International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - vol 08 issue 08, April, 2016

Pages: 32-36

Date of Publication: 20-Apr-2016


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STUDY OF PAEDIATRIC CNS TUMORS IN TERTIARY CARE CENTER

Author: Grishma P. Jobanputra

Category: Healthcare

Abstract:Objective: To elaborate pattern and frequency of CNS Tumors in a tertiary care center. Primary Neoplasm of the Central Nervous system are the most common solid tumors of childhood, making up 20% of all paediatric oncologic conditions,1,7 surpassed only by leukemia and lymphoma in frequency2 . They have tendency to occur along the central neural axis and posterior fossa and CNS metastasis from extra-cerebral tumors are uncommon in childhood. Material Andmethod: In the present study, A two year retrospective review of CNS tumors in paediatric age group (< 12 years) was conducted in tertiary care center. 32 cases of paediatric CNS tumors were studied for their incidence in relation to age, sex, location and histopathological features were evaluated with clinical and radiological correlation. Conclusion: All the cases were found intracranial. Overall there is a male preponderance in the paediatric CNS tumors and the incidence is quite similar to study conducted in Middle East region but somehow different than those reported by authors from the Western and Far Eastern countries.

Keywords: Intracranial, Infratentorial, Medulloblastoma

Full Text:

INTRODUCTION
Primary Neoplasm of the Central Nervous system (CNS) are the most common solid tumors of childhood, making up 20% of all paediatric oncologic conditions1,7 and are surpassed only by leukemia and lymphoma in frequency2 . They have included many histological subtypes, which vary in their site of origin and degree of malignancy. Seventy percent of childhood CNS tumours arise in the posterior fossa; a comparable number of tumours in adults arise within the cerebral hemispheres above the tentorium.7 Thus overall, infratentorial tumors occurs more in frequency then supratentorial tumors. Supratentorial tumors are more common in <2yrs of age while infratentorial tumors are more common in 4-10yrs and equally common after 10yrsof age.

CLINICAL PRESENTATION:
Clinical symptoms depend upon age, sex, location and type of tumor and grade Symptoms may include
• Infants-Increasing head circumference, lethargy, nausea and vomiting.
• Children-Also may have headaches, ↓visual acuity, seizures, cranial nerve palsies, endocrine dysfunction, Increased intracranial pressure, hormonal changes (pituitary adenoma). Classification of tumours is one of the arts of pathology, drawing on emerging molecular methods and the traditional recognition of histologic and biologic patterns. While pathologists have developed classification schemes that distinguish between benign and malignant lesions on histologic grounds, the clinical course of disease is also influenced by relatively unique features of brain tumours.

CLASSIFICATION7:

• Posterior fossa

• Supratentorial

♦ Intraparenchymal

♦ Sellar/Suprasellar

♦ Extra-axial Most common types of Primary Brain Tumours • Astrocytomas - Grades I-IV • Medulloblastomas

• Ependymoma

• Oligodendroglioma

• Meningioma Pituitary adenomas

• Choroid Plexus Papilloma

HOW THEY VARY FROM ADULT

• Unlike tumors of adults, childhood brain tumors have tendency to occur along the central neural axis and posterior fossa.9,11. In Adults: 70% of tumors are supratentorial

• Meningioma

• Pituitary adenoma

• High grade astrocytoma

♦ Anaplastic astrocytoma (grade III)

♦ Glioblastoma multiforme (grade IV astrocytoma) In Pediatric: 70% are in posterior fossa

• Medulloblastoma

• Pilocytic astrocytoma (cerebellar astrocytoma)

• CNS metastasis from extra-cerebral tumors are uncommon in childhood.11

AIMS AND OBJECTIVES
The study was undertaken with the following aims and objectives:
• To elaborate the pattern and frequency of CNS Tumors in a tertiary care center.
• To study the pathology of CNS tumors in relation to age, sex, location and incidence.
• To study the relative incidence of various CNS tumors among different paediatric age groups.
• To compare the obtained results with previous studies.

MATERIAL AND METHOD A Study of two year review of CNS tumours in paediatric age group (<12 years) was conducted in one of the teaching tertiary care hospital, Ahmedabad. Study includes all tumours occurs in CNS in <12 years of age group. Histopathological features were evaluated with clinical and radiological correlation. The clinical details are obtained from original case record. The gross examination of each available specimen includes its size, shape, weight, consistency and appearance of cut surface especially pertaining to areas of Haemorrhage, necrosis and cystic spaces. Total 32 cases were found to have primary CNS tumours. All the specimens were preserved in 10% formalin.

