Shagufta Shaheen

All Publications

• Circulating Chromogranin A as Surveillance Biomarker in Patients with Carcinoids - The CASPAR Study. Clinical cancer research : an official journal of the American Association for Cancer Research Meng, Q. H., Halfdanarson, T. R., Bornhorst, J. A., Jann, H., Shaheen, S., Shi, R. Z., Schwabe, A., Stade, K., Halperin, D. M. 2024

  Abstract

  Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are relatively indolent but can be more aggressive. The current recommendations for the use of serum CgA for GEP-NET patients are equivocal. This study was designed to validate an automated CgA immunofluorescence assay for monitoring disease progression in GEP-NET patients.A prospective, multi-center blinded observational study was designed to validate an automated chromogranin A (CgA) immunofluorescence assay for monitoring disease progression in GEP-NET patients. Tumor progression was evaluated with Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 by CT/MRI. An increase ≥ 50% above the prior CgA concentration to a value > 100 ng/mL in the following CgA concentration was considered positive.153 GEP-NET patients were enrolled. Using the pre-specified cut-off of CgA change for tumor progression, specificity was 93·4% (95%-CI: 90·4%-95·5%, p < 0·001), sensitivity 34·4% (25·6%-44·3%), positive predictive value 57·9% (45·0-69·8), negative predictive value (NPV) 84·3% (80·5-87·6), and area under the curve 0·73 (0·67-0·79).Changes in serial measurements of serum CgA had a favorable specificity and NPV, making this test a useful adjunct to routine radiographic monitoring.

  View details for DOI 10.1158/1078-0432.CCR-24-1875

  View details for PubMedID 39453770

• Phase 3 Trial of Cabozantinib to Treat Advanced Neuroendocrine Tumors. The New England journal of medicine Chan, J. A., Geyer, S., Zemla, T., Knopp, M. V., Behr, S., Pulsipher, S., Ou, F., Dueck, A. C., Acoba, J., Shergill, A., Wolin, E. M., Halfdanarson, T. R., Konda, B., Trikalinos, N. A., Tawfik, B., Raj, N., Shaