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Biomedical subjects

C K Chen

Publications and source records attributed to C K Chen.

At least 73 records · Page 4Linked to original sources

Activation status of T and NK cells in the endometrium throughout menstrual cycle and normal and abnormal early pregnancy.

Endometrial lymphocytes were studied at all stages throughout the menstrual cycle and early pregnancy by flow cytometry to examine different lymphocyte subpopulations and the expression of the T- and NK-cell activation markers. After pregnancy, CD8+CD3+ lymphocytes were decreased in the decidua. In both endometrium and decidua, more T cells expressed CD69, CD71, HLA-DR, and CD38 antigens than in peripheral blood. After pregnancy, CD71+CD3+ lymphocytes were further increased. CD25+CD3+ lymphocytes decreased significantly in the endometrium and decidua of ectopic pregnancies, but not in the decidua of normal pregnancies. These findings indicate that T cells are regionally activated in the first trimester, and it may be the result of the stimulation by fetal antigens. NK cells were the most abundant cell type in the decidua, which expressed the phenotype CD16- CD56+, and CD57-CD56+. The proportion of activated decidual NK cells was increased in anembryonic pregnancies more than in normal pregnancies, although the total NK subpopulation was similar in both groups. This might result in increased NK cytotoxicity in anembryonic pregnancies. In conclusion, T cells are activated, but NK cytotoxicity is decreased in the decidua of early normal pregnancies. This might be important in the control of trophoblast growth and placental development.

Abortion, Induced↗

Factors involved in the transformation of previously non-transformable Clostridium perfringens type B.

The pre-shock incubation of cells plus DNA and the methylation state of plasmid DNA were found to play a role in the electroporation-based transformation of Clostridium perfringens 3626B. Following pre-shock incubation, the highest number of C. perfringens 3626B transformants was obtained when plasmid pGK201 was both dam+ dcm+ modified, while no transformants were obtained when pGK201 was not methylated or only dcm methylated. This is consistent with the observation that plasmid pGK201 was protected against digestion by C. perfringens 3626B cell-associated nucleases for up to 3 min when methylated by both methylases. C. perfringens 3626B was successfully transformed only within a narrow cell recovery rate window. The ermAM gene associated with pGK201 and pAK102 was found to integrate into the chromosome of C. perfringens strain 13A and 3626B.

Anti-Bacterial Agents↗

Responses of the phototransduction cascade to dim light.

The biochemistry of visual excitation is kinetically explored by measuring the activity of the cGMP phosphodiesterase (PDE) at light levels that activate only a few tens of rhodopsin molecules per rod. At 23 degrees C and in the presence of ATP, the pulse of PDE activity lasts 4 s (full width at half maximum). Complementing the rod outer segments (ROS) with rhodopsin kinase (RK) and arrestin or its splice variant p44 does not significantly shorten the pulse. But when the ROS are washed, the duration of the signal doubles. Adding either arrestin or p44 back to washed ROS approximately restores the pulse width to its initial value, with p44 being 10 times more efficient than arrestin. This supports the idea that, in vivo, capping of phosphorylated R* is mostly done by p44. When myristoylated (14:0) recoverin is added to unwashed ROS, the pulse duration and amplitude increase by about 50% if the free calcium is 500 nM. This effect increases further if the calcium is raised to 1 microM. Whenever R* deactivation is changed--when RK is exogenously enriched or when ATP is omitted from the buffer--there is no impact on the rising slope of the PDE pulse but only on its amplitude and duration. We explain this effect as due to the unequal competition between transducin and RK for R*. The kinetic model issued from this idea fits the data well, and its prediction that enrichment with transducin should lengthen the PDE pulse is successfully validated.

3',5'-Cyclic-GMP Phosphodiesterases↗

Drosophila neurocalcin, a fatty acylated, Ca2+-binding protein that associates with membranes and inhibits in vitro phosphorylation of bovine rhodopsin.

