Atormac
Home  -  About us  -  Editorial board  -  Search  -  Ahead of print  -  Current issue  -  Archives  -  Instructions  -  Subscribe  -  Contacts  -  Advertise - Login 
 
 
     

 Table of Contents  
CASE REPORT - TUMORS AND TUMOR LIKE CONDITIONS
Year : 2019  |  Volume : 9  |  Issue : 2  |  Page : 439-443

Extraskeletal myxoid chondrosarcoma of the parotid gland


1 Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral and Maxillofacial Surgery, Teaching Hospital of Kinshasa University, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
2 Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
3 Department of Oral and Maxillofacial Surgery, Teaching Hospital of Kinshasa University, University of Kinshasa, Kinshasa, Democratic Republic of the Congo

Date of Web Publication11-Dec-2019

Correspondence Address:
Bing Liu
Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan 430079
China
Login to access the Email id


DOI: 10.4103/ams.ams_145_18

PMID: 31909032

Rights and Permissions
  Abstract 


Extraskeletal myxoid chondrosarcoma (EMC) is a rare tumor with an estimated incidence of <3% among of all soft-tissue sarcomas. It is characterized by a multinodular architecture, abundant myxoid matrix, and malignant chondroblast-like cells arranged in cords. The tumor is an entity from chondrosarcomas of bones, commonly found in the soft tissues of the lower extremities at 80%. There are very limited reports of this tumor in the head and neck, especially in the parotid gland. The purpose of this paper is to describe an EMC located at an unusual site in the parotid gland, and briefly, the literature review with special reference to the clinicopathological features and the treatment approach was discussed.

Keywords: Clinical features, extraskeletal myxoid chondrosarcoma, parotid gland, treatment


How to cite this article:
Fidele NB, Tianfu W, Liu B, Sun Y, Yifang Z. Extraskeletal myxoid chondrosarcoma of the parotid gland. Ann Maxillofac Surg 2019;9:439-43

How to cite this URL:
Fidele NB, Tianfu W, Liu B, Sun Y, Yifang Z. Extraskeletal myxoid chondrosarcoma of the parotid gland. Ann Maxillofac Surg [serial online] 2019 [cited 2020 Apr 3];9:439-43. Available from: http://www.amsjournal.com/text.asp?2019/9/2/439/272520

Nyimi Bushabu Fidele and Wu Tianfu are equal contributors





  Introduction Top


Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft tissue tumor characterized by a multinodular architecture, abundant myxoid matrix, and malignant chondroblast-like cells arranged in cords, clusters, or delicate networks. It was first described by Enzinger and Shiraki in 1972 as a distinct tumor type.[1] EMC has been classified by the WHO as a tumor of uncertain differentiation in its classification of tumors of soft tissues and bones.[2] Chondrosarcomas are the third most common primary malignancy of bone after myeloma and osteosarcoma that produces cartilaginous matrix.[3] Myxoid chondrosarcoma is an intermediate subtype, which is found in either bones or soft tissues. EMC is a separate entity from chondrosarcomas of bones commonly found in the soft tissues of the lower extremities (80%) and in the trunk (20%). To the best of our knowledge, 42 EMC cases of the head and neck region have been reported in literature, including the present report. Of these EMCs, only one previous case arose from the parotid gland region. The purpose of this paper was to describe an EMC reported at an unusual site in the parotid gland. In addition, the literature review was briefly discussed with special reference to the possible clinicopathological features and the treatment of EMC.


