Kliniğimizde tanı almış benign ve malign nazal patolojili olguların retrospektif olarak değerlendirilmesi

Emine Altuntaş; Şahende Elagöz; Hatice Özer; İsmail Uysal; Suphi Müderris

Kliniğimizde tanı almış benign ve malign nazal patolojili olguların retrospektif olarak değerlendirilmesi

Year 2009, Volume: 31 Issue: 4, 393 - 400, 23.10.2009

Emine Altuntaş , Şahende Elagöz , Hatice Özer İsmail Uysal Suphi Müderris

Abstract

Özet

Amaç. Nasal kavitenin primer tümörleri; benign ve malign, epitelyal ve non-epitelyal tümörler olarak sınıflandırılır. Nazal kavite tümörlerinin etyolojisinde rol oynayan faktörler arasında odun tozu ile uzun süreli temas, sigara ve tütün kullanma alışkanlıkları sayılabilir. Bu lokalizasyondaki malign tümörlerin klinikte ilk belirtileri nonspesifik bulgular olduğundan, sıklıkla inflamatuar hastalıklarla karışmakta, bu nedenle tanı almaları gecikmektedir. Bu makalede; nazal kavite, septum, vestibül ve konkadan köken almış benign ve malign patolojilerin literatür bilgileri eşliğinde semptom, klinik bulgular ve tedavi yaklaşımları açısından gözden geçirilmesi amaçlanmıştır. Yöntem. Cumhuriyet Üniversitesi Tıp Fakültesi Kulak Burun Boğaz (KBB) Anabilim Dalında Ocak 1989-Ocak 2009 tarihleri arasında nazal patoloji nedeniyle operasyonları yapılmış olan 102'si (%60,0) erkek ve 68'i (%40,0) kadın olmak üzere toplam 170 olgu çalışmaya dâhil edildi. Olguların tümü yaş, cinsiyet, lezyonun lokalizasyonu, kliniğe ilk başvuru şikâyetleri, semptomların ortaya çıkış zamanı ve süreleri; fizik muayene bulguları, uygulanan tedavi, nüksler ve histopatolojik tanıları, takip süreleri, rekürensleri ve bunlara yapılan kurtarma cerrahilerinin özellikleri kaydedilerek istatistiksel olarak incelendi. Bulgular. Çalışmaya katılan olguların KBB muayenesinde lezyonların; 18 (%10,6)'inde nasal septum, 142 (%83,5)'sinde nazal kavite, 5 (%2,9)'inde konka ve 5 (%2,9)'inde ise vestibülden köken aldığı görüldü. Olguların 168'ne (%98,8) cerrahi eksizyon, 2'sine (% 1,2) insizyonel biyopsi yapılarak histopatolojik tanıları konmuştur. Sonuçlar. Nazal bölgede KBB hekimleri klinik semptomları inflamatuar patolojileri taklit eden pek çok benign ve malign patolojiler ile karşılaşmaktadır. Malign patolojilerde tanının gecikmesi prognozu belirgin ölçüde kötüleştirmektedir. Bu nedenle tedaviye dirençli olguların daima çok yakın klinik takipleri yapılmalı ve bu patolojilerin malign olabileceği akılda tutularak tanısal amaçlı ısrarla belki de tekrarlayan biopsiler yapılmalıdır.