Neurocalcins belong to a family of neuronal specific EF hand Ca2+-binding proteins defined by recoverin. Previously, we reported the cloning and initial characterization of neurocalcin in Drosophila melanogaster (Teng, D. H.-F., Chen, C.-K., and Hurley, J. B. (1994) J. Biol. Chem. 269, 31900-31907). We showed that the Drosophila neurocalcin protein (DrosNCa) is expressed in neurons and that bacterially expressed recombinant DrosNCa (rDrosNCa) can be myristoylated. Here, we present two lines of evidence that DrosNCa is fatty acylated in vivo. First, the mobility of affinity-purified native DrosNCa on two-dimensional gel electrophoresis is identical to that of myristoylated rDrosNCa and distinct from that of nonacylated rDrosNCa. Second, the membrane binding properties of native DrosNCa are similar to those of myristoylated rDrosNCa; both of these proteins bind to membranes at 0.2 mM Ca2+, whereas nonacylated rDrosNCa always remains soluble. It has been shown that recoverin inhibits the phosphorylation of rhodopsin when Ca2+ is present (Kawamura et al., 1993) and that a dependent recoverin/rhodopsin kinase interaction underlies the inhibitory effect of recoverin (Chen et al., 1995). Given the similarities between recoverin and neurocalcin, we examined the effect of DrosNCa on rhodopsin phosphorylation. We find that rDrosNCa is capable of inhibiting bovine rhodopsin phosphorylation in vitro in a Ca2+-dependent manner. The inhibitory activity of rDrosNCa is enhanced by myristoylation, and the potency of its effect is similar to that of recoverin. Two other related EF hand proteins, guanylate cyclase-activating protein-2 and calmodulin, are only poor inhibitors in these phosphorylation assays. in vitro inhibition of rhodopsin phosphorylation therefore appears to be an assayable property of a subset of recoverin-like proteins.

Acylation↗

Sexual differences in bone markers and bone mineral density of normal Chinese.

We measured bone mineral density (BMD) at lumbar (L2-L4) vertebrae and proximal femurs of 385 healthy Chinese women aged 40-70 years and 156 healthy Chinese men aged 20-85, and four markers-bone alkaline phosphatase isozyme (BAP), procollagen-I C terminal propeptide (PICP), osteocalcin (BGP) in serum, and a bone resorption marker, urinary cross-linked N-telopeptide of type I collagen (NTX), of these subjects. The results indicate that in postmenopausal women, levels of all the markers increased with age. In men, serum BAP, PICP, and urinary NTX decreased significantly, and serum BGP decreased with borderline significance (P = 0.08). With increasing age, bone density decreased at both sites in postmenopausal women and at the proximal femur in men. The lumbar bone density showed no significant age-related changes in men. In premenopausal women, BMD at either site showed no significant change with increasing age. Despite the different trends between men and women of age-related changes in BMD and bone markers, bone density of both proximal femur and spine in both sexes correlated inversely with levels of the bone markers in a manner independent of age or body weight. The meaning of opposite age effects on bone markers in men and women needs further investigation. In addition, higher bone marker levels, implying faster bone turnover rate, are associated with lower BMD in both sexes.

Adult↗

Risk factors for recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation.

OBJECTIVE: To identify risk factors for cancer recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation. METHODS: One hundred and eighty-seven patients with cervical carcinoma stage IB (n = 63), IIA (n = 43), and IIB (n = 81) disease who received abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation were followed-up for 2-10 years. The histologic type, grade, lymphovascular tumor emboli, tumor size, invasion sites, deep cervical stromal invasion, and pelvic lymph node metastases were assessed for correlation with cancer recurrence. RESULTS: Recurrence occurred in 45 cases (24%), of whom 40 had died of the disease at the 5-year follow-up period. Univariate proportional hazards analysis revealed that the significant risk factors were adenocarcinoma, bulky tumor size (4 cm or greater), lymphovascular tumor emboli, deep cervical stromal invasion, and lymph node metastases, especially iliac nodal metastases and bilateral nodal metastases. Multivariate proportional hazards analysis showed that bulky tumor size (hazard ratio 2.34), tumor emboli (hazard ratio 2.74) and iliac nodal metastases (hazard ratio 5.31) remained significant risk factors. In contrast, no deaths occurred in the other 142 cases who did not have recurrence. CONCLUSION: This retrospective study suggests that stage IB, IIA, and IIB cervical carcinoma cases with the above-mentioned pathologic factors are at higher risk of recurrence after abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation.

Combined Modality Therapy↗

Vasorelaxing activity of resveratrol and quercetin in isolated rat aorta.

