Skip to main content

Advertisement

Log in

Phosphaturic Mesenchymal Tumor: 2 New Oral Cases and Review of 53 Cases in the Head and Neck

  • Original Paper
  • Published:
Head and Neck Pathology Aims and scope Submit manuscript

Abstract

Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm that secretes fibroblast growth factor-23 (FGF-23) and causes oncogenic osteomalacia. It occurs in adults with equal gender distribution and the most common location is the lower extremities, followed by the head and neck. Besides osteomalacia, the clinical presentation includes bone pain and multiple bone fractures. Microscopic features consist of spindle cells, multinucleated giant cells, and calcifications embedded in a chondromyxoid matrix. Laboratory findings indicate normal calcium and parathyroid levels, hypophosphatemia, and increased levels of FGF-23 that usually revert to normal after surgical removal. Due to its rarity, the purpose of the study was to report 2 new oral cases of PMT and to review the literature in the head and neck. The first case occurred in the gingiva and had been present for 6 years. The second case was a recurrence of a previously diagnosed PMT in the right mandible that metastasized to the lung and soft tissue. The literature review included 53 cases in the head and neck. There was a predilection for extra-oral sites (76 %) compared to intra-oral sites (24 %) with paranasal sinuses considered the most common location (38 %) followed by the mandible (15 %). There were 9 recurrences that included 3 malignant cases indicating a potentially aggressive tumor. Due to the indeterminate biological behavior of PMT and its rarity, a comprehensive evaluation of medical, laboratory, radiographic, and histological findings are crucial for a definitive diagnosis and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Koplas MC, Rubin BP, Sundaram M. Phosphaturic mesenchymal tumor: two contrasting cases. Skeletal Radiol. 2014;43(6):841–5. doi:10.1007/s00256-013-1798-x.

    Article  PubMed  Google Scholar 

  2. Ledford CK, Zelenski NA, Cardona DM, Brigman BE, Eward WC. The phosphaturic mesenchymal tumor: Why is definitive diagnosis and curative surgery often delayed? Clin Orthop Relat Res. 2013;471(11):3618–25. doi:10.1007/s11999-013-3178-1.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Woo VL, Landesberg R, Imel EA, Singer SR, Folpe AL, Econs MJ, et al. Phosphaturic mesenchymal tumor, mixed connective tissue variant, of the mandible: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(6):925–32. doi:10.1016/j.tripleo.2009.07.005.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Folpe AL, Fanburg-Smith JC, Billings SD, Bisceglia M, Bertoni F, Cho JY, et al. Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature. Am J Surg Pathol. 2004;28(1):1–30.

    Article  PubMed  Google Scholar 

  5. Gonzalez-Compta X, Manos-Pujol M, Foglia-Fernandez M, Peral E, Condom E, Claveguera T, et al. Oncogenic osteomalacia: case report and review of head and neck associated tumours. J Laryngol Otol. 1998;112(4):389–92.

    Article  CAS  PubMed  Google Scholar 

  6. Crouzet J, Mimoune H, Beraneck L, Juan LH. Hypophosphatemic osteomalacia with plantar neurilemoma. A review of the literature (100 cases). Revue du Rhumatisme (English ed). 1995;62(6):463–6.

  7. Guglielmi G, Bisceglia M, Scillitani A, Folpe AL. Oncogenic osteomalacia due to phosphaturic mesenchymal tumor of the craniofacial sinuses. Clin Cases Miner Bone Metab. 2011;8(2):45–9.

    PubMed  PubMed Central  Google Scholar 

  8. Luo L, Low N, Vandervord J. Mandibular phosphaturic mesenchymal tumor-mixed connective tissue variant in a young girl. Cleft Palate Craniofac J. 2013;50(6):751–3. doi:10.1597/12-085.

    Article  PubMed  Google Scholar 

  9. Deep NL, Cain RB, McCullough AE, Hoxworth JM, Lal D. Sinonasal phosphaturic mesenchymal tumor: case report and systematic review. Allergy Rhinol. 2014;5(3):162–7. doi:10.2500/ar.2014.5.0100 (Providence, RI).