Anahtar sözcükler: Nazal patoloji, ayırıcı tanı, tedavi

Abstract

Aim. Primary tumors of nasal cavity are classified as benign and malignant or epithelial and non-epithelial tumors. Nasal cavity tumors among the factors that play a role in the etiology of prolonged contact with wood dust, cigarette and tobacco use habits can be considered. Malignant tumors in these locations, the first signs of clinical findings are nonspecific, often are confused with inflammatory diseases, so diagnosis is delayed to take. The aim of these study benign and malignant pathology of the nasal cavity, septum, vestibulum and concha symptoms, clinical findings and treatment approaches review with the literature. Methods. During 10 years period (from January 1989 to January 2009), the 102 (%60.0) of men and 68 (%40) of women in total 170 patients that were operated because of the nasal patalogies in Cumhuriyet University Faculty of Medicine department of otorhinolaryngology was included in this study. All of the patients age, gender, lesion location, the first clinical complaints, symptoms of the emergence time and duration; physical examination findings, treatment, recurrence and histopathological diagnosis, follow-up period, recurrence and their surgical recovery of the properties recorded as statistically were analyzed. Results. ENT examination of these cases in this study lesions were located in the 18 (10.6%) nasal septum, 142 (% 83.5) nasal cavity, 5 (2.9%) turbinate and 5 (2.9%) originate in vestibuli. Histopathologically diagnosis of patient were done with 168 (98.8%) of the cases by surgical excision and 2 (1.2%) of the cases by incisional biopsy. Conclusions. ENT physicians are encountered many benign and malignant pathologies in the nasal region that clinical symptoms mimic inflammatory pathologies. Delay in the diagnosis of malignant pathology significantly worse prognosis. Therefore, treatment-resistant patients, and this should always be very close clinical follow-up could be kept in mind in the diagnostic pathology of the malignant purpose perhaps repeating insistently biopsiler be made.

