Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2008 | Month : June | Volume : 2 | Issue : 3 | Page : 892 - 898

Malignant Fibrous Histiocytoma Of The Anterior Maxilla

RASTOGI S, MODI M, DHAWAN V Correspondence Address :
Sanjay Rastogi Assistant Professor (Unit Chief)Department of Dental Manipal Teaching Hospital Pokhra, Nepal

Abstract

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma, but is relatively uncommon in head and neck area. Histologically, it is difficult to distinguish this tumor from other sarcomas and carcinomas. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumor in the head and neck is low in comparison with MFH of the extremities and trunk. Around 61 cases reported in the international literature since 1974. We present a rare case of primary MFH of the maxilla in the unusual location of maxilla in a 20-year-old female. The tumor was located in the maxillary anterior region mimicking periodontal ulcer. We have described the difficulty in diagnosing the tumor along with differential diagnosis, histopathological diagnosis, and current methods in diagnosing the tumor i.e. immunohistochemical analysis. The literature was reviewed briefly along with treatment guidelines.

Keywords

Histiocytoma, Dental, Maxilla

Introduction
Tumors which are composed of cells differentiating as both fibroblasts and histiocytes have been designated fibrous histiocytomas, although only a small percentage of these lesions behave in a malignant fashion; they are called malignant fibrous histiocytoma, MFH.(2),(4) MFH arises predominantly in soft tissue, especially in the trunk and extremities,(5) and is one of the most common malignant tumors among the elderly, with a peak incidence in the fifth through the seventh decades of life.(6)

The term was introduced in 1963, (1) as it was believed that the tumor arose from histiocytes acting as facultative fibroblasts. Although current thinking is that the term histogenesis is related to fibroblasts themselves, the term, malignant fibrous histiocytoma has been retained for convenience, as it is descriptive of a clinico-pathological entity. The etiology of MFH is unknown. However, in long bones, there is a strong association between medullary bone infarcts and the subsequent development of osteosarcoma and malignant fibrous histiocytoma.

Malignant fibrous histiocytomas can arise from soft tissue or bone. Their occurrence is most common in the soft tissues of the abdomen and extremities, while 23% of histiocytomas occur at osseous sites. Although they can be found in the head and neck region, their occurrence is uncommon, accounting for 3–8.5% of the cases.(6),(7) The peak occurrence is in persons aged 50–70 years. A slight male predominance is observed. They can occur everywhere, owing to their mesenchymal origin.(2),(3) The most common sites of occurrence in the head and neck, are the sino-nasal tract,(8)soft tissues of the neck, craniofacial bones, and salivary glands. A literature search showed around 61 well-documented cases of malignant fibrous histiocytoma arising at the maxilla, maxillary sinuses and zygoma.(11)-(40)

We describe an interesting case of unusual location of tumors that had been diagnosed at a late stage, in the maxilla (anterior). The present case demonstrates the typical difficulty in recognizing this tumor.

Case Report

A 20 year old female came to the Department of Oral Medicine with a complaint of a 4 month old ulcer in the upper jaw, in the front region of the gums. The patient gave a history of tooth brush trauma in the maxillary anterior gingival area, followed by an ulcer which persisted for 4 months. There was no history of vesicle or bullae prior to the ulcer formation. A provisional diagnosis of pyogenic granuloma/chronic fungal infection was given, and the patient was referred to the Department of Periodontics.

A course of antibiotics were given to the patient, and an incisional biopsy was taken, which was not conclusive. A repeat biopsy of the lesion was taken, histopathological and special stain (Reticulin positive) studies were done, which gave the diagnosis of Malignant Fibrous Histiocytoma (Storiform Type), and the patient was referred to the Dept. of Oral Surgery for further management.

On examination of the lesion –it was observed that the gingiva was red in color and inflamed with respect to the upper central incisors, with ulceration measuring 2cm in size and extending upto the middle third of the upper central incisors and the mucogingival junction (Table/Fig 1). The lesion was severely tender on palpation, with bleeding on probing, and grade III mobility of the upper central incisors. No cervical lymph nodes were palpable. Chest radiographs and biochemical and hematological investigations showed no evidence of metastases. Axial and Coronal CT scan of the facial bones demonstrated a minimally enhancing soft tissue density mass lesion, measuring about 3x1.5 cm, seen in the midline in the superior gingivolabial sulcus. The underlying bone of the alveolar process of the maxilla showed scalloping without frank destruction (Table/Fig 2). A Bone scan revealed no abnormal skeleton uptake.

At operation under general anaesthesia, resection of the premaxilla was done, with extraction of the upper anterior canine and excision of the labial and palatal mucosa with 1.5 cm clearance margins. The BIPP pack was given into the defect, and was covered by a surgical obturator.

Histological examination of the surgical specimen showed a tumor composed of numerous fibroblasts, macrophages, and atypical cells, with evidence of numerous mitotic figures admixed with numerous proliferating blood vessels, with a lumen filled with RBC’s. The macrophages were arranged in a storiform pattern. Certain areas showed a myxomatous degeneration (Table/Fig 3).

The surgical margins were free of tumor. The diagnosis of Malignant Fibrous Histiocytoma was confirmed after routine histology and special stains like reticulin.