    Article  Google Scholar 

  10. Gardner KH, Shon W, Folpe AL, Wieland CN, Tebben PJ, Baum CL. Tumor-induced osteomalacia resulting from primary cutaneous phosphaturic mesenchymal tumor: a case and review of the medical literature. J Cutan Pathol. 2013;40(9):780–4. doi:10.1111/cup.12209.

    Article  PubMed  Google Scholar 

  11. Honda R, Kawabata Y, Ito S, Kikuchi F. Phosphaturic mesenchymal tumor, mixed connective tissue type, non-phosphaturic variant: report of a case and review of 32 cases from the Japanese published work. J Dermatol. 2014;41(9):845–9. doi:10.1111/1346-8138.12602.

    Article  CAS  PubMed  Google Scholar 

  12. Salih KHSA, Montgomery EA. Selected lesions featuring giant cells. Surg Pathol. 2011;4:887–913.

    Article  Google Scholar 

  13. Suryawanshi P, Agarwal M, Dhake R, Desai S, Rekhi B, Reddy KB, et al. Phosphaturic mesenchymal tumor with chondromyxoid fibroma-like feature: an unusual morphological appearance. Skeletal Radiol. 2011;40(11):1481–5. doi:10.1007/s00256-011-1159-6.

    Article  PubMed  Google Scholar 

  14. Kaylie DM, Jackson CG, Gardner EK. Oncogenic osteomalacia caused by phosphaturic mesenchymal tumor of the temporal bone. Otolaryngol Head Neck Surg. 2006;135(4):653–4. doi:10.1016/j.otohns.2005.03.086.

    Article  PubMed  Google Scholar 

  15. Puthenveetil PJ, Hattab EM, Peacock M, Horn EM. Thoracic phosphaturic mesenchymal tumors causing oncogenic osteomalacia. J Clin Neurosci. 2013;20(8):1057–61. doi:10.1016/j.jocn.2012.09.035.

    Article  PubMed  Google Scholar 

  16. Dupond JL, Mahammedi H, Prie D, Collin F, Gil H, Blagosklonov O, et al. Oncogenic osteomalacia: diagnostic importance of fibroblast growth factor 23 and F-18 fluorodeoxyglucose PET/CT scan for the diagnosis and follow-up in one case. Bone. 2005;36(3):375–8. doi:10.1016/j.bone.2005.01.001.

    Article  CAS  PubMed  Google Scholar 

  17. Kabtouri H, Karmali R, Spinato L, Khamaktchian M, Bisschop P. Oncogenic osteomalacia induced by a sinonasal tumour: case report and review. B-ENT. 2014;10(2):149–55.

    CAS  PubMed  Google Scholar 

  18. Viscasillas G, Maiz J, Lao X, Zschaeck C, Sanz JJ. Oncogenic osteomalacia due to phosphaturic mesenchymal tumour in infratemporal fossa. Acta Otorrinolaringol Esp. 2010;61(5):392–4. doi:10.1016/j.otorri.2009.10.007.

    Article  PubMed  Google Scholar 

  19. Weidner N, Santa Cruz D. Phosphaturic mesenchymal tumors. A polymorphous group causing osteomalacia or rickets. Cancer. 1987;59(8):1442–54.

    Article  CAS  PubMed  Google Scholar 

  20. Mori Y, Ogasawara T, Motoi T, Shimizu Y, Chikazu D, Tamura K, et al. Tumor-induced osteomalacia associated with a maxillofacial tumor producing fibroblast growth factor 23: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):e57–63. doi:10.1016/j.tripleo.2009.10.052.

    Article  PubMed  Google Scholar 

  21. Hannan FM, Athanasou NA, Teh J, Gibbons CL, Shine B, Thakker RV. Oncogenic hypophosphataemic osteomalacia: biomarker roles of fibroblast growth factor 23, 1,25-dihydroxyvitamin D3 and lymphatic vessel endothelial hyaluronan receptor 1. Eur J Endocrinol. 2008;158(2):265–71. doi:10.1530/eje-07-0485.