  Case Report Top


A 56-year-old female was admitted in the Department of Oral Maxillofacial Head and Neck Oncology Surgery with a history of painless mass of the left posterior region of the parotid gland. The swelling was slowly progressive over a period of 2 months and there were no associated systemic symptoms. Physical examination revealed a parotid mass 1.5 cm × 2 cm × 2 cm in size, firm in consistency, and with no palpable cervical lymph nodes. The preoperative computed tomography (CT) scan depicted a 4.5 cm × 3.4 cm × 3.2 cm sized irregular lobular mass involving the deep lobe of the left parotid gland. Margins were clear, uneven texture, and the compression of the left internal jugular vein with the forward displacement was observed. The cervical lymph nodes were not enlarged [Figure 1]a. The coronal CT demonstrated a soft tissue mass that extended up to the left temporal bone [Figure 1]b. Parotid gland pleomorphism adenoma or facial nerve neurilemmoma was the clinical differential diagnosis. Following discussion and after obtaining consent from the patient, left partial parotidectomy with conservation of facial nerve was performed under general anesthesia. During the course of the surgery, the tumor was identified with an intact capsule and jugular vein, and the carotid artery was palpated [Figure 2]a, [Figure 2]b, [Figure 2]c.
Figure 1: CT Scan showed an irregular lobular mass on the left parotid gland involving deep lobe with clear boundary and showing compression of the left internal jugular vein without cervical lymph nodes enlargement (a), The coronal incidence demonstrating a heterogeneous soft-tissue mass extended upon to the left temporal bone, and the boundary was not a rough (b)

Click here to view
Figure 2: View of intraoperative shows conservation of facial nerve (a) with excision of tumour (b) Palpated vessels (c)

Click here to view



  Materials and Methods Top


A biopsy specimen was collected, fixed immediately in 4% buffered paraformaldehyde, and embedded in paraffin and then cut at a thickness of approximately 4 μm. The study was performed strictly in accordance with the guidelines set forth by the Review Board of the Ethics Committee in the Hospital of Stomatology, Wuhan University. Macroscopic pathology showed the tumor was grossly jelly like with a localized myxoid transparent appearance and irregular. In hematoxylin and eosin-stained section (×10), the tumor was highlighting nodular or lobulated growth pattern. The tumor cells were small with uniform size and shape, with a small hyperchromatic nucleus and a moderate amount of eosinophilic cytoplasm that was occasionally vacuolated. These cells were embedded in an abundant mucus-like matrix, with rare mitoses and cartilage differentiation. Alignment of the tumor cells in strands and cords separated by myxoid stroma was characteristic of EMC [Figure 3].
Figure 3: Histological features of the tumor showed cells embedded in a mucus-like matrix structure (×10), cells relatively small with uniform size and shape, alignment in strands and cords separated by large amount of myxoid stroma

Click here to view


In accordance to a pathology book on salivary glands,[4] immunohistochemical studies were performed on paraffin sections of the parotid gland mass using antibodies against antigens. To evaluate the immunoreactivity, we assessed the staining areas of the markers. The numbers of stained cells were counted at an original magnification of ×200 in five random fields by two investigators. The images were then analyzed using the ImageJ version 1.48v. Immunocytochemical staining showing reactivity for marker S-100, vimentin, and Ki-67 was focally and weakly positive (<5%) as well. The tumor cells did not react with antibodies to the keratin, calponin, desmin, P63, NSE, and Syn. Based on these findings, the diagnosis of EMC was rendered. After a follow-up period of 12 months, the postoperative course was uneventful, and as of the time of writing, no recurrence had appeared.


  Discussion Top


EMCs are a group of rare malignancies of soft-tissue sarcomas whose ultrastructural and molecular features are distinct from that of myxoid chondrosarcoma. Clinical examination of EMC has no specific findings which separates it from other types of chondrosarcomas. Pain, tenderness, and detection of a palpable mass may characterize some cases.[5] Tumors arising in specific sites can produce associated symptoms and large or superficial tumors may ulcerate the skin. EMC is low-grade malignant tumors with a predilection for males;[6] as from 42 cases found in literature, males were affected in 59.52% (n = 25) and females in 35.71% (n = 15), and 4.86% (n = 2 cases) were unavailable [Table 1]. In addition, the age group ranging from 36 to 66 was the most affected (45.23%; n = 19) as for the present case. Imaging characteristics are nonspecific, most tumors appear lobulated, and highly myxoid tumors have a homogeneous high signal on T2-weighted magnetic resonance imaging image.[5] Furthermore, as the tumor may undergo hemorrhagic and necrotic degeneration, signal characteristics on T1-weighted magnetic resonance images could be varied, ranging from low, intermediate, to high intensity compared to muscles. Calcification is usually absent as in this report and, if present, it is not prominent. Since its original description, EMC of the head and neck is a rare entity, occurring less than 3% of all soft-tissue sarcomas,[2] including the nasal cavity, buccal mucosa, neck region, infratemporal fossa, sphenoidal sinus, base of the tongue, and the parotid gland [Table 1]. To date, there is only one previous report of EMC involving the parotid gland.
Table 1: Epidemiological summary of extraskeletal myxoid chondrosarcoma of the head and neck reported in the literature

