-26.
    PMID: 29704380
    Tonsillectomy is among the most commonly performed operations in children. Although follicular lymphoid hyperplasia is usually the main and only pathologic finding at microscopic examination, a variety of other rare but important pathologic changes may be encountered. This review aims to provide an inclusive practical resource and reference for both training and practising pathologists. It discusses the spectrum of pathologic findings, including both neoplastic and non-neoplastic conditions and provides illustrative images.
    MeSH terms: Child; Child, Preschool; Female; Humans; Male; Palatine Tonsil/pathology*; Palatine Tonsil/surgery; Tonsillectomy
  11. Yousuf R, Abdul Ghani SA, Abdul Khalid N, Leong CF
    Malays J Pathol, 2018 Apr;40(1):27-32.
    PMID: 29704381 MyJurnal
    INTRODUCTION: 'InTec Blood Grouping Test kit' using solid-phase technology is a new method which may be used at outdoor blood donation site or at bed side as an alternative to the conventional tile method in view of its stability at room temperature and fulfilled the criteria as point of care test. This study aimed to compare the efficiency of this solid phase method (InTec Blood Grouping Test Kit) with the conventional tile method in determining the ABO and RhD blood group of healthy donors.

    METHODS: A total of 760 voluntary donors who attended the Blood Bank, Penang Hospital or offsite blood donation campaigns from April to May 2014 were recruited. The ABO and RhD blood groups were determined by the conventional tile method and the solid phase method, in which the tube method was used as the gold standard.

    RESULTS: For ABO blood grouping, the tile method has shown 100% concordance results with the gold standard tube method, whereas the solid-phase method only showed concordance result for 754/760 samples (99.2%). Therefore, for ABO grouping, tile method has 100% sensitivity and specificity while the solid phase method has slightly lower sensitivity of 97.7% but both with good specificity of 100%. For RhD grouping, both the tile and solid phase methods have grouped one RhD positive specimen as negative each, thus giving the sensitivity and specificity of 99.9% and 100% for both methods respectively.

    CONCLUSION: The 'InTec Blood Grouping Test Kit' is suitable for offsite usage because of its simplicity and user friendliness. However, further improvement in adding the internal quality control may increase the test sensitivity and validity of the test results.

    MeSH terms: Point-of-Care Testing*; Blood Grouping and Crossmatching/methods*; Cross-Sectional Studies; Humans; Sensitivity and Specificity
  12. Nadaraja RND, Sthaneshwar P, Razali N
    Malays J Pathol, 2018 Apr;40(1):33-39.
    PMID: 29704382 MyJurnal
    INTRODUCTION: Hyperandrogenism remains as one of the key features in Polycystic Ovarian Syndrome (PCOS) and can be assessed clinically or determined by biochemical assays. Hirsutism is the most common clinical manifestation of hyperandrogenism. The clinical assessment is subjected to wide variability due to poor interobserver agreement and multiple population factors such as ethnic variation, cosmetic procedures and genetic trait. The difficulty in resolving the androgen excess biochemically is due to a lack of consensus as to which serum androgen should be measured for the diagnosis of PCOS. The aim of the study was to compare and establish the diagnostic cut off value for different androgen biomarker for the diagnosis of PCOS.

    MATERIALS AND METHODS: A total of 312 patients classified to PCOS (n = 164) and non PCOS (n = 148) cohorts were selected from the Laboratory Information System (LIS) based on serum total testosterone (TT) and sex hormone binding globulin (SHBG) from the period of 1st April 2015 to 31st March 2016. PCOS was diagnosed based on Rotterdam criteria. Clinical hyperandrogenism and ultrasound polycystic ovarian morphology were obtained from the clinical records. The other relevant biochemical results such as serum luteinizing hormone (LH), follicle stimulating hormone (FSH) and albumin were also obtained from LIS. Free androgen index (FAI), calculated free testosterone (cFT) and calculated bioavailable testosterone (cBT) were calculated for these patients. Receiver Operating Characteristic (ROC) curve analysis were performed for serum TT, SHBG, FAI, cFT, cBT and LH: FSH ratio to determine the best marker to diagnose PCOS.