    Article  CAS  PubMed  Google Scholar 

  22. Pedrazzoli M, Colletti G, Ferrari M, Rossetti G, Moneghini L, Autelitano L. Mesenchymal phosphaturic neoplasm in the maxillary sinus: a case report. Int J Oral Maxillofac Surg. 2010;39(10):1027–32. doi:10.1016/j.ijom.2010.04.039.

    Article  CAS  PubMed  Google Scholar 

  23. Okamiya T, Takahashi K, Kamada H, Hirato J, Motoi T, Fukumoto S, et al. Oncogenic osteomalacia caused by an occult paranasal sinus tumor. Auris Nasus Larynx. 2015;42(2):167–9. doi:10.1016/j.anl.2014.10.001.

    Article  PubMed  Google Scholar 

  24. Allevi F, Rabbiosi D, Mandala M, Colletti G. Mesenchymal phosphaturic tumour: early detection of recurrence. BMJ Case Rep. 2014. doi:10.1136/bcr-2013-202827.

    PubMed Central  Google Scholar 

  25. Mathis DA, Stehel EJ Jr, Beshay JE, Mickey BE, Folpe AL, Raisanen J. Intracranial phosphaturic mesenchymal tumors: report of 2 cases. J Neurosurg. 2013;118(4):903–7. doi:10.3171/2012.12.jns12598.

    Article  PubMed  Google Scholar 

  26. Fatani HA, Sunbuli M, Lai SY, Bell D. Phosphaturic mesenchymal tumor: a report of 6 patients treated at a single institution and comparison with reported series. Ann Diagn Pathol. 2013;17(4):319–21. doi:10.1016/j.anndiagpath.2012.06.005.

    Article  PubMed  Google Scholar 

  27. Syed MI, Chatzimichalis M, Rossle M, Huber AM. Recurrent phosphaturic mesenchymal tumour of the temporal bone causing deafness and facial nerve palsy. J Laryngol Otol. 2012;126(7):721–4. doi:10.1017/s0022215112000989.

    Article  CAS  PubMed  Google Scholar 

  28. Xian-Ling W, Jian-Ming B, Wen-Wen Z, Zhao-Hui L, Jing-Tao D, Ju-Ming L, et al. Osteomalacia caused by tumors in facies cranii mimicking rheumatoid arthritis. Rheumatol Int. 2012;32(8):2573–6. doi:10.1007/s00296-011-2018-4.

    Article  PubMed  Google Scholar 

  29. Munoz J, Ortega RM, Celzo F, Donthireddy V. Tumour-induced osteomalacia. BMJ Case Rep. 2012. doi:10.1136/bcr.03.2012.5975.

    Google Scholar 

  30. Andreopoulou P, Dumitrescu CE, Kelly MH, Brillante BA, Cutler Peck CM, Wodajo FM, et al. Selective venous catheterization for the localization of phosphaturic mesenchymal tumors. J Bone Miner Res. 2011;26(6):1295–302. doi:10.1002/jbmr.316.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Uno T, Kawai K, Kunii N, Fukumoto S, Shibahara J, Motoi T, et al. Osteomalacia caused by skull base tumors: report of 2 cases. Neurosurgery. 2011;69(1):E239–44. doi:10.1227/NEU.0b013e31821867f7.

    Article  PubMed  Google Scholar 

  32. Kominek P, Starek I, Geierova M, Matousek P, Zelenik K. Phosphaturic mesenchymal tumour of the sinonasal area: case report and review of the literature. Head Neck Oncol. 2011;3:16. doi:10.1186/1758-3284-3-16.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sidell D, Lai C, Bhuta S, Barnes L, Chhetri DK. Malignant phosphaturic mesenchymal tumor of the larynx. Laryngoscope. 2011;121(9):1860–3. doi:10.1002/lary.21916.

    PubMed  Google Scholar 

  34. Peterson NR, Summerlin DJ, Cordes SR. Multiple phosphaturic mesenchymal tumors associated with oncogenic osteomalacia: case report and review of the literature. Ear Nose Throat J. 2010;89(6):E11–5.