Keywords: Nasal pathologies, differential diagnosis, treatment

Keywords

References

1. Editör Koç C. Karcı B. Kulak Burun Boğaz Hastalıkları ve Baş-Boyun Cerrahisi. Burun ve paranazal sinüs tümörleri. Güneş Kitabevi, Ankara, 2004; Bölüm 5: 22: 745-69.
2. Myers EN and Suen JY: Cancer of the head and neck. Ed 3. Philadephia, W.B. Saunders Company.1996.
3. Million RR and Cassisi NJ: Management of Head and Neck Cancer: A Multidisciplinary Approach, ed 2. Philadephia, JB Lippincott, 1994.
4. Barnes L, Eveson JW, Reichart P, Sidransky D. World Health Organization Classification of tumors. Pathology and Genetics Head and Neck tumors. IARC Press, Lyon. 2005; Chapter 1: 9-81.
5. Butler RM, Nahum AN, Hanafee W: New surgical approach to nasopharyngeal anjiofibromas. Trans Am Acad Ophtalmol Otolaryngol 1967: 71-92.
6. Lawson W,Benger JL, Som P: Inverted papiloma: An analysis of 87 cases. Laryngoscope 99 November,1989; 117-23.
7. Ballenger JJ, Snow JB. Editör: Şenocak D. Çeviri: Eryaman E. Otorinolaringoloji Baş ve Boyun Cerrahisi. Burun ve Paranazal Sinüs Neoplazımları. Nobel Tıp Kitabevi, İstanbul. 2000; Bölüm:14: 194-205.
8. Fradis M, Podoshin L, Gertner R, Sabo E. Squamous cell carcinoma of the nasal septum mucosa. Ear Nose Thro at J 1993; 72: 217-21.
9. Lee man DJ, Shuler KJ, Han K, Mirani N. De - differentiation of primary squamous cell carcinoma arising from the nasal septum. Otolaryngol Head Neck Surg 1996; 114:131-6.
10. Lund V. Introduction. Allergy 1999; 54: 5-6.
11. Hosemann W, Göde U, Wagner W. Epidemiology, pathophysiology of nasal polyposis and spectrum of endonasal sinus surgery. Am J Otolaryngol 1994; 15: 85-98.
12. Umur AS, Gunhan K, Songu M, Temiz C, Yuceturk AV. Frontal sinus osteoma complicated with intracranial inflammatory polyp: a case report and review of the literature. Rev Laryngol Otol Rhinol (Bord). 2008; 129: 333-6.
13. Wenig BM. Atlas of head and neck pathology. 2nd edition. Philadelphia/London: Elsevier Saunders; 2008.
14. Miller F, D’agostina M, Schlack K. Lobular capillary hemangioma of the nasal cavity. Otolaryngol Head Neck Surg 1999; 120: 783-84.
15. Bebek Aİ, Yıldırım A, Atalar M, Özer H, Kunt T.Orta konkanın lobuler kapiller hemanjiomu. KBB-Forum 2006;5: 171-3.
16. Mansell NJ, Bates GJ. The inverted schneiderian papilloma: a review and literature report of 43 new cases. Rhinology 2000; 38: 97-101.
17. Kaufman MR, Brandwein MS, Lawson W. Sinonasal papillomas: clinicopathologic review of 40 patients with inverted and oncocytic schneiderian papillomas. Laryngoscope. 2002; 112: 1372-7.
18. İkiz A Ö, Sütay S, Edağ T K, Güneri E A. İnverted papillom ve cerrahi tedavisi. K.B.B. ve BBC Dergisi. 2001; 134-8.
19. Bielamowicz S, Calcaterra TC, Watson D. İnverting papilloma of the head and neck: the UCLA update. Otolaryngology-head and neck surgery 1993; 109: 71-6.
20. Okuyucu Ş, Uzun H, Kocatürk S. İnverted Papilloma Klinik Yaklaşım. C. Ü. Tıp Fakültesi Dergisi. 2005: 27; 47-50.
21. Yaman H, Öztürk K, Ünaldı D, Toy H, Arbağ H, Özer B Üç olgu nedeni ile inverted papillom. Genel Tıp Derg 2006; 16: 133-5.
22. Unlu HH, Songu M, Ovali GY, Nese N. Inverted papilloma with new bone formation: report of three cases. Am J Rhinol 2007; 21: 607-10.
23. Morris JM, Lane JI, Witte RJ, Thompson DM. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol 2004; 25: 1263-5.
24. Congenital and Acquired Lesions of the Nasal Septum: A Practical Guide for Differential Diagnosis1. Valencia MP, Castillo M. RadioGraphics 2008; 28: 205-23.
25. Patsiaoura K, Anagnostou E, Benis N. Intramuscular myxoma of the nasal vestibule. Auris Nasus Larynx Auris Nasus Larynx. 2009 May 2. [Epub ahead of print].
26. Fletcher CDM, Unni KK, Mertens F, editors. World Health Organization of tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press; 2002. p. 186-7.
27. Okamoto S, Hisaoka M, Meis-Kindblom JM, Kindblom LG, Hashimoto H. Juxtaarticular myxoma and intramuscular myxoma are two distinct entities. Activating Gsa mutation does not occur in juxtaarticular myxoma. Virchow Arch 2002; 440: 12-5.
28. Karcı B, Günhan Ö, Bilgen C, Aras E, Öner K, Övül İ. Paranazal sinüslerin malign tümörleri. KBB İhtisas Dergisi. 2001; 39: 1-15.
29. Wiseman SM, Popat SR, Rigual NR, Hicks WL, Orner JB, Wein RO, McGary CT, Loree TR. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity: a 40-year review of 35 cases. Ear Nose Throat J 2002; 81: 510-4, 6-7.
30. Tai S-Y, Chien C-Y, Tai C-F, Kuo W-R, Huang W-T, Wang L-F. Nasal septum adenoid cystic carcinoma: a case report. Kaohsiung J Med Sci August 2007: Vol 23; 426-30.
31. Baek CH, Kım KS, Kong MK: Primary mucosal melanoma of the nasal cavity; Otolaryngol Head Neck Surg 1996, 115: 582-37.
32. Samuel M, Jonathan DH, George M, Graham CP: Malignant melanoma arising in the fontal sinuses: J Laryngol Otol. 1997; 111: 376-8.
33. Spınos M, Poul JD: Malignant mucosal melanoma of the head and neck: Review of the literature and report of 14 patients Cancer 1997; 80: 1373-86.
34. Dreher A, Grevers G. Malignant melanomas of the nasal cavity and paranasal sinuses. Laryngorhinootologie 1995; 74: 95-7.
35. Folz BJ, Nıemann AM, Lıppert BM, Hauschıld A, Werner JA. Mucous membrane melanomas of the upper aerodigestive tract. An analysis of 34 cases. Laryngorhinootologie 1997; 76: 289-94.
36. Loree TR, Mullıns AP, Spellman J, North JH JR, Hıcks WL JR. Head and neck mucosal melanoma: a 32-year review. Ear Nose Throat J. 1999; 78: 372-5.
37. Medina E.J. Malignant Melanomas, Myers E.N, Suen J.Y (editors). In Cancer of The Head and Neck. New York, USA: Churchill Livingstone, 1989. pp 302-5.
38. Robbins KT. Fuller LM, Vlasak M, Osborne B, Jing BS, Velasquez WS, Sullivan J. Primary lymphomas of the nasal cavity and paranasal sinuses. Cancer 1985. 56: 814-19.
39. Güven O, Keskin A, Saraçoğlu U, Akyürek N. Oral ve Sinonazal Kavitenin Periferal TCell Lenfoması: Vaka Raporu (Perıpheral T-Cell Lymphoma Of Oral And Sınonasal Cavıty: A Case Report) T Klin Diş Hek Bil 2000; 6: 133-7.
40. Abbondanzo SL, Wenig BM: Non-Hodgkin's lymphoma of the sinonasal tract. Cancer. 1995; 75: 1281.
41. Chandu A, Mitchell A, Corrigan M: Cutaneus CD30 positive large T cell lymphoma of the upper lip.Br J Oral Maxillofac Surg 1997; 35: 193.
42. Cheung MM, Chan JK, Lau WH, Foo W, Chan PT, Ng CS, Ngan RK. Primary nonHodgkin’s lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients. J Clin Oncol 1998; 16: 70-7.
43. Kim GE, Lee SW, Chang SK, Park HC, Pyo HR, Kim JH, Moon SR, et al. Combined chemotherapy and radiation versusradiation alone in the management of localized angiocentric lymphoma of the head and neck. Radiother Oncol 2001; 61: 261-9.

