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Differential CD44 expression patterns in primary brain tumours and brain metastases.

Splicing variants of CD44 (CD44v) are increasingly recognised as metastasis-promoting factors in rodent and some human cancers. However, the frequency for CD44v expression in human cancers and their metastases and the status of CD44v expression in low or non-metastatic tumours is still uncertain. To address this issue, we investigated CD44 expression patterns in brain metastases (BMTs) spread from more than ten organs and five types of primary brain tumours (PBTs) by Northern blot, reverse transcription-polymerase chain reaction (RT-PCR) and immunocytochemical analysis. The results demonstrated that all of the 56 PBTs examined express standard form of CD44 (CD44s) but none of them express CD44v. In contrast, 22 of 26 BMTs studied were found with CD44v expression. Our data thus present direct evidence of a general distribution of CD44 in BMTs but suggest that such expression is an extremely rare event in PBTs. Therefore, the presence or absence of CD44v expression may be related to high or low metastatic potential of human malignancies.

Adult↗

Cytological evaluation of head and neck tumors in children--a pattern analysis.

A total of 135 pediatric head and neck tumors diagnosed in our institute were reviewed with a view to elucidate the overall cytological patterns and analyze the important cytological features. Ninety-four tumors (69.6%) were aspirated for a primary diagnosis, and in 41 (30.4%) cases, fine-needle aspiration cytology was performed to document relapse, recurrence or a metastasis. Among the 94 tumors aspirated for a primary diagnosis, 66 cases (70.2%) were accurately diagnosed, in 22 cases (23.4%) a broad working diagnosis was offered, and 6 cases (6.4%) were misdiagnosed. The accuracy rate was higher (79.3%) when relapse-recurrent and metastatic tumors were included. The smears were broadly divided into six patterns, viz. round cell, epithelial, anaplastic, giant cell, mixed inflammatory, and spindle cell patterns. The round cell pattern was the most frequent one encountered in this group. The cytological features that stood the test of variability were lymphoglandular bodies and a noncohesive cell population in hematolymphoid malignancies, pale chromatin and cytoplasmic vacuoles in primitive neuroectodermal tumor/Ewing's sarcoma (PNET/ES), neuropil and rosettes in neuroblastoma, and plasmacytoid rhabdomyoblasts in rhabdomyosarcoma. A fairly good accuracy was seen in the diagnosis of metastatic undifferentiated carcinoma and anaplastic lymphoma, but the giant-cell and spindle-cell tumors continued to pose a problem in diagnosis. Ancillary techniques such as immunocytochemistry and electron microscopy applied in limited cases helped evaluate Langerhans cell histiocytosis, alveolar rhabdomyosarcoma, and the PNET/ES family of tumors.

Adolescent↗

Diagnostic utility of Glut-1 and CA 15-3 in discriminating adenocarcinoma from hepatocellular carcinoma in liver tumors biopsied by fine-needle aspiration.

BACKGROUND: Diagnosing liver tumors can be difficult in the setting of a poorly differentiated tumor or tumors with no known prior malignancy. Frequently, alpha-fetoprotein, carcinoembryonic antigen, factor VIII, and mucicarmine have been employed to distinguish hepatocellular carcinoma (HCC) from adenocarcinoma. However, these stains have their limitations. CA 15-3 and Glut-1 are expressed in a variety of carcinomas. To the authors' knowledge, their expression in HCC has not been studied extensively. The authors examined the clinical utility of CA 15-3 and Glut-1 in the setting of fine-needle aspiration biopsy samples from the liver. METHODS: Thirty-five cases of HCC and 59 cases of tumors metastatic to the liver were studied. These cases previously were studied with the hepatocyte paraffin-1 antibody. Each case was stained with CA 15-3 and Glut-1 using the avidin-biotin complex method. Each case was evaluated in a blinded fashion for membranous staining that was stronger than cytoplasmic or background staining. The diagnoses were unblinded and staining patterns were compared. RESULTS: CA 15-3 stained 43 of 59 metastatic carcinoma samples and 3 of 35 HCC samples. Glut-1 stained 34 of 59 metastases and 2 of 35 HCCs. Together, the 2 immunostains stained 51 of 59 metastases and 5 of 35 HCCs. Diagnostic accuracy was improved by adding hepatocyte paraffin-1 to the staining panel. CONCLUSIONS: CA 15-3 and Glut-1, especially in conjunction with hepatocyte paraffin-1, appear to be helpful in discriminating HCC from other carcinomas.