In histopathological study, no. of sections were taken from different sites according to the size of the specimen while in case of small biopsy whole specimen was given. Sections were processed in automated tissue processor and embedded in paraffin blocks. All the sections were studied by routine paraffin sectioning and Haematoxylin and eosin stain. Selected cases may require special stain. The tumours classified according to (WHO) World Health Organisation’s histological typing of CNS Tumours. Data acquired from examination of each specimen was processed in systemic manner. The collected data were analysed statistically and results obtained are compared with existing studies in the literature.

RESULTS
During the period of January 2013 to December 2015; a total of 12587 specimens were received for histopathological examination. Out of which 164 specimens were of CNS tumors, among which 32 cases were of <12 years, in paediatric age group. All the cases were intracranial. Out of 32 cases 20 were infratentorial (62%) and 12 were supratentorial (38%). Sex wise distribution show 19 (59%) were males and 13(41%) were females.(Table II) The frequency of various tumors show that Medulloblastomas were the single most frequent tumor (37.5%), followed by Astrocytoma (25%) and Ependymoma (12.5%) and rest were Meningioma, Choroid plexus papilloma, Craniopharyngioma.(Table I) In our study male preponderance is present with M: F ratio of 1.46: 1. The most common clinical presentation was hydrocephalus, seizures and nausea vomiting in infant and seizures, increased intracranial pressure and headache in children.

DISCUSSION
This present study was conducted over period of two year from January 2013 to December 2015 in one of the tertiary care teaching hospital. Studies of 32 cases were done with respect of sex, location of tumor and with morphological type of tumor. The results obtained were compared with those of previous studies of well-known workers in this study and the significant difference and similarities in result are discussed below. This study show all the cases were intracranial as compare to other authors Farwellet al4 and Jhang R Shen WQ et al.5 (Table III) In this study Medulloblastoma were the single most frequent tumor followed by astrocytomas and ependymoma. It is evident that our study matches with the study conducted in Middle East by Kadari et al.3 (Table IV) In present study out of 32 cases 20 were infratentorial (62%) and 12 were supratentorial (38%) which is comparable with other authors Farwell et al4 and Hassan Kadri et al3 .(Table V) In our study male preponderance is present with M: F ratio of 1.46 : 1.

CONCLUSION

• 32 cases of paediatric CNS tumours were studied in present study for their histopathology and incidence in relation to age, sex, location and incidence.

• Almost all the cases were found intracranial.

• In decreasing order of frequency, the intracranial tumours are Medulloblastoma, Astrocytoma, Ependymoma, PNET, Meningioma, Craniopharyngioma, Choroid Plexus Papilloma.

• In our patient population, the incidence is quite similar to study conducted in Middle East region but somehow different than those reported by authors from the Western and Far Eastern countries. Whether these results are unique or reflect a regional difference in the disease distribution, remains to be determined

. • Overall there is a male preponderance in the paediatric CNS tumours.

• Overall paediatric tumours predominate in the infratentorial regions.

• All medulloblastomas were infratentorial.

ACKNOWLEDGEMENT
The author acknowledges the help received from Dr. Hansa Goswami, MD. PATH, Professor and Head, Department of Pathology for teaching me the scientific approach of the subject and its subtle aspects. I am also thankful to Dr.Urvi Parikh, MD. PATH, Assistant Professor Pathology Dept., B.J. Medical College, Ahmedabad for motivating me for doing the work meticulously and her kind co-operation. I would like to give my special thanks to all the technicians of Histopathology Section, Pathology Dept., B.J. Medical College, Ahmedabad for helping me while conducting the present study. Last but not least Author acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

 

References:

1. Atlas of paediatric Oncology: D.Sinniah; giulio J. D’Angio; Jane Chatten; Mahboubi; Henrietta Rosenberg.

2. Young JR, Dohrmann GJ, Flannery Jt. Intracranial Neoplasm in infants.

3. Hassari Kadri, Alkhakam A. Mawla, Lina Murad Incidence of childhood brain tumours in Syria,(1993-2002).

4. Farwell Jr ; Dohrman GJ and Flannery Jt. Medulloblastoma in childhood; an epidemiologic study journal of neurosurgery.

5. Jacqueline R. Farwell, MD , George J. Dohrmann, MD, George J. Dohrmann, MD, PH.D and John T. Flannery , BS : Central Nervous System in children.

6. Heiskanen O:Intracranial tumours of children.

7. Rosai and Ackerman’s Surgical Pathology, 10th edition, Vol. 2

8. Robbins SL; Cartan RS ; and Kumar V. Robbin’s Pathological Basis of Disease. 8th edition.

9. Brain and other central nervous tumours- UK incidence statistics, Cancer Research UK.

10. Wilne S, Koller K,Collier J , et al; The diagnosis of brain tumours in children: a guideline to assist healthcare Arch Dis Child. 2010 Jul;95(7):534-9. Epub 2010 Apr 6. [abstract]

11. Childhood cancer incidence statistics, Cancer Research UK, Oct 2005.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
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A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
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A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
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A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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