    RESULTS: All the androgen parameters (except SHBG) were significantly higher in PCOS patients than in control (p<0.0001). The highest area under curve (AUC) curve was found for cBT followed by cFT and FAI. TT and LH: FSH ratio recorded a lower AUC and the lowest AUC was seen for SHBG. cBT at a cut off value of 0.86 nmol/L had the highest specificity, 83% and positive likelihood ratio (LR) at 3.79. This is followed by FAI at a cut off value of 7.1% with specificity at 82% and cFT at a cut off value of 0.8 pmol/L with specificity at 80%. All three calculated androgen indices (FAI, cFT and cBT) showed good correlation with each other. Furthermore, cFT, FAI and calculated BT were shown to be more specific with higher positive likelihood ratio than measured androgen markers.

    CONCLUSIONS: Based on our study, the calculated testosterone indices such as FAI, cBT and cFT are useful markers to distinguish PCOS from non-PCOS. Owing to ease of calculation, FAI can be incorporated in LIS and can be reported with TT and SHBG. This will be helpful for clinician to diagnose hyperandrogenism in PCOS.

    MeSH terms: Adult; Androgens/blood*; Female; Humans; Middle Aged; Polycystic Ovary Syndrome/blood*; Reference Values; Biomarkers/blood*; Young Adult
  13. Ahadon M, Abdul Aziz S, Wong CL, Leong CF
    Malays J Pathol, 2018 Apr;40(1):41-48.
    PMID: 29704383 MyJurnal
    INTRODUCTION: Microparticles are membrane bound vesicles, measuring less than 1.0 um, which are released during cellular activation or during apoptosis. Studies have shown that these circulating microparticles play a role in coagulation, cell signaling and cellular interactions. Increased levels of circulating microparticles have been observed in a number of conditions where there is vascular dysfunction, thrombosis and inflammation. The objective of this study was to determine the various plasma-derived microparticles in patients with polycythaemia vera (PV) in Universiti Kebangsaan Malaysia Medical Centre and to compare them with normal control.

    METHODS: A total of 15 patients with PV and 15 healthy volunteers were included in this cross-sectional descriptive study. Plasma samples from both patients and healthy volunteers were prepared and further processed for isolation of microparticles. Flow cytometry analyses were then carried out in all samples to determine the cellular origin of the microparticles. Full blood count parameters for both groups were also collected. Data collected were analyzed using SPSS version 12.0.

    RESULTS: Patients with PV had a significantly higher percentage of platelet derived microparticles compared to healthy controls (P <0.05). The control group had a higher level of endothelial derived microparticles but the differences were not statistically significant (P > 0.05).

    CONCLUSION: The median percentage of positive events for platelet derived microparticles was higher in patients with PV compared to normal healthy controls.

    MeSH terms: Adult; Blood Platelets/pathology; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Polycythemia Vera/blood*; Cell-Derived Microparticles/pathology*
  14. Abdelrahim LM, Peh SC, Kallarakkal TG
    Malays J Pathol, 2018 Apr;40(1):49-56.
    PMID: 29704384
    INTRODUCTION: Epstein-Barr virus (EBV) might be an aetiological agent involved in the pathogenesis of certain Non-Hodgkin's Lymphomas (NHLs). EBV infection has been diagnosed by serologic testing within the tumour biopsies of patients with NHL. However, the association between EBV and NHL is inconsistent with a preference for certain anatomic sites, histologic subtypes and immunosuppressed patients. The objective of this study was to characterise the B-cell NHLs of the oral cavity and maxillofacial region using histological and immunophenotypical techniques and to determine its association with EBV infection.