Click here to view


The pathogenesis of EMC remains controversial. Surgical or accidental trauma may be key factors, along with the inhalation of chemical carcinogens such as hydrocarbons.[17] Our patient did not report any head and neck region trauma. Another theory suggested that these tumors arise from a primitive mesenchymal or a synovial intimal cell with a propensity for differentiation. EMC is lobulated or multinodular and varies from gray to tan in color with a gelatinous and mucoid consistency. The pathological characteristics of the surface of EMC are myxoid or jelly-like, with a localized myxoid-like transparent appearance; cysts, hemorrhage, or necrosis may be observed. Under a light microscope, EMC usually exhibits a nodular structure with abundant myxoid stroma.[43] Histologically, it is characterized by a collection of round-to-spindle-shaped cells; arranged in cords, strands, and nests; and surrounded by a mucinous, hypovascular matrix. The cell nuclei demonstrate minimal to absent pleomorphism, hyperchromatic nuclei, and are surrounded by eosinophilic cytoplasm which is occasionally vacuolated.[44] Even though EMC is now recognized as a distinct lesion from chondrosarcomas of the bones, the term EMC probably still a misnomer for this tumor and does not highlight its true chondrosarcomatous differentiation. Three distinct histologic patterns of EMC have been described in the literature such as solid type, the rhabdoid phenotype (a rare type) and the classical EMC as described in the present paper, which presents as a low grade tumor with loose matrix, fibrils and myxoid material.[45] Compared to the solid tumor type, the latter usually has a large vesicular nucleus and increased mitotic activity. The classical EMC is the most common type that is less aggressive than chondrosarcomas of the bone.

The treatment of EMC is largely surgical excision as demonstrated in [Table 1]. Even with adequate surgical margins, however, the technical complexities related to this anatomical region, complete tumor resection often is not achieved, thus resulting in a poorer prognosis.[13] Therefore, en bloc resection and the longitudinal follow-up are necessary. The present case was treated by superficial parotidectomy, and after postoperative follow-up of 12 months, no signs of recurrence had appeared unlike as reported in the case of Ratnadeep and Abhishek [7] in which recurrence was detected three months after surgery. Even though the overall prognosis of EMC is difficult to estimate due to rarity of the tumor, one report demonstrated 5-year survival rate to be 82% and 65% survival rate at 10-year with 48% of local recurrence and 46% of metastases.[18] There are prognostic variations depending on cellularity, cellular maturity, differentiation, and amount of myxoid matrix. Dedifferentiated EMC is assumed to be more aggressive.[19] Some reports suggest that the tumor showing increased cellularity and atypia is more aggressive [10],[44] and the presence of rhabdoid cells may be an adverse histologic variable.[28] In addition, older patients with larger tumors, especially greater than 10 cm, have poorer prognosis. To date, the use of radiotherapy for EMC is controversial, and optimal chemotherapy regimen remains unclear determined. Some studies show that these tumors are resistant to radiotherapy, while others maintain that radiotherapy should be considered.[28]

While hematoxylin-eosin staining remains the gold standard for salivary gland tumor diagnosis, immunohistochemistry (IHC) is more commonly being used to obtain better understanding of the morphogenesis of the disease and to enhance diagnostic accuracy.[7] IHC marker panels can support and may be useful in refining the diagnosis of EMC. Vimentin is the only marker consistently expressed in EMC,[5],[16],[43] while S-100 protein, synaptophysin, cytokeratin, and epithelial membrane antigen are focally expressed in a minority of tumors. In the present case, S-100 protein and vimentin had the highest expression. Reactivity with vimentin, S-100 protein, and EMA has also been reported.[46] The analysis of IHC markers associated with the location of the lesion; cytology and radiology factors constitute systematic keywords for the diagnosis of EMC. Therefore, a meticulous academic exercise for analysis and interpretation of the findings is mandatory. In the recent study, Ki-67 index was remarkably higher in cellular variant (N30%) but 5%–10% in a classic EMC variety,[16] which was similar to the present report. The low proliferative index as shown by Ki-67 (<5%), i.e., low mitotic activity, appears to be associated with a good outcome.