Retrospective evaluation of benign and malignant nasal pathologies patients were diagnosed in our clinic

Year 2009, Volume: 31 Issue: 4, 393 - 400, 23.10.2009

Emine Altuntaş , Şahende Elagöz , Hatice Özer İsmail Uysal Suphi Müderris

Abstract

Objectives

Primary tumors of nasal cavity are classified as benign and malignant or epithelial and non-epithelial tumors. Nasal cavity tumors among the factors that play a role in the etiology of prolonged contact with wood dust, cigarette and tobacco use habits can be considered. Malignant tumors in these locations, the first signs of clinical findings are nonspecific, often are confused with inflammatory diseases, so diagnosis is delayed to take.

The aim of these study benign and malignant pathology of the nasal cavity, septum, vestibulum and concha symptoms, clinical findings and treatment approaches review with the literature.

Material and Method

During 10 years period (from January 1989 to January 2009), the 102 (%60.0) of men and 68 (%40) of women in total 170 patients that were operated because of the nasal patalogies in Cumhuriyet University Faculty of Medicine department of otorhinolaryngology was included in this study. All of the patients age, gender, lesion location, the first clinical complaints, symptoms of the emergence time and duration; physical examination findings, treatment, recurrence and histopathological diagnosis, follow-up period, recurrence and their surgical recovery of the properties recorded as statistically were analyzed.

Findings

ENT examination of these cases in this study lesions were located in the 18 (10.6%) nasal septum, 142 (% 83.5) nasal cavity, 5 (2.9%) turbinate and 5 (2.9%) originate in vestibuli. Histopathologically diagnosis of patient were done with 168 (98.8%) of the cases by surgical excision and 2 (1.2%) of the cases by incisional biopsy.

Results

ENT physicians are encountered many benign and malignant pathologies in the nasal region that clinical symptoms mimic inflammatory pathologies. Delay in the diagnosis of malignant pathology significantly worse prognosis. Therefore, treatment-resistant patients, and this should always be very close clinical follow-up could be kept in mind in the diagnostic pathology of the malignant purpose perhaps repeating insistently biopsiler be made.