Adenocarcinoma↗

Receptor tyrosine kinases expressed in metastatic colon cancer.

Using a PCR-based cloning technique, we have isolated a series of DNA fragments coding for tyrosine kinases that are expressed in a metastatic human colon tumor, and have subsequently analyzed their expression pattern at the protein level in human tumors. We identified both the alpha and the beta forms of the platelet-derived growth factor receptor (PDGFR), axl and 8 other genes, including 3 cytoplasmic tyrosine kinases. To study their expression in human colon cancer, we performed Western blots of matched sets of normal tissues and of carcinomas from the same patient. These revealed that the alpha-PDGFR migrates predominantly as a 200-kDa band in 8/8 normal tissues, and as a 170-kDa band in 17/17 malignant tissues, as well as in colonic polyps, suggesting that expression of an isoform of this receptor may be a marker for the progression of colon cancer. Additional studies showed that the Axl receptor tyrosine kinase was expressed at 10-fold higher levels in a peritoneal metastatic nodule than in other normal and malignant tissues. Immunohistochemistry revealed Axl over-expression specifically in the malignant cells of the tumor. This indicates that over-expression and possibly a differential processing event of tyrosine kinase receptors may be involved in colon cancer, and that they are potential markers for the progression of this disease.

Amino Acid Sequence↗

[The growth and metastatic characteristics of Lewis lung carcinoma during reproductive dysfunction in male C57BL/6 mice].

Results of a study of the pattern of spontaneous dissemination of Lewis lung carcinoma in male mice with reproductive system dysfunction showed that removal of the gonads followed by substitution treatment with testosterone failed to influence tumor metastatic potential. The data suggested that the androgen lacked a modulating effect on growth and dissemination of Lewis lung carcinoma.

Animals↗

Genetic alterations in prostate cancer.

A number of genetic changes have been documented in prostate cancer, ranging from allelic loss to point mutations and changes in DNA methylation patterns (summarized in Fig. 1). To date, the most consistent changes are those of allelic loss events, with the majority of tumors examined showing loss of alleles from at least one chromosomal arm. The short arm of chromosome 8, followed by the long arm of chromosome 16, appear to be the most frequent regions of loss, suggesting the presence of novel tumor suppressor genes. Deletions of one copy of the Rb and p53 genes are less frequent, as are mutations of the p53 gene, and accumulating evidence suggests the presence of an additional tumor suppressor gene on chromosome 17p, which is frequently inactivated in prostate cancer. Alterations in the E-cadherin/alpha-catenin-mediated cell-cell adhesion mechanism appear to be present in almost half of all prostate cancers and may be critical to the acquisition of metastatic potential of aggressive prostate cancers. Finally, altered DNA methylation patterns have been found in the majority of prostate cancers examined, suggesting widespread alterations in methylation-modulated gene expression. The presence of multiple changes in these tumors is consistent with the multistep nature of the transformation process. Finally, efforts to identify prostate cancer susceptibility loci are under way and may elucidate critical early events in prostatic carcinogenesis.

Cadherins↗

Molecular biology of prostate cancer progression.

A number of genetic changes have been documented in prostate cancer, ranging from allelic loss to point mutations and changes in DNA methylation patterns (summarized in Fig. 1). The most consistent changes seen are those of allelic loss events, with the majority of tumours examined showing loss of alleles from at least one chromosomal arm. The short arm of chromosome 8, followed by the long arm of chromosome 16, seem to be the most frequent regions of loss, suggesting the presence of novel tumour suppressor genes. Deletions of one copy of the RB and TP53 genes are less frequent as are mutations of the TP53 gene, and accumulating evidence suggests the presence of an additional tumour suppressor gene on chromosome 17p, which is frequently inactivated in prostate cancer. Alterations in the E-cadherin/alpha catenin mediated cell-cell adhesion mechanism appear to be present in almost half of all prostate cancers and may be critical to the acquisition of metastatic potential of aggressive prostate cancers. Finally, altered DNA methylation patterns have been found in the majority of prostate cancers examined, suggesting widespread alterations in methylation modulated gene expression. The presence of multiple changes in these tumours is consistent with the multistep nature of the transformation process. Finally, efforts to identify prostate cancer susceptibility loci are under way, which may elucidate critical early events in prostatic carcinogenesis.