1. Both resveratrol and quercetin dose-dependently inhibited the contractile response to noradrenaline (NA) in isolated endothelium-intact rat aorta. This inhibitory effect on vascular contraction was blocked by pretreatment of the blood vessel with the nitric oxide (NO) synthase inhibitor, L-NNA (1 microM). 2. Quercetin at a concentration > 1 x 10(-5) M, and resveratrol at > 3 x 10(-5) M, caused relaxation of the phenylephrine (PE) precontracted endothelium-intact aorta, and L-NNA, at 1 x 10(-6) M, reversed the relaxation. 3. At higher concentrations, > 6 x 10(-5) M, resveratrol and quercetin also relaxed the endothelium-denuded aortic rings. However, this effect could not be reversed by the NO inhibitor. 4. It is concluded that resveratrol and quercetin exert both indirect and direct vasodilator effects on the blood vessel by nitric oxide-mediated and non-NO-mediated mechanisms, respectively.

Animals↗

Bone mineral density and bone markers in relation to vitamin D receptor gene polymorphisms in Chinese men and women.

Whether vitamin D receptor gene (VDRG) polymorphism can be used as a predictor for bone turnover rate or bone mass remains controversial. Its role within various ethnic populations are also unsettled. We examined VDRG polymorphism using restrictive enzymes Bsm-I, Apa-I, and Taq-I in 155 men aged 22-88 and 113 premenopausal women aged 40-53. The bone mineral density (BMD) of the vertebrae (L2-4), proximal femur, and total body bone mineral content (tb-BMC) (women only), as well as urinary N-terminal crosslinked fragment of type I collagen (NTX), serum osteocalcin, bone isozyme of alkaline phosphatase, and caboxyterminal propeptide of type I procollagen levels were measured. Chinese men and women exhibited a low prevalence for B (absence of Bsm-I restriction site) phenotypes than white and Japanese. Within the tested samples there were 0.4% BB homozygotes, 6.7% Bb heterozygotes, and 93% bb homozygotes. The distributions of Apa-I polymorphism (9.0% AA, 42.5% Aa, and 48.5% aa) also differed from those reported for the white populations. Most of the Chinese men and women were TT homozygous (96.6%). A comparison of actual values and values adjusted for age and weight of tb-BMC and BMD at the lumbar spine, Trochanter, Ward's triangle, and femoral neck showed no significant difference among three subgroups in each of the three sets of polymorphism. Furthermore, the actual values and adjusted values (adjusted for age) of the four bone markers, respectively, showed no significant differences. We conclude that given the very low prevalence of the suspected high risk genotypes (B, A, and t), and the lack of difference among the polymorphic subgroups, VDRG polymorphism may not be an important determinant of the bone turnover rate and bone mass of Chinese men and women.

Adult↗

Unusual alpha-adrenoceptor subtype in canine saphenous vein: comparison to mesenteric vein.