Keywords

Nazal patoloji, ayırıcı tanı, tedavi

References

1. Editör Koç C. Karcı B. Kulak Burun Boğaz Hastalıkları ve Baş-Boyun Cerrahisi. Burun ve paranazal sinüs tümörleri. Güneş Kitabevi, Ankara, 2004; Bölüm 5: 22: 745-69.
2. Myers EN and Suen JY: Cancer of the head and neck. Ed 3. Philadephia, W.B. Saunders Company.1996.
3. Million RR and Cassisi NJ: Management of Head and Neck Cancer: A Multidisciplinary Approach, ed 2. Philadephia, JB Lippincott, 1994.
4. Barnes L, Eveson JW, Reichart P, Sidransky D. World Health Organization Classification of tumors. Pathology and Genetics Head and Neck tumors. IARC Press, Lyon. 2005; Chapter 1: 9-81.
5. Butler RM, Nahum AN, Hanafee W: New surgical approach to nasopharyngeal anjiofibromas. Trans Am Acad Ophtalmol Otolaryngol 1967: 71-92.
6. Lawson W,Benger JL, Som P: Inverted papiloma: An analysis of 87 cases. Laryngoscope 99 November,1989; 117-23.
7. Ballenger JJ, Snow JB. Editör: Şenocak D. Çeviri: Eryaman E. Otorinolaringoloji Baş ve Boyun Cerrahisi. Burun ve Paranazal Sinüs Neoplazımları. Nobel Tıp Kitabevi, İstanbul. 2000; Bölüm:14: 194-205.
8. Fradis M, Podoshin L, Gertner R, Sabo E. Squamous cell carcinoma of the nasal septum mucosa. Ear Nose Thro at J 1993; 72: 217-21.
9. Lee man DJ, Shuler KJ, Han K, Mirani N. De - differentiation of primary squamous cell carcinoma arising from the nasal septum. Otolaryngol Head Neck Surg 1996; 114:131-6.
10. Lund V. Introduction. Allergy 1999; 54: 5-6.
11. Hosemann W, Göde U, Wagner W. Epidemiology, pathophysiology of nasal polyposis and spectrum of endonasal sinus surgery. Am J Otolaryngol 1994; 15: 85-98.
12. Umur AS, Gunhan K, Songu M, Temiz C, Yuceturk AV. Frontal sinus osteoma complicated with intracranial inflammatory polyp: a case report and review of the literature. Rev Laryngol Otol Rhinol (Bord). 2008; 129: 333-6.
13. Wenig BM. Atlas of head and neck pathology. 2nd edition. Philadelphia/London: Elsevier Saunders; 2008.
14. Miller F, D’agostina M, Schlack K. Lobular capillary hemangioma of the nasal cavity. Otolaryngol Head Neck Surg 1999; 120: 783-84.
15. Bebek Aİ, Yıldırım A, Atalar M, Özer H, Kunt T.Orta konkanın lobuler kapiller hemanjiomu. KBB-Forum 2006;5: 171-3.
16. Mansell NJ, Bates GJ. The inverted schneiderian papilloma: a review and literature report of 43 new cases. Rhinology 2000; 38: 97-101.
17. Kaufman MR, Brandwein MS, Lawson W. Sinonasal papillomas: clinicopathologic review of 40 patients with inverted and oncocytic schneiderian papillomas. Laryngoscope. 2002; 112: 1372-7.
18. İkiz A Ö, Sütay S, Edağ T K, Güneri E A. İnverted papillom ve cerrahi tedavisi. K.B.B. ve BBC Dergisi. 2001; 134-8.
19. Bielamowicz S, Calcaterra TC, Watson D. İnverting papilloma of the head and neck: the UCLA update. Otolaryngology-head and neck surgery 1993; 109: 71-6.
20. Okuyucu Ş, Uzun H, Kocatürk S. İnverted Papilloma Klinik Yaklaşım. C. Ü. Tıp Fakültesi Dergisi. 2005: 27; 47-50.
21. Yaman H, Öztürk K, Ünaldı D, Toy H, Arbağ H, Özer B Üç olgu nedeni ile inverted papillom. Genel Tıp Derg 2006; 16: 133-5.
22. Unlu HH, Songu M, Ovali GY, Nese N. Inverted papilloma with new bone formation: report of three cases. Am J Rhinol 2007; 21: 607-10.
23. Morris JM, Lane JI, Witte RJ, Thompson DM. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol 2004; 25: 1263-5.
24. Congenital and Acquired Lesions of the Nasal Septum: A Practical Guide for Differential Diagnosis1. Valencia MP, Castillo M. RadioGraphics 2008; 28: 205-23.
25. Patsiaoura K, Anagnostou E, Benis N. Intramuscular myxoma of the nasal vestibule. Auris Nasus Larynx Auris Nasus Larynx. 2009 May 2. [Epub ahead of print].