    PubMed  Google Scholar 

  35. Shelekhova KV, Kazakov DV, Michal M. Sinonasal phosphaturic mesenchymal tumor (mixed connective tissue variant): report of 2 cases. Am J Surg Pathol. 2010;34(4):596–7. doi:10.1097/PAS.0b013e3181d594fa.

    Article  PubMed  Google Scholar 

  36. Parshwanath HA, Kulkarni PR, Rao R, Joshi SK, Patil P. Phosphaturic mesenchymal tumor of ethmoid sinus. Indian J Pathol Microbiol. 2010;53(2):384. doi:10.4103/0377-4929.64317.

    Article  CAS  PubMed  Google Scholar 

  37. Winters R, Bihlmeyer S, McCahill L, Cooper K. Phosphaturic mesenchymal tumour-mixed connective tissue variant without oncogenic osteomalacia. J Clin Pathol. 2009;62(8):760–1. doi:10.1136/jcp.2008.055996.

    Article  CAS  PubMed  Google Scholar 

  38. Savage CR, Zimmer LA. Oncogenic osteomalacia from pterygopalatine fossa mass. J Laryngol Otol. 2009;123(9):1052–4. doi:10.1017/s0022215109004927.

    Article  CAS  PubMed  Google Scholar 

  39. Gupta R, Sharma A, Ksh A, Khadgawat R, Dinda AK. Phosphaturic mesenchymal tumor of the sinonasal tract. Acta Endocrinol Buchar. 2009;5(4):537–42. doi:10.4183/aeb.2009.537.

    Article  Google Scholar 

  40. Kenealy H, Holdaway I, Grey A. Occult nasal sinus tumours causing oncogenic osteomalacia. Eur J Intern Med. 2008;19(7):516–9. doi:10.1016/j.ejim.2008.01.011.

    Article  PubMed  Google Scholar 

  41. Elston MS, Stewart IJ, Clifton-Bligh R, Conaglen JV. A case of oncogenic osteomalacia with preoperative secondary hyperparathyroidism: description of the biochemical response of FGF23 to octreotide therapy and surgery. Bone. 2007;40(1):236–41. doi:10.1016/j.bone.2006.07.027.

    Article  CAS  PubMed  Google Scholar 

  42. Koriyama N, Nishimoto K, Kodama T, Nakazaki M, Kurono Y, Yoshida H, et al. Oncogenic osteomalacia in a case with a maxillary sinus mesenchymal tumor. Am J Med Sci. 2006;332(3):142–7.

    Article  PubMed  Google Scholar 

  43. Inokuchi G, Tanimoto H, Ishida H, Sugimoto T, Yamauchi M, Miyauchi A, et al. A paranasal tumor associated with tumor-induced osteomalacia. Laryngoscope. 2006;116(10):1930–3. doi:10.1097/01.mlg.0000231295.67060.89.

    Article  PubMed  Google Scholar 

  44. Ungari C, Rocchi G, Rinna C, Agrillo A, Lattanzi A, Pagnoni M. Hypophosphaturic mesenchymal tumor of the ethmoid associated with oncogenic osteomalacia. J Craniofac Surg. 2004;15(3):523–7.

    Article  PubMed  Google Scholar 

  45. Reis-Filho JS, Paiva ME, Lopes JM. August 2003: 47-year-old female with a 7-year history of osteomalacia and hypophosphatemia. Brain pathol. 2004;14(1):111–2 (Zurich, Switzerland).

    Article  PubMed  Google Scholar 

  46. Clunie GP, Fox PE, Stamp TC. Four cases of acquired hypophosphataemic (‘oncogenic’) osteomalacia. Problems of diagnosis, treatment and long-term management. Rheumatology. 2000;39(12):1415–21 (Oxford, England).