1. We investigated the nature of the adrenoceptors in the dog saphenous vein (DSV) and dog mesenteric vein (DMV) to determine the nature of the unexpected interactions of phenylephrine and methoxamine with rauwolscine in the DSV, i.e. the ability of the putative alpha 2-adrenoceptor antagonist to inhibit competitively contractions to these alpha 1-agonists. Radioligand binding studies were performed in parallel with contractility studies. 2. Functionally, in the DSV, phenylephrine and methoxamine-induced, contractions were antagonized by rauwolscine with Schild slopes of -0.52 and -0.46, respectively and apparent pA2 values of 8.5 and 9.2, respectively. Such antagonism was not observed in the DMV. In the DSV, prazosin competes for [3H]-rauwolscine binding sites with a high and a low affinity binding site (Ki of 1.49 +/- 0.65 and 94.7 +/- 51 microM, n = 6, respectively). 3. Pretreatment with 100 microM chloroethylclonidine (CEC) for 15 min abolished [3H]-prazosin binding in microsomes from both veins and reduced binding (Bmax) of [3H]-rauwolscine in microsomes by 55.1 +/- 0.8% (n = 3) in the DSV but did not affect the Bmax in the DMV. CEC pretreatment in the venular rings denuded of endothelium caused persistent contraction in the DSV but not in the DMV. In the DSV, CEC appeared to interact with a single [3H]-rauwolscine binding site. In both the DSV and the DMV, CEC (100 microM) caused a significant shift in the EC50 values for phenylephrine and methoxamine. Maximum responses in the DMV were significantly attenuated while those in the DSV were unaffected when total tension was considered. 4. Studies of the functional interactions of the DSV and the DMV with WB 4101 or 5-methylurapidil (5-MU) suggested the presence of alpha 1D-adrenoceptors in the DSV and alpha 1A-adrenoceptors in the DMV. The receptors inactivated by CEC in the DMV and DSV may represent some or all of the receptors with properties of alpha 1D and alpha 1A-receptors present in the two veins. Studies of radioligand binding interactions of these two antagonists with [3H]-prazosin, were consistent with the presence of some alpha 1D-receptors in DSV and alpha 1A-receptors in DMV. These findings raise questions about the selectivity of CEC in differentiating alpha 1-adrenoceptor subtypes. 5. B-HT 920 caused contractions in the DSV smaller than those to the alpha 1-agonists but the maximum was not affected by CEC pretreatment. The EC50 values were shifted to the left after CEC. In radioligand binding studies, B-HT 920 competition for [3H]-rauwolscine binding was not significantly affected by CEC pretreatment. 6. These results suggest the presence of unusual alpha-adrenoceptors in the DSV. In addition to alpha 2-adrenoceptors, receptors recognizing rauwolscine as well as prazosin, WB 4101, phenylephrine and methoxamine and susceptible to inactivation by CEC are present. They appear to be, in part, unusual alpha 1D-adrenoceptors.

Adrenergic alpha-Agonists↗

Scalene lymph node metastases with the negative pelvic nodes in invasive cervical carcinoma.

Cervical carcinoma spreads predominantly by lymphatic routes and lymph node metastases may occur even in early stages of disease. Metastases usually first appear in pelvic lymph nodes, then disseminate along the efferent lymphatic chain to the extrapelvic lymph nodes. Cases of positive lymph node metastases with negative pelvic nodes in invasive cervical carcinoma are extremely rare. We report a 50-year-old woman with bulky stage IIA cervical carcinoma who had scalene lymph node metastases in the absence of pelvic lymph node metastases after radical hysterectomy and postoperative pelvic irradiation. This rare "skipping" nodal metastasis was probably via posterior trunk lymphatic drainage of the bulky cervical carcinoma which mainly invaded the posterior vaginal cuff. Neoadjuvant or adjuvant chemotherapy is recommended to prolong survival of patients in such cases.

Carcinoma, Squamous Cell↗

Triplet pregnancy complicated by intrauterine fetal death of conjoined twins from an umbilical cord accident of an acardius. A case report.

BACKGROUND: Acardius is a rare occurrence in monozygotic multiple pregnancies. Triplet pregnancy composed of an acardiac fetus and a pair of conjoined twins is even more rare. The outcome of the acardius is invariably fatal, and the mortality rate of the other fetuses ranges between 50% and 70%. Perinatal mortality results mainly from complications of twin-twin transfusion syndrome. CASE: Intrauterine fetal death, caused by an umbilical cord accident, with twisting of the acardius's cord around the fused cords of conjoined twins is reported in this present work. CONCLUSION: An acardius should be thoroughly sought when monochorionic multiple pregnancies are found by ultrasound during prenatal care. The complications of pregnancy caused by an acardiac fetus can be avoided by using proper management.

Adult↗

Clinical application of chemiluminescent immunoassay for thyroid stimulating hormone, free-T4 and intact-parathyroid hormone.

To meet the demands of clinical practice, rapid, sensitive and specific laboratory tests are essential. We evaluated the performance of a newer generation of chemiluminescent immunoassay (CLIA) system (Immulite, Diagnostic Products Corp, Los Angeles, CA, USA) and compared it with a popular immunoradiometric immunoassay (IRMA) system. The data of 158 patients whose thyroid function was assessed and that of another 158 patients whose parathyroid function was assessed were analyzed. The thyroid stimulating hormone (TSH) CLIA is an ultrasensitive TSH (us-TSH) assay that provides more detailed, reliable results for low TSH concentrations than TSH IRMA. Coupled with the free-T4 assay, the us-TSH assay enhances the ability to detect and monitor the status of thyroid dysfunction. Intact-parathyroid hormone (PTH) CLIA can detect lower serum intact-PTH levels, is more sensitive and is as reliable as IRMA. Combined with serum calcium levels and clinical conditions, it proved efficient and discriminated reliably between hypercalcemia associated with malignancy and that of hyperparathyroidism.