    MATERIALS AND METHODS: This was a descriptive cross-sectional study that included 14 cases of B-cell NHLs of the oral cavity and maxillofacial region. The haematopoietic and lymphoid tissue tumours classification of WHO was used to categorize the cases. In-situ hybridisation for EBV-encoded RNA was performed to confirm the EBV infection.

    RESULTS: The average age of the patients included in the study was found to be 48.8 ± 23 years with a higher female to male ratio (1.3:1). Our study suggested that diffuse large B-cell lymphomas (DLBCLs) and Burkitt's lymphomas (BLs) constitute the predominant subtypes of lymphomas affecting the oral cavity and maxillofacial regions.

    CONCLUSION: The findings from our study support the view that at least a relatively smaller proportion of B-cell NHLs that occur in the oral cavity and maxillofacial region do not have a pathogenic association with EBV.

    MeSH terms: Adolescent; Adult; Aged, 80 and over; Child; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Mouth Neoplasms/virology*; Incidence; Lymphoma, B-Cell/virology*; Epstein-Barr Virus Infections/epidemiology*
  15. Kaur M, Verma S, Gupta R, Pant L, Singh S
    Malays J Pathol, 2018 Apr;40(1):57-60.
    PMID: 29704385
    CD10, a transmembrane endopeptidase, has been shown to be lost as an early event in prostate cancer. We aimed at evaluating the pattern of expression of CD10 in various Gleason's grades of prostatic adenocarcinoma in comparison with nodular hyperplasia of prostate. This retrospective study included 30 cases of nodular hyperplasia and 30 of prostatic adenocarcinoma of various Gleason's grades. Immunohistochemical staining for CD10 was performed on all cases and positivity evaluated as percentage of cells as well as location (membranous or cytoplasmic or both). Of prostatic adenocarcinomas, grade 3 was seen in 10 foci, grade 4 in 28 and grade 5 in 22 foci. CD10 positivity in carcinoma was lower than in nodular hyperplasia, with the lowest positivity in grade 5. The pattern of expression of CD10 also changed from membranous in grade 3 to cytoplasmic in grade 5. Loss of CD10 expression appears to be associated with increasing tumour grade in carcinoma prostate and this can potentially be useful in stratification of such patients.
    MeSH terms: Adenocarcinoma/pathology*; Aged; Humans; Male; Middle Aged; Prostatic Neoplasms/pathology*; Retrospective Studies; Biomarkers, Tumor/analysis*; Neprilysin/biosynthesis*; Neoplasm Grading
  16. Wan Jamaludin WF, Mohamad Yusoff F, Ismail NA, Mohd Idris MR, Palaniappan S, Ng CKK, et al.
    Malays J Pathol, 2018 Apr;40(1):61-67.
    PMID: 29704386 MyJurnal
    INTRODUCTION: Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival.

    BACKGROUND: Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding. Clinical applications of autologous mononuclear cells therapy in wound healing in non-malignant patients with critical limb ischaemia have been reported with remarkable outcome.

    METHODS: We report three patients with haematological malignancies undergoing chemotherapy, who received autologous mononuclear cells implantation to treat non-healing wound after optimum conventional wound care. The sources of mononuclear cells (MNC) were from bone marrow (BM), peripheral blood (PB) and mobilised PB cells (mPB-MNC) using granulocyte colony stimulating factor (G-CSF). The cells were directly implanted into wound and below epidermis. Wound sizes and adverse effects from implantation were assessed at regular intervals.

    RESULTS: All patients achieved wound healing within three months following autologous mononuclear cells implantation. No implantation adverse effects were observed.

    CONCLUSIONS: Autologous mononuclear cells therapy is a feasible alternative to conventional wound care to promote complete healing in non-healing wounds compounded by morbid factors such as haematological malignancies, chemotherapy, diabetes mellitus (DM), infections and prolonged immobility.