    Article  CAS  PubMed  Google Scholar 

  47. Reyes-Mugica M, Arnsmeier SL, Backeljauw PF, Persing J, Ellis B, Carpenter TO. Phosphaturic mesenchymal tumor-induced rickets. Pediatr Dev Pathol. 2000;3(1):61–9.

    Article  CAS  PubMed  Google Scholar 

  48. David K, Revesz T, Kratimenos G, Krausz T, Crockard HA. Oncogenic osteomalacia associated with a meningeal phosphaturic mesenchymal tumor. J Neurosurg. 1996;84(2):288–92. doi:10.3171/jns.1996.84.2.0288.

    Article  CAS  PubMed  Google Scholar 

  49. Olefsky J, Kempson R, Jones H, Reaven G. “Tertiary” hyperparathyroidism and apparent “cure” of vitamin-D-resistant rickets after removal of an ossifying mesenchymal tumor of the pharynx. N Engl J Med. 1972;286(14):740–5. doi:10.1056/nejm197204062861402.

    Article  CAS  PubMed  Google Scholar 

  50. Monappa V, Naik AM, Mathew M, Rao L, Rao SK, Ramachandra L, et al. Phosphaturic mesenchymal tumour of the mandible–the useful criteria for a diagnosis on fine needle aspiration cytology. Cytopathology. 2014;25(1):54–6. doi:10.1111/cyt.12030.

    Article  CAS  PubMed  Google Scholar 

  51. Yun KI, Kim DH, Pyo SW. A phosphaturic mesenchymal tumor of the floor of the mouth with oncogenic osteomalacia: report of a case. J Oral Maxillofac Surg. 2009;67(2):402–5. doi:10.1016/j.joms.2008.01.007.

    Article  PubMed  Google Scholar 

  52. Uramoto N, Furukawa M, Yoshizaki T. Malignant phosphaturic mesenchymal tumor, mixed connective tissue variant of the tongue. Auris Nasus Larynx. 2009;36(1):104–5. doi:10.1016/j.anl.2008.01.003.

    Article  PubMed  Google Scholar 

  53. Yang IM, Park YK, Hyun YJ, Kim DY, Woo JT, Kim SW, et al. Oncogenic osteomalacia caused by a phosphaturic mesenchymal tumor of the oral cavity: a case report. Korean J Intern Med. 1997;12(1):89–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Mc CR. Osteomalacia with Looser’s nodes (Milkman’s syndrome) due to a raised resistance to vitamin D acquired about the age of 15 years. Q J Med. 1947;16(1):33–46.

    Google Scholar 

  55. Prader A, Illig R, Uehlinger E, Stalder G. Rickets following bone tumor. Helv Paediatr Acta. 1959;14:554–65.

    CAS  PubMed  Google Scholar 

  56. Shimada T, Hasegawa H, Yamazaki Y, Muto T, Hino R, Takeuchi Y, et al. FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res. 2004;19(3):429–35. doi:10.1359/jbmr.0301264.

    Article  CAS  PubMed  Google Scholar 

  57. Mangham DC, Kindblom LG. Rarely metastasizing soft tissue tumours. Histopathology. 2014;64(1):88–100. doi:10.1111/his.12310.

    Article  PubMed  Google Scholar 

  58. Lee JC, Jeng YM, Su SY, Wu CT, Tsai KS, Lee CH, et al. Identification of a novel FN1-FGFR1 genetic fusion as a frequent event in phosphaturic mesenchymal tumour. J Pathol. 2015;235(4):539–45. doi:10.1002/path.4465.

    Article  CAS  PubMed  Google Scholar 

  59. Paul S, Kurtz M, Mentzer SJ. Osteomalacia associated with a fibroblast growth factor-23 secreting chest wall tumor. J Thorac Cardiovasc Surg. 2007;134(3):803–5. doi:10.1016/j.jtcvs.2007.05.025.

    Article  PubMed  Google Scholar 

  60. Pithankuakul K, Ratanasuwan T, Thanakit V, Sukhantanak B, Kiatisevi P. Oncogenic osteomalacia caused by phosphaturic mesenchymal tumours in the proximal and shaft of the tibia: a case report. J Orthop Surg. 2014;22(2):257–62 (Hong Kong).