26. Fletcher CDM, Unni KK, Mertens F, editors. World Health Organization of tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press; 2002. p. 186-7.
27. Okamoto S, Hisaoka M, Meis-Kindblom JM, Kindblom LG, Hashimoto H. Juxtaarticular myxoma and intramuscular myxoma are two distinct entities. Activating Gsa mutation does not occur in juxtaarticular myxoma. Virchow Arch 2002; 440: 12-5.
28. Karcı B, Günhan Ö, Bilgen C, Aras E, Öner K, Övül İ. Paranazal sinüslerin malign tümörleri. KBB İhtisas Dergisi. 2001; 39: 1-15.
29. Wiseman SM, Popat SR, Rigual NR, Hicks WL, Orner JB, Wein RO, McGary CT, Loree TR. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity: a 40-year review of 35 cases. Ear Nose Throat J 2002; 81: 510-4, 6-7.
30. Tai S-Y, Chien C-Y, Tai C-F, Kuo W-R, Huang W-T, Wang L-F. Nasal septum adenoid cystic carcinoma: a case report. Kaohsiung J Med Sci August 2007: Vol 23; 426-30.
31. Baek CH, Kım KS, Kong MK: Primary mucosal melanoma of the nasal cavity; Otolaryngol Head Neck Surg 1996, 115: 582-37.
32. Samuel M, Jonathan DH, George M, Graham CP: Malignant melanoma arising in the fontal sinuses: J Laryngol Otol. 1997; 111: 376-8.
33. Spınos M, Poul JD: Malignant mucosal melanoma of the head and neck: Review of the literature and report of 14 patients Cancer 1997; 80: 1373-86.
34. Dreher A, Grevers G. Malignant melanomas of the nasal cavity and paranasal sinuses. Laryngorhinootologie 1995; 74: 95-7.
35. Folz BJ, Nıemann AM, Lıppert BM, Hauschıld A, Werner JA. Mucous membrane melanomas of the upper aerodigestive tract. An analysis of 34 cases. Laryngorhinootologie 1997; 76: 289-94.
36. Loree TR, Mullıns AP, Spellman J, North JH JR, Hıcks WL JR. Head and neck mucosal melanoma: a 32-year review. Ear Nose Throat J. 1999; 78: 372-5.
37. Medina E.J. Malignant Melanomas, Myers E.N, Suen J.Y (editors). In Cancer of The Head and Neck. New York, USA: Churchill Livingstone, 1989. pp 302-5.
38. Robbins KT. Fuller LM, Vlasak M, Osborne B, Jing BS, Velasquez WS, Sullivan J. Primary lymphomas of the nasal cavity and paranasal sinuses. Cancer 1985. 56: 814-19.
39. Güven O, Keskin A, Saraçoğlu U, Akyürek N. Oral ve Sinonazal Kavitenin Periferal TCell Lenfoması: Vaka Raporu (Perıpheral T-Cell Lymphoma Of Oral And Sınonasal Cavıty: A Case Report) T Klin Diş Hek Bil 2000; 6: 133-7.
40. Abbondanzo SL, Wenig BM: Non-Hodgkin's lymphoma of the sinonasal tract. Cancer. 1995; 75: 1281.
41. Chandu A, Mitchell A, Corrigan M: Cutaneus CD30 positive large T cell lymphoma of the upper lip.Br J Oral Maxillofac Surg 1997; 35: 193.
42. Cheung MM, Chan JK, Lau WH, Foo W, Chan PT, Ng CS, Ngan RK. Primary nonHodgkin’s lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients. J Clin Oncol 1998; 16: 70-7.
43. Kim GE, Lee SW, Chang SK, Park HC, Pyo HR, Kim JH, Moon SR, et al. Combined chemotherapy and radiation versusradiation alone in the management of localized angiocentric lymphoma of the head and neck. Radiother Oncol 2001; 61: 261-9.

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Details

Primary Language	English
Journal Section	Surgical Science Research Articles
Authors	Emine Altuntaş Şahende Elagöz Hatice Özer İsmail Uysal Suphi Müderris
Publication Date	October 23, 2009
Published in Issue	Year 2009Volume: 31 Issue: 4

Cite

AMA	Altuntaş E, Elagöz Ş, Özer H, Uysal İ, Müderris S. Kliniğimizde tanı almış benign ve malign nazal patolojili olguların retrospektif olarak değerlendirilmesi. CMJ. December 2009;31(4):393-400.

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