Humans↗

Mature cystic teratoma of the ovary: a clinicopathologic study of 283 cases.

BACKGROUND: Although in the English literature, much has been published about ovarian teratoma, no large series has been reported in Taiwan. Therefore a retrospective study of 283 consecutive cases of mature cystic teratomas of the ovary, operated at National Taiwan University Hospital between 1988 and 1993, was undertaken. METHODS: This series was based on a retrospective chart study at the Department of Obstetrics and Gynecology of the National Taiwan University Hospital from 1988 to 1993. All cases included in this study were proven by pathology review. The clinical data, pathology and complications are summarized. RESULTS: The incidence of mature cystic teratoma was 32.6% of primary ovarian neoplasm. As for the age distribution, the youngest patient was 12 years old and the oldest, 76. The largest number of cases was found in patients between the ages of 20 and 30 years; the mean age was 35.4 years. Pain, the most common complaint, was noted in 48.1% of the cases in whom it varied from a dull ache to the sharp, stabbing pain of torsion. Of greater interest was an unexpectedly high incidence (16.6%) of asymptomatic cysts found on routine physical examination. The right ovary was involved in 51.2%, the left ovary in 40.6% and bilateral ovaries were involved in 8.2%. The incidence of torsion was 9.2%, and was the highest in all complications. Ten concurrent pregnancies were noted, an incidence of 3.5%. The incidence of malignant transformation was 0.7%, with a pathology of squamous cell carcinoma. CONCLUSIONS: Mature cystic teratom is the most common germ cell tumor and accounts for about 33% of all ovarian neoplasm They occur primarily during the reproductive years, but may occur in the postmenopausal period or in childhood. A cystic teratoma can undergo malignant transformation; it occurs most frequently in postmenopausal women, and the prognosis is poor. However, it is a rare complicaiton, with an incidence less than 1%.

Adolescent↗

The effect of thrombolytic therapy on short- and long-term cardiac autonomic activity in patients with acute myocardial infarction.

BACKGROUND: Reduced heart rate variability after acute myocardial infarction is an important risk stratification factor for mortality and life threatening ventricular arrhythmias. In recent years, thrombolytic therapy has revolutionized the therapy of acute myocardial infarction. However, there is little information about the mechanism of the beneficial effect of thrombolysis on cardiovascular mortality. This study was launched to investigate the relationship between thrombolytic therapy and cardiac autonomic activity, and the sequential changes in heart rate variability after acute myocardial infarction. METHODS: From October 1994 to July 1995, all consecutive patients with their first acute myocardial infarction were prospectively enrolled into the study. Patients without contraindication underwent thrombolytic therapy within six hours of the onset of symptoms. Other patients received conventional treatment. Ambulatory electrocardiography (EKG) was recorded on each patient 7, 90 and 180 days after acute myocardial infarction. Heart rate variability in time- and frequency-domain was analyzed. RESULTS: A total of 49 patients, 45 males and 4 females, were included in this study. The short-term heart rate variability (HRV) (seven-day) in the thrombolytic group was significantly higher than in the nonthrombolytic group in SDANN and SDNN. No significant difference in rMSSD, pNN50, LF, HF or LF/HF ratio was found. The location of MI did not influence the short-term HRV following acute myocardial infarction. In patients treated with thrombolytic agent, the follow-up HRV at 90 days and 180 days increased significantly compared to the baseline HRV (seven-day) in SDANN, SDNN, LF and HF bands. For patients without thrombolytic therapy, their follow-up HRV at 90-day and 180-day increased significantly as compared to the baseline HRV (seven-day) in SDANN and SDNN only. After correction of ventricular ejection fraction, the higher short-term (seven day) HRV activities were still present in SDANN and SDNN in patients with thrombolysis as compared to those without. The 90-day and 180-day HRV did not differ between patients with and without thrombolytic agent. Three patients died suddenly during follow-up, and all showed significantly lower values of HRV than the survivors. CONCLUSIONS: The findings of the present study suggest that 1) in patients with uncomplicated AMI, HRV was transiently reduced with progressive improvement within three months after AMI in both those with and without thrombolytic therapy, and 2) patients who had received thrombolytic treatment had more improved HRV early (seven days) after AMI than those who did not. This improvement, independent of the change of left ventricular function, could be associated with the beneficial effect of thrombolytic therapy in patients with AMI.