  Conclusion Top


Although some reports have been published about EMC in the head and neck region, there is an extremely limited report in the parotid gland. EMC should remain in the differential diagnosis for a soft-tissue parotid gland mass. The histological and immunohistochemical features associated with clinical features are essential for the diagnosis of such lesions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Enzinger FM, Shiraki M. Extraskeletal myxoid chondrosarcoma. An analysis of 34 cases. Hum Pathol 1972;3:421-35.  Back to cited text no. 1
    
2.
Fletcher CD, Bridge JA, Hogendoorn PC, Mertens F. WHO Classification of Tumors of Soft Tissue and Bone. Lyon: IARC; 2013.  Back to cited text no. 2
    
3.
Dorfman HD, Czerniak B. Bone cancers. Cancer 1995;75:203-10.  Back to cited text no. 3
    
4.
Eric RC, Robert AO. Textbook and Color Atlas of Salivary Gland Pathology. Salivary Gland Pathology: Diagnosis and Management. 2nd ed. Johnson City, Tennessee: Willey Blackwell; 2016.  Back to cited text no. 4
    
5.
Ceylan K, Kizilkaya Z, Yavanoglu A. Extraskeletal myxoid chondrosarcoma of the nasal cavity. Eur Arch Otorhino Laryngol 2006;263:1044-7.  Back to cited text no. 5
    
6.
Miettinen M. Cartilage and bone-forming tumors and tumor-like lesions. Diagnostic Soft Tissue Pathology. Philadelphia, PA: Churchill-Livingstone; 2003. p. 407-9.  Back to cited text no. 6
    
7.
Ratnadeep G, Abhishek M. Maxillofacial extraskeletal myxoid chondrosarcoma: A case report and discussion. Korean J Pathol 2011;45:639-43.  Back to cited text no. 7
    
8.
Angiero F. Extraskeletal myxoid chondrosarcoma of the left buccal mucosa. Anticancer Res 2012;32:3345-50.  Back to cited text no. 8
    
9.
Oh YJ, Yang I, Yoon DY, Cho SJ, Lee Y, Woo JY, et al. Extraskeletal myxoid chondrosarcoma of the neck. Dentomaxillofac Radiol 2013;42:31808012.  Back to cited text no. 9
    
10.
Antonescu CR, Argani P, Erlandson RA, Healey JH, Ladanyi M, Huvos AG. Skeletal and extraskeletal myxoid chondrosarcoma: A comparative clinicopathologic, ultrastructural, and molecular study. Cancer 1998;83:1504-21.  Back to cited text no. 10
    
11.
Navdeep RS, Christine L, John P. Extraskeletal myxoid chondrosarcoma of the neck. Otolaryngol Case Rep 2017;2:22-5.  Back to cited text no. 11
    
12.
Zaki M, Laszewski P, Robinette N, Saleh H, Raza N, Sukari A, et al. Unresectable extraskeletal myxoid chondrosarcoma of the neck: Early tumor response to chemoradiotherapy. Cureus 2015;7:e432.  Back to cited text no. 12
    
13.
Acero J, Escrig M, Gimeno M, Montenegro T, Navarro-Vila C. Extraskeletal myxoid chondrosarcoma of the infratemporal fossa: A case report. Int J Oral Maxillofac Surg 2003;32:342-5.  Back to cited text no. 13
    
14.
Jérôme-Marson V, Uro-Coste E, Lacoste-Collin L, Gomez-Brouchet A, Serrano E, Delisle MB. Extraskeletal myxoid chondrosarcoma of the nasopharynx. Ann Pathol 2003;23:253-7.  Back to cited text no. 14
    
15.
Sotomayor EA, Sarma DP, Xiao S. Extraskeletal myxoid chondrosarcoma of oropharynx. Int J Pathol 2007;6:1.  Back to cited text no. 15
    
16.
Shao R, Lao IW, Wang L, Yu L, Wang J, Fan Q. Clinicopathologic and radiologic features of extraskeletal myxoid chondrosarcoma: A retrospective study of 40 Chinese cases with literature review. Ann Diagn Pathol 2016;23:14-20.  Back to cited text no. 16
    