Postoperatively, patient recovery was uneventful. In the patient follow up, during the course of 4 months, healing was adequate, with no complaints. An interim obturator was given. The patient was explained about the postoperative chemotherapy, for which she was not willing. The patient remains free of disease, with minimal aesthetic deformity, and is tolerating her prosthesis well, 6 months postoperatively (Table/Fig 4)

Discussion

Stout(2) coined the term malignant fibrous histiocytoma on the basis of tissue culture studies made by Margaret Murray, which purportedly showed that these pleomorphic fibroblastic tumors arose from tissue histiocytes capable of fibroblastic transformation which are called ‘‘facultative fibroblasts’’. Enzinger and Weiss subsequently defined five subtypes of MFH as follows: (1) Storiform-pleomorphic, (2) myxoid, (3) giant cell, (4) inflammatory, and (5) angiomatoid. MFH is the most common adult soft tissue sarcoma.(9)

Recently, there are controversial entities regarding tumors of fibroblastic differentiation. The ubiquitous fibroblast is capable of a wide variety of morphological and functional adaptations with respect to its body site, as well as local physiological and pathological changes. The active collagen synthesizing fibroblast is a spindle shaped or plump epithelioid cell with prominent juxtanuclear Golgi apparatus, and well developed branching rough endoplasmic reticulum (RER).(10) There is a longstanding disagreement as to whether the cell type composing MFH is a histiocyte or a fibroblast. Initially, it was proposed by Ozzello et al.(1) that the cell was ‘‘facultative fibroblast’’ (a histiocyte that could appear and function as a fibroblast). However, the majority of more recent histochemical, immunohistochemical, and ultrastructural studies of this tumor support the contention that MFH is a form of fibrosarcoma.(9),(10) Previously, the diagnosis was made on the basis of the histological appearance. Recently, distinction among these pleomorphic soft tissue tumors is best achieved by a joint immunohistochemical and ultra structural study.(10)

Malignant Fibrous Histiocytoma is the most common soft tissue sarcoma, first described by Ozzelo et al. and O’Brien and Stout(1),(2) The storiform-pleomorphic type is the most common, and is a highly cellular tumor, which can range from well differentiated to anaplastic. MFH affects individuals later in life, and occurs more often in men, with an approximate 2:1 male: female ratio.

Maxillary MFH is very rare. It was first reported in 1974.(40) The review of the literature produced 61 well-documented cases of maxillary malignant fibrous histiocytoma(11)-(40) ranging in age from 12 to 83 years, with a median age of 44.7 years. Most patients 54/61 (88.5%) showed clinical signs of primary maxillary MFH. MFH can also arise in the site of previous radiation. However, radiation induced MFH of the head and neck is exceedingly rare. A literature search showed only 7/61 cases (11.47%) of post-radiation maxilla MFH.(19)(20)(26)(33)(35) The sinonasal tract has been reported to be the commonest site (30%) of tumor involvement in the head and neck region(8) But Sabesan et al.(12) found that maxilla is the most common site (15/54 cases). This literature review of Maxilla MFH revealed that 41/61 cases (67.2%) of the lesions occurred in the maxilla(11)-(15),(17),(18),(20)-(30),(32)-(40) while only 5/61 cases (8.19%) occurred in the maxillary sinus,(14),(19),(30), and only two cases (3.2%) were reported to have occurred in the post-maxillary and alveolar ridge

Conclusion

Malignant Fibrous Histiocytoma is an aggressive tumor with potential for both local recurrence and hematogenous metastatic spread. Clinicians should not overlook any kind of gingival ulcer or swelling that may not appear distinct visually, and therefore consider it to be a part of the normal anatomy, an anomaly with no significance, or treat them injudiciously. An accurate diagnosis should be established prior to any surgical treatment using histological analysis and special stains. MFH should be treated aggressively with the main modality of treatment as surgery, followed by combined radiotherapy and chemotherapy.

References

1.
Ozzello L, Stout A P, Murray M R. Cultural characterstics of malignant histiocytomas and fibrous xanthomas. Cancer 1963; 16: 331-343.
2.
O’Brien JE, Stout AP. Malignant fibrous xanthomas. Cancer 1964; 17:1445-55.
3.
Kempson RL, Kyriakos M. Fibroxanthosarcoma of the soft tissues. A type of malignant fibrous histiocytoma. Cancer 1972; 29:961–76.
4.
Leite C, Goodwin JW, Sinkovics JG, Baker LH, Benjamin R. Chemotherapy of malignant fibrous histiocytoma. A southwest oncology group report. Cancer 1977; 40:2010-4.
5.
Weiss SW, Enzinger FM. Myxoid variant of malignant fibrous histiocytoma. Cancer 1977; 39:1672-85.
6.
Weiss SW, Enzinger FM. Malignant fibrous histiocytoma—An analysis of 200 cases. Cancer 1978; 41: 2250-66.
7.
Huvos AG, Heilweil M, Bretsky SS. The pathology of malignant fibrous histiocytoma of bone. Am J Surg Pathol 1985; 9:853.
8.
Wood SW, Enzinger FM. Malignant fibrous histiocytoma tumour cells resemble fibroblasts. Am J Surg Pathol 1986; 10:323–5.
9.
Enzinger FM, Weiss SW. Soft tissue tumors. 3rd ed. Mosby: St. louis; 1995.
10.
Erlandson RA, Woodruff JM. Role of electron microscopy in the evaluation of soft tissue neoplasms, with emphasis on spindle cell and pleomorphic tumors. Human pathology 1998; 29(12).
11.
Watanabe K, Yambe M, Toh T, Ueda M. Malignant fibrous histiocytoma of the maxilla. Report of a case. Oral Oncol Suppl 2005; 1(1):203. (Abstract).
12.
Sabesana T, Xuexi Wu, Yongfab Qi, Pingzhangb Tang, Ilankovan V. Malignant fibrous histiocytoma: Outcome of tumours in the head and neck compared with those in the trunk and extremities. British Journal of Oral and Maxillofacial Surgery, 2005
13.
Chan Y-W, Guo Y-C, Tsai T-L, Tsay S-H, Lin C-Z. Malignant fibrous histiocytoma of the maxillary sinus presenting as toothache. J Chin Med Assoc 2004; 67:104–7.
14.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3] [Table / Fig - 4]

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