Cadherins↗

Molecular biology of prostate cancer.

A number of genetic changes have been documented in prostate cancer, ranging from allelic loss to point mutations and changes in DNA methylation patterns (summarized in Fig 1). To date, the most consistent changes are those of allelic loss events, with the majority of tumors examined showing loss of alleles from at least one chromosomal arm. The short arm of chromosome 8, followed by the long arm of chromosome 16 appear to be the most frequent regions of loss, suggesting the presence of novel tumor suppressor genes. Deletions of one copy of the Rb and p53 genes are less frequent as are mutations of the p53 gene, and accumulating evidence suggests the presence of an additional tumor suppressor gene on chromosome 17p, which is frequently inactivated in prostate cancer. Alterations in the E-cadherin/alpha catenin mediated cell-cell adhesion mechanism appear to be present in almost half of all prostate cancers, and may be critical to the acquisition of metastatic potential of aggressive prostate cancers. Finally, altered DNA methylation patterns have been found in the majority of prostate cancers examined, suggesting widespread alterations in methylation-modulated gene expression. The presence of multiple changes in these tumors is consistent with the multistep nature of the transformation process. Finally, efforts to identify prostate cancer susceptibility loci are underway and will hopefully elucidate critical early events in prostatic carcinogenesis.

Cadherins↗

Endoscopic ultrasonography in the diagnosis of regional lymph nodes in esophageal and gastric cancer--results of studies in vitro.

A total of 90 regional lymph nodes (43 benign/47 metastatic) from 16 surgical resection specimens of patients with esophageal and gastric carcinoma were examined in vitro by endosonography. The validity of endosonographic criteria of lymph node dignity (size, echogenicity, internal echo pattern and margin structure) was assessed using computer-supported B-mode analysis and compared to histopathological results. Of 26 lymph nodes with a diameter of more than 10 mm, 19 were metastatic (72%). The subjective assessment of the internal echo pattern (homogeneity) and the node margins by an experienced observer allowed the diagnosis of metastatic lymph nodes, but there was a high proportion of false positives (52%). Lymph node echogenicity, assessed either subjectively or by computer analysis, did not permit the differentiation between benign and metastatic lymph nodes.

Endoscopy↗

Usefulness of TA02 (napsin A) to distinguish primary lung adenocarcinoma from metastatic lung adenocarcinoma.

TA02 (napsin A) associated with primary lung adenocarcinoma detected by the two-dimensional polyacrylamide gel electrophoresis (2-DE), has a molecular weight of 35.0 kDa and an isoelectric point 5.29. We developed a mouse monoclonal antibody against the N-terminal of the TA02 molecule (clone TMU-Ad02 (6A1)) and attempted to investigate its immunohistochemical reactivity for nodular lesions of the peripheral lung, and evaluate its usefulness for making a differential diagnosis between primary and metastatic lung adenocarcinomas. The TA02-immunohistochemical evaluation was carried out using surgically resected materials of 109 cases of lung cancer (76 cases of primary lung cancer and 33 cases of metastatic lung adenocarcinoma from other organs), five cases with mesothelioma, four cases with atypical adenomatous hyperplasia (AAH) and five cases with tuberculoma of the lung. In 39 out of 43 (90.7%) primary lung adenocarcinomas, positive immunohistochemical reactivity with a granular cytoplasmic staining pattern was observed. Even though two out of seven (28.6%) large cell carcinomas showed positive results with a granular staining pattern, the immunohistochemical staining intensity was weak. The other cancerous lesions containing metastatic lung adenocarcinoma and mesothelioma were all completely negative. In comparison with the immunohistochemical reactivity of TA02 and SpA, TA02 was superior to SpA both in terms of positive rate and immunohistochemical intensity. We concluded that the evaluation of TA02 expression in lung tumorous lesions was very valuable for discriminating between primary and metastatic lung adenocarcinoma, and TA02 was superior to SpA as a discriminating marker.

Adenocarcinoma↗

Impact of smoking on cancer stage at diagnosis.