17.
Jawad J, Lang J, Leader M, Keane T. Extraskeletal myxoid chondrosarcoma of the maxillary sinus. J Laryngol Otol 1991;105:676-7.  Back to cited text no. 17
    
18.
Drilon AD, Popat S, Bhuchar G, D'Adamo DR, Keohan ML, Fisher C, et al. Extraskeletal myxoid chondrosarcoma: A retrospective review from 2 referral centers emphasizing long-term outcomes with surgery and chemotherapy. Cancer 2008;113:3364-71.  Back to cited text no. 18
    
19.
Jung G, Cho KJ, Choi CH, Kim MJ. Dedifferentiated extraskeletal myxoid chondrosarcoma of the masticator space. A case reports. Korean J Pathol 2011;45(S1): S101-5.  Back to cited text no. 19
    
20.
Romañach MJ, Carlos R, Nuyens M, de Andrade BA, de Almeida OP. Extraskeletal myxoid chondrosarcoma of the masticator space in a pediatric patient. J Clin Exp Dent 2017;9:e825-31.  Back to cited text no. 20
    
21.
Englert TP, Kahn MR, Bushkoff SH, Mendelow H. Mandibular metastasis of an extraskeletal myxoid chondrosarcoma arising on the plantar surface of the foot: Report of case. J Oral Surg 1978;36:401-5.  Back to cited text no. 21
    
22.
Tsuneyoshi M, Enjoji M, Iwasaki H, Shinohara N. Extraskeletal myxoid chondrosarcoma – A clinicopathologic and electron microscopic study. Acta Pathol Jpn 1981;31:439-47.  Back to cited text no. 22
    
23.
Charabi S, Engel P, Bonding P. Myxoid tumours in the temporal bone. J Laryngol Otol 1989;103:1206-9.  Back to cited text no. 23
    
24.
Liu-Shindo M, Rice DH, Sherrod AE. Extraskeletal myxoid chondrosarcoma of the head and neck: A case report. Otolaryngol Head Neck Surg 1989;101:485-8.  Back to cited text no. 24
    
25.
Salcman M, Scholtz H, Kristt D, Numaguchi Y. Extraskeletal myxoid chondrosarcoma of the falx. Neurosurgery 1992;31:344-8.  Back to cited text no. 25
    
26.
Sato K, Kubota T, Yoshida K, Murata H. Intracranial extraskeletal myxoid chondrosarcoma with special reference to lamellar inclusions in the rough endoplasmic reticulum. Acta Neuropathol 1993;86:525-8.  Back to cited text no. 26
    
27.
Worley GA, Wareing MJ, Sergeant RJ. Myxoid chondrosarcoma of the external auditory meatus. J Laryngol Otol 1999;113:742-3.  Back to cited text no. 27
    
28.
Oshiro Y, Shiratsuchi H, Tamiya S, Oda Y, Toyoshima S, Tsuneyoshi M, et al. Extraskeletal myxoid chondrosarcoma with rhabdoid features, with special reference to its aggressive behavior. Int J Surg Pathol 2000;8:145-52.  Back to cited text no. 28
    
29.
De Las Casas LE, Singh HK, Halliday BE, Xu F, Strausbauch PH, Silverman JF. Myxoid chondrosarcoma of the sphenoid sinus and chondromyxoid fibroma of the iliac bone: Cytomorphologic findings of two distinct and uncommon myxoid lesions. Diagn Cytopathol 2000;22:383-9.  Back to cited text no. 29
    
30.
Goh YW, Spagnolo DV, Platten M, Caterina P, Fisher C, Oliveira AM, et al. Extraskeletal myxoid chondrosarcoma: A light microscopic, immunohistochemical, ultrastructural and immuno-ultrastructural study indicating neuroendocrine differentiation. Histopathology 2001;39:514-24.  Back to cited text no. 30
    
31.
Deik A, Azizi E, Shapira I, Boniece IR. Supraclavicular extraskeletal myxoid chondrosarcoma presenting with a sensorimotor polyneuropathy associated with anti-Hu antibodies. Oncology (Williston Park) 2009;23:718-21.  Back to cited text no. 31
    