    Google Scholar 

  61. Bahrami A, Weiss SW, Montgomery E, Horvai AE, Jin L, Inwards CY, et al. RT-PCR analysis for FGF23 using paraffin sections in the diagnosis of phosphaturic mesenchymal tumors with and without known tumor induced osteomalacia. Am J Surg Pathol. 2009;33(9):1348–54. doi:10.1097/PAS.0b013e3181aa2311.

    Article  PubMed  Google Scholar 

  62. Uchihashi K, Nishijima-Matsunobu A, Matsuyama A, Yamasaki F, Tanabe T, Uemura T, et al. Phosphaturic mesenchymal tumor, nonphosphaturic variant, causing fatal pulmonary metastasis. Hum Pathol. 2013;44(11):2614–8. doi:10.1016/j.humpath.2013.04.027.

    Article  PubMed  Google Scholar 

  63. Sandhu FA, Martuza RL. Craniofacial hemangiopericytoma associated with oncogenic osteomalacia: case report. J Neurooncol. 2000;46(3):241–7.

    Article  CAS  PubMed  Google Scholar 

  64. Battoo AJ, Salih S, Unnikrishnan AG, Jojo A, Bahadur S, Iyer S, et al. Oncogenic osteomalacia from nasal cavity giant cell tumor. Head Neck. 2012;34(3):454–7. doi:10.1002/hed.21562.

    Article  PubMed  Google Scholar 

  65. Lamont EB, Cavaghan MK, Brockstein BE. Oncogenic osteomalacia as a harbinger of recurrent osteosarcoma. Sarcoma. 1999;3(2):95–9. doi:10.1080/13577149977712.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Giri GV, Sukumaran G, Ravindran C, Narasimman M. Giant cell tumor of the mandible. J Oral Maxillofac Pathol. 2015;19(1):108. doi:10.4103/0973-029x.157217.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Paparella ML, Olvi LG, Brandizzi D, Keszler A, Santini-Araujo E, Cabrini RL. Osteosarcoma of the jaw: an analysis of a series of 74 cases. Histopathology. 2013;63(4):551–7. doi:10.1111/his.12191.

    PubMed  Google Scholar 

  68. Biernat W, Kaniuka S, Stempniewicz M, Reclawowicz D, Sworczak K. Phosphaturic mesenchymal tumor of spinal nerve in a patient with osteomalacia and multiple fractures. Acta Neuropathol. 2010;119(3):379–80. doi:10.1007/s00401-010-0648-3.

    Article  PubMed  Google Scholar 

  69. Ogose A, Hotta T, Emura I, Hatano H, Inoue Y, Umezu H, et al. Recurrent malignant variant of phosphaturic mesenchymal tumor with oncogenic osteomalacia. Skeletal Radiol. 2001;30(2):99–103.

    Article  CAS  PubMed  Google Scholar 

  70. Houang M, Clarkson A, Sioson L, Elston MS, Clifton-Bligh RJ, Dray M, et al. Phosphaturic mesenchymal tumors show positive staining for somatostatin receptor 2A (SSTR2A). Hum Pathol. 2013;44(12):2711–8. doi:10.1016/j.humpath.2013.07.016.

    Article  CAS  PubMed  Google Scholar 

  71. Yamashita T, Konishi M, Miyake A, Inui K, Itoh N. Fibroblast growth factor (FGF)-23 inhibits renal phosphate reabsorption by activation of the mitogen-activated protein kinase pathway. J Biol Chem. 2002;277(31):28265–70. doi:10.1074/jbc.M202527200.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiba Qari.

Ethics declarations

Conflict of interest

None declared.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qari, H., Hamao-Sakamoto, A., Fuselier, C. et al. Phosphaturic Mesenchymal Tumor: 2 New Oral Cases and Review of 53 Cases in the Head and Neck. Head and Neck Pathol 10, 192–200 (2016). https://doi.org/10.1007/s12105-015-0668-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12105-015-0668-3

Keywords

Navigation