BACKGROUND: Studies evaluating the relationship between smoking and cancer spread are limited. METHODS: We studied the relationship between cancer stage at diagnosis (local, regional, or metastatic) and smoking history (current, previous, or nonsmoker). For lung cancer, patterns of spread were also studied. RESULTS: In a tumor registry for eastern North Dakota, northwestern Minnesota, and northern South Dakota, 11,716 cases were identified from 1986 to 2001. Current smokers (relative risk [RR], 2.11; 95% confidence interval, 1.93 to 2.32; P <.001) and previous smokers (RR, 1.56; 95% confidence interval, 1.42 to 1.72; P <.001) had an increased risk of metastatic disease at diagnosis. Current smokers (RR, 1.39; 95% confidence interval, 1.29 to 1.51; P <.001), but not previous smokers, also had an increased risk of regional disease. An increase in metastatic disease was most evident for prostate cancer (RR, 1.53; P =.003). An increase in regional disease was most evident for head and neck (RR, 3.53; P <.001), prostate (RR, 1.83; P =.030), and breast cancer (RR, 1.22; P =.005). Compared with previous smokers, current smokers with metastatic lung cancer were more likely to have involvement of the brain (33.6% v 23.0%; P =.004), bone marrow, adrenal gland, and pericardium (24.7% v 15.9%; P =.004). CONCLUSION: Previous or current smoking is a risk factor for increased cancer stage in a wide range of malignancies. Further study is required to determine whether this association is causal.

Adolescent↗

National Cancer Data Base report on malignant paragangliomas of the head and neck.

BACKGROUND: Malignant paragangliomas of the head and neck are rare, with previous reports limited to nine or fewer patients. The current review included 59 cases extracted from the National Cancer Data Base that were diagnosed between 1985-1996. METHODS: The primary criterion for inclusion in the current study was verified metastatic spread from a paraganglioma of the head and neck. Patterns of presentation and treatment as well as clinically relevant associations were demonstrated in contingency tables. Relative survival was used for analysis of outcome. RESULTS: The average patient age at presentation was 44 years, and gender distribution was equivalent. Metastases were confined to regional lymph nodes in the majority of cases (68.6%), with carotid body tumors found to have an even higher rate of regional confinement (93.8%). Surgery was the most common treatment (76.3%). The use of adjuvant irradiation for regionally confined disease increased across time, from 27% (1985-1990) to 46% (1991-1996). The 5-year relative survival rate was 59.5% (76.8% for regionally confined carcinoma and 11.8% for distant metastasis). Among patients who were followed until death, those treated with adjuvant irradiation had a longer median survival (45 months) compared with those patients who were treated with surgery alone (12 months). CONCLUSIONS: Malignant paraganglioma represents metastatic spread of a tumor type that, when restricted to the site of origin, is considered benign. Metastases from malignant paragangliomas of the head and neck usually are regionally confined. The primary management of a recognized malignancy should be directed toward complete surgical removal of the primary tumor and regional lymph nodes. Postoperative irradiation may be beneficial in slowing the progression of residual disease.

Adult↗

Colonic adenocarcinoma metastatic to the urinary tract versus primary tumors of the urinary tract with glandular differentiation: a report of 7 cases and investigation using a limited immunohistochemical panel.

OBJECTIVE: To determine whether a limited immunohistochemical panel can help differentiate metastatic colonic adenocarcinoma from primary enteric-type adenocarcinoma of the urinary tract and urothelial (transitional cell) carcinoma with glandular differentiation, which appear morphologically similar but most often necessitate different treatment protocols. DESIGN: We examined lower urinary tract tumors (5 urinary bladder, 2 urethral) from 7 patients with a history of colonic adenocarcinoma. The differential diagnoses in these cases included metastatic colonic adenocarcinoma, primary enteric-type adenocarcinoma of the urinary tract, and urothelial carcinoma with glandular differentiation. An immunohistochemical panel consisting of cytokeratin 7 (CK-7), cytokeratin 20 (CK-20), and villin was evaluated in all cases. Four primary enteric-type adenocarcinomas of the urinary tract and 5 conventional urothelial carcinomas were also studied to compare morphologic features and immunohistochemical staining patterns. RESULTS: Of the 7 cases, 6 were determined to be metastatic colonic adenocarcinoma and 1 was diagnosed as a primary urothelial carcinoma with glandular differentiation. All 6 metastatic colonic adenocarcinomas, 6 of the 7 primary colonic adenocarcinomas, and all 4 primary enteric-type adenocarcinomas of the urinary tract were CK-20 positive (1 was CK-20 negative), villin positive, and CK-7 negative. The single urothelial carcinoma with glandular differentiation and all 5 control cases of urothelial carcinoma were CK-7 and CK-20 positive, and villin negative. CONCLUSIONS: We conclude that (1) villin is expressed in primary enteric-type adenocarcinoma of the urinary tract; (2) in difficult cases, urothelial carcinoma with glandular differentiation can be distinguished from colonic adenocarcinoma because the former is CK-7 positive, CK-20 positive, and villin negative, whereas the latter is CK-20 positive, villin positive, and CK-7 negative; (3) clinical information is essential when evaluating lower urinary tract tumors that are clinically and morphologically similar to enteric-type adenocarcinoma of the urinary tract; and (4) the similar immunohistochemical profiles of metastatic colonic adenocarcinoma and primary enteric-type adenocarcinoma of the urinary tract may be in keeping with the hypothesis that the latter arise from intestinal metaplasia.