32.
Bahri I, Boudawara T, Sellami A, Khabir A, Ghorgel M, Drira M, et al. A rare tumor of the parapharyngeal space: Myxoid chondrosarcoma. Rev Laryngol Otol Rhinol (Bord) 2002;123:255-8.  Back to cited text no. 32
    
33.
González-Lois C, Cuevas C, Abdullah O, Ricoy JR. Intracranial extraskeletal myxoid chondrosarcoma: Case report and review of the literature. Acta Neurochir (Wien) 2002;144:735-40.  Back to cited text no. 33
    
34.
Cummings TJ, Bridge JA, Fukushima T. Extraskeletal myxoid chondrosarcoma of the jugular foramen. Clin Neuropathol 2004;23:232-7.  Back to cited text no. 34
    
35.
Jörg S, August C, Stoll W, Alberty J. Myxoid chondrosarcoma of the maxilla in a pediatric patient. Eur Arch Otorhinolaryngol 2006;263:195-8.  Back to cited text no. 35
    
36.
Saint-Blancard P, Jancovici R, Ceccaldi B, Lagace R, Sastre-Garau X. Extraskeletal myxoid chondrosarcoma of the neck: Report of a case with lymph nodes metastasis. Rev Med Interne 2006;27:160-2.  Back to cited text no. 36
    
37.
Nakazora S, Kusuzaki K, Matsubara T, Shintani K, Matsumine A, Fukutome K, et al. Extraskeletal myxoid chondrosarcoma arising from the clavicle. Oncol Rep 2006;16:115-8.  Back to cited text no. 37
    
38.
Betz CS, Janda P, Arbogast S, Leunig A. Myxoma and myxoid chondrosarcoma of the nasal septum: Two case reports. HNO 2007;55:51-5.  Back to cited text no. 38
    
39.
Kim YJ, Im SA, Lim GY, Chun HJ, Park HJ, Kim MS, et al. Myxoid chondrosarcoma of the sinonasal cavity in a child: A case report. Korean J Radiol 2007;8:452-5.  Back to cited text no. 39
    
40.
O'Brien J, Thornton J, Cawley D, Farrell M, Keohane K, Kaar G, et al. Extraskeletal myxoid chondrosarcoma of the cerebellopontine angle presenting during pregnancy. Br J Neurosurg 2008;22:429-32.  Back to cited text no. 40
    
41.
Willems SM, Schrage YM, Baelde JJ, Briaire-de Bruijn I, Mohseny A, Sciot R, et al. Myxoid tumours of soft tissue: The so-called myxoid extracellular matrix is heterogeneous in composition. Histopathology 2008;52:465-74.  Back to cited text no. 41
    
42.
Kaplan I, Shah SS, Nicolaou-Ioannou Z, Fliss DM. Clinical-pathological conference: Case 1. Head Neck Pathol 2010;4:214-20.  Back to cited text no. 42
    
43.
Meis-Kindblom JM, Bergh P, Gunterberg B, Kindblom LG. Extraskeletal myxoid chondrosarcoma: A reappraisal of its morphologic spectrum and prognostic factors based on 117 cases. Am J Surg Pathol 1999;23:636-50.  Back to cited text no. 43
    
44.
Oliveira AM, Sebo TJ, McGrory JE, Gaffey TA, Rock MG, Nascimento AG. Extraskeletal myxoid chondrosarcoma: A clinicopathologic, immunohistochemical, and ploidy analysis of 23 cases. Mod Pathol 2000;13:900-8.  Back to cited text no. 44
    
45.
Hachitanda Y, Tsuneyoshi M, Daimaru Y, Enjoji M, Nakagawara A, Ikeda K, et al. Extraskeletal myxoid chondrosarcoma in young children. Cancer 1988;61:2521-6.  Back to cited text no. 45
    
46.
Stacchiotti S, Dagrada GP, Morosi C, Negri T, Romanini A, Pilotti S, et al. Extraskeletal myxoid chondrosarcoma: Tumor response to sunitinib. Clin Sarcoma Res 2012;2:22.  Back to cited text no. 46
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

Top
 
 
Search
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
  Introduction
  Case Report
   Materials and Me...
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed288    
    Printed10    
    Emailed0    
    PDF Downloaded40    
    Comments [Add]    

Recommend this journal