Adult↗

Ca(2+)-dependent interaction of recoverin with rhodopsin kinase.

Recoverin (Rv) is a myristoylated Ca(2+)-binding protein present primarily in bovine photoreceptors. It represents a newly identified family of neuronal specific Ca(2+)-binding proteins that includes neurocalcin, hippocalcin, and guanylyl cyclase-activating protein. To investigate the function of Rv in photoreceptors, we identified proteins that bind immobilized Rv in a Ca(2+)-dependent manner. Rhodopsin kinase (RK), interphotoreceptor retinoid-binding protein, and tubulin interact with Rv in the presence of Ca2+. The importance of the Rv/RK interaction was further characterized. RK, purified using immobilized Rv as an affinity matrix, catalyzed the light-dependent and Ca(2+)-independent incorporation of phosphates into rhodopsin when reconstituted with urea-stripped rod outer segment membranes. When only a small fraction (0.04%) of rhodopsin was photolyzed, as many as 700 phosphates were incorporated per photolyzed rhodopsin, a phenomenon known as "high gain" phosphorylation. When recoverin was added, the activity of RK became sensitive to free Ca2+, with EC50 = 3 microM. The N-terminal myristoyl residue of Rv enhances the inhibitory effect of Rv and introduces cooperativity to the Ca(2+)-dependent inhibition of rhodopsin phosphorylation. Rv neither interacts with other members of the G-protein-coupled receptor kinase family such as beta-adrenergic receptor kinase 1 nor inhibits beta-adrenergic receptor kinase 1 activity. The specific and Ca(2+)-dependent Rv/RK interaction is necessary for the inhibitory effect of Rv on rhodopsin phosphorylation and may play an important role in photoreceptor light adaptation.

Amino Acid Sequence↗

Leiomyosarcoma of the broad ligament: a case report and literature review.

Solitary tumors of the broad ligament are rare. The most frequent solid tumor of the broad ligament is leiomyoma. Leiomyosarcoma of the broad ligament (LBL) is an extremely rare malignant tumor. Nine cases of leiomyosarcoma of the broad ligament had been reported previously. A 59-year-old woman with LBL is reported. Treatment consisted of resection and total abdominal hysterectomy with bilateral salpingo-oophorectomy. No evidence of metastasis is noted after 12 months follow-up. We conclude that the management of LBL is excision of the leiomyosarcoma as completely as possible and postoperative adjuvant chemotherapy.

Broad Ligament↗

Adenomatoid tumor of the female genital tract.

OBJECTIVE: To remind gynecologists of the diagnosis of adenomatoid tumor of the female genital tract, a pathology which is often mistaken for leiomyoma, and in addition to warn of the malignant appearance of adenomatoid tumor. MATERIALS AND METHODS: During the study period from January 1988 to May 1994, the clinical features and pathologic findings of 25 cases of adenomatoid tumor of the female genital tract were reviewed at the National Taiwan University Hospital. RESULTS: The age of the patients ranged from 26 to 55 years with a median of 41 years. Adenomatoid tumor was an incidental finding during the surgical treatment of myoma (16 cases), cervical intraepithelial neoplasm (two cases), invasive cervical cancer (one case), adnexal cyst (five cases), and pregnancy with myoma (one case). Twenty-three cases had tumors in the uterine corpus and two in the fallopian tubes. Twenty percent of the patients had multiple tumors. Their sizes ranged from 1.0 to 8.0 cm. The case with the largest tumor measuring 8 cm in diameter is presented in detail. Its histologic, immunohistochemical and ultrastructural characteristics strongly support the mesothelial origin of adenomatoid tumor. CONCLUSION: Some different results were obtained than those hitherto reported in the literature, such as younger age, frequency of multiple tumors, and fewer cases accompanied by leiomyomas.

Adenomatoid Tumor↗