Adenocarcinoma↗

Cytoplasmic staining of TTF-1 in the differential diagnosis of hepatocellular carcinoma vs cholangiocarcinoma and metastatic carcinoma of the liver.

The cytoplasmic staining of thyroid transcription factor (TTF)-1 was analyzed in 86 liver resection specimens, including 40 hepatocellular carcinoma (HCC), 4 metastatic HCC, 20 cholangiocarcinoma, 2 combined hepatocellular-cholangiocarcinoma (CHC), and 20 metastatic carcinoma (MC) specimens with immunohistochemical stains to TTF-1, cytokeratin (CK)19, hepatocyte paraffin 1, alpha-fetoprotein, polyclonal carcinoembryonic antigen, CK7, and CK20. TTF-1 cytoplasmic staining was identified in 93% of HCCs (37/40), 100% of metastatic HCCs (4/4), 10% of cholangiocarcinomas (2/20), and 5% of MCs (1/20). CK19 was positive in all cholangiocarcinomas and MCs but only in 5% of HCCs (2/40) and none of the metastatic HCCs (0/4). TTF-1 cytoplasmic staining positively correlates with differentiation and the trabecular growth pattern of HCC. The results suggest TTF-1 cytoplasmic staining, together with CK19, might serve as a useful marker for the diagnosis of primary and metastatic HCC and for the differential diagnosis of HCC from cholangiocarcinoma and MC. The mechanism of TTF-1 cytoplasmic staining is explored.

Adult↗

Influence of phosphotyrosine kinase inhibitors on adhesive properties of highly and poorly metastatic HT-29 colon carcinoma cells to collagen.

Organ-specific sites of metastastic lesions are determined in part by integrin-mediated adhesion to extracellular matrix (ECM) components. Using poorly (HT-29P) and highly liver-metastatic (HT-29LMM) colon carcinoma cells we previously found different integrin-mediated adhesion to various ECM components, but similar integrin expression of both cell lines. These HT-29 cell lines were used to study adhesion to collagen I (C I) and possible intracellular signaling mechanisms that could explain different adhesive properties. HT-29LMM cells had significantly poorer rates of adhesion to C I (P < 0.05) than HT-29P cells. For examination of the integrin subunits involved in adhesion to C I, cells were treated with various anti-integrin antibodies. These results demonstrated that adhesion of HT-29 cells to C I is mediated in part by the alpha 2 beta 1 integrin. Using immunoprecipitation and Western blotting, both cell lines expressed similar patterns of integrins (alpha 2, alpha 3, alpha 6, and beta 1). Weaker signals were found for the expression of alpha v and beta 5 integrins. Although poorly and highly metastatic cells possessed different patterns of adhesion to C I, these differences were not caused by different expression of integrin subunits. For investigation of the involvement of phosphotyrosine kinases in adhesion, cells were pretreated with the Erbstatin analog, Genistein, or Herbimycin A. Genistein transiently stimulated the adhesive properties of both cell lines. In contrast, Herbimycin A had biphasic effects. At lower concentrations of Herbimycin A stimulation of adhesion was found after 30 and 90 min. However, higher concentrations inhibited adhesive properties. The stimulatory effect was more pronounced in poorly metastatic HT-29P cells. The Erbstatin analog had no effect, probably because of the lack of epidermal growth factor receptor expression in both cell lines. The results suggest that adhesion of tumor cells to ECM components may be dependent on signal transduction into the cell, and tyrosine phosphorylation appears to be involved.

Benzoquinones↗

Tibial adamantinoma with local recurrence and pulmonary metastasis: report of a case with histocytologic findings.

BACKGROUND: Adamantinoma is a rare primary bone neoplasm of low malignant potential that may recur or metastasize in a mall percentage of patients. The myriad histologic patterns may cause difficulty in distinguishing this tumor from other primary or metastatic neoplasms. The cytomorphologic findings of fine needle aspiration biopsy were reported previously in only a small number of cases. CASE: A 32-year-old man presented with a mass in the distal side of the left leg that was diagnosed as classic adamantinoma by open biopsy. Local recurrence and pulmonary metastases were confirmed by fine needle aspiration biopsy, which showed low grade, uniform cells with nuclear membrane grooves. The patient underwent a below-the-knee amputation and is receiving palliative treatment for progressive pulmonary spread. CONCLUSION: The diagnosis of adamantinoma requires knowledge of compatible clinical and radiologic studies as well as understanding of the variable histologic patterns that one may encounter. Fine needle aspiration biopsy is particularly useful in the diagnosis of recurrent and metastatic adamantinoma. This case report describes a distinctive cytomorphologic feature of nuclear grooves that may be a useful aid in distinguishing the tumor cells of adamantinoma from other cell types.

Adamantinoma↗

Differentiation of multicentric origin from intra-organ metastatic spread of hepatocellular carcinomas by comparative genomic hybridization.

In hepatocellular carcinoma (HCC), multifocal growth may be due to intrahepatic metastatic spread or to the multicentric origin of clonal neoplasms. Although this issue is of potential clinical and prognostic importance, reliable differentiation cannot be achieved using clinical or morphological criteria alone. In this study, comparative genomic hybridization (CGH) was used to differentiate between metastatic spread and multicentric growth in two cases of HCC. In the first case, six carcinoma nodules were examined. The affected chromosomes and their pattern of aberrations were almost identical for all six nodules. In addition to aberrations of chromosomes 1, 4, 9, and 13, further aberrations were observed for chromosomes 2, 5, 7, and 17, which are less typical for HCC. These findings were seen as indicative of metastatic spread of the HCC. In the second case, 75% (3/4) of the nodules showed comparable aberration patterns involving chromosomes 1, 4, 8, 13, and 17, together with a number of further aberrations also not frequently seen in HCC including chromosomes 5, 7, 10, 12, 14, and 18. Chromosomes 4, 5, 8, 10, and 12 were also altered in the fourth nodule examined for this case, but they exhibited a unique aberration pattern. Additionally, gain of chromosome 15q was seen in only this fourth nodule. In the two cases examined, metastatic spread and multicentric origin of HCC could be differentiated by different patterns of karyotypic change. The CGH results were confirmed by fluorescence in situ hybridization (FISH). In conclusion, CGH facilitates the differentiation of multicentric growth from metastatic spread in HCC and appears to be superior to techniques previously used to resolve this clinically important diagnostic problem.

Adult↗

[DNA content and c-erbB-2 oncoprotein expression in hepatic metastases from colorectal carcinoma--in relation to clinicopathologic findings and prognosis].

The nuclear DNA ploidy pattern and c-erbB-2 oncoprotein expression in primary and metastatic lesions were investigated using paraffin-embedded materials from 44 cases of colorectal carcinoma with hepatic metastases and 45 cases without hepatic metastases. The frequency of aneuploidy and positive staining of c-erbB-2 in primary tumor with hepatic metastases were significantly higher compared with those without hepatic metastases (p less than 0.05). There were significant correlations between diameter of metastases and DNA ploidy pattern of the metastases and between metachronous metastases, degree of metastases, vessel involvement and DNA ploidy pattern of the primary tumor. Positive staining of c-erbB-2 was detected more frequently with the advancement of depth of tumor invasion. There was no significant correlation between DNA ploidy pattern and c-erbB-2 expression. In the survival of patients whose primary tumor and hepatic metastases were resected, it was shown that DNA ploidy pattern of metastases was the most important independent prognostic factor. Expression of c-erbB-2 in primary tumor predicted the hepatic metastases.

Colorectal Neoplasms↗