    MeSH terms: Adolescent; Aged; Female; Humans; Leukocytes, Mononuclear/transplantation*; Male; Transplantation, Autologous/methods; Wound Healing*; Hematologic Neoplasms/complications*
  17. Ding CH, Yusoff H, Muttaqillah NAS, Tang YL, Tan TL, Periyasamy P, et al.
    Malays J Pathol, 2018 Apr;40(1):69-72.
    PMID: 29704387 MyJurnal
    Pneumocystis pneumonia is an important human immunodeficiency virus (HIV)-associated opportunistic infection, and especially so in pregnant HIV-positive patients. We report a case of a 40-year-old woman in her first trimester of pregnancy who initially presented with acute gastroenteritis symptoms but due to a history of high-risk behaviour and the observation of oral thrush, she was worked up for HIV infection. Her retroviral status was positive and her CD4+ T cell count was only 8 cells/µL. She was also worked up for pneumocystis pneumonia due to the presence of mild resting tachypnoea and a notable drop in oxygen saturation (from 100% to 88%) following brief ambulation. Her chest radiograph revealed bilaterally symmetrical lower zone reticular opacities and Giemsa staining of her bronchoalveolar lavage (BAL) was negative for Pneumocystis jirovecii cysts. However, real-time P. jirovecii polymerase chain reaction (PCR) testing on the same BAL specimen revealed the presence of the organism. A course of oral co-trimoxazole plus prednisolone was commenced and her clinical condition improved.
    MeSH terms: Adult; Female; Humans; Pneumonia, Pneumocystis/immunology*; Pregnancy; Pregnancy Complications, Infectious/immunology*; HIV Infections/complications*; Immunocompromised Host*; Pneumocystis carinii
  18. Son HJ, Lee H, Kim JH, Yu IK, Han HY
    Malays J Pathol, 2018 Apr;40(1):73-78.
    PMID: 29704388
    Progressively transformed germinal centers (PTGC) is a benign process characterised by a morphological variant of reactive follicular hyperplasia in lymph nodes. It was recently shown that some cases of PTGC are associated with IgG4-related disease (IgG4-RD) or increased IgG4 plasma cells. Five years ago, a 57-year-old woman presented with enlargement of multiple lymph nodes in the left parotid, submandibular, and neck areas, pathologically diagnosed as PTGC after excisional biopsy. Since then, she has experienced numbness in her extremities, especially the left shoulder and arm, pruritus on the left side of the face and intermittent facial palsy, for which she has been receiving regular symptomatic treatment. Recently the patient developed diabetes mellitus (approximately seven months ago). In routine follow-up scans, a mass was detected in left kidney and magnetic resonance imaging of the abdomen prior to surgery revealed a slightly enhanced bulky mass replacing the pancreatic tail and uncinate process. The mass in left kidney was diagnosed as clear cell renal cell carcinoma, and the pathological features of the pancreatic lesion were those of IgG4-related chronic fibrosing pancreatitis. Retrograde examination of the neck lymph node diagnosed as PTGC showed increased deposition of IgG4-positive plasma cells.
    MeSH terms: Carcinoma, Renal Cell/complications; Carcinoma, Renal Cell/pathology; Female; Fibrosis; Humans; Hyperplasia/pathology; Immunoglobulin G*; Kidney Neoplasms/complications; Kidney Neoplasms/pathology; Middle Aged; Germinal Center/pathology*; Pancreatitis, Chronic/complications; Pancreatitis, Chronic/immunology; Pancreatitis, Chronic/pathology*
  19. Malays J Pathol, 2018 Apr;40(1):79-82.
    PMID: 29704389
    No abstract available.
    MeSH terms: Humans; Intestinal Neoplasms/classification*; Intestinal Neoplasms/pathology*; Pancreatic Neoplasms/classification*; Pancreatic Neoplasms/pathology*; Research Design; Stomach Neoplasms/classification*; Stomach Neoplasms/pathology*; Neuroendocrine Tumors/classification*; Neuroendocrine Tumors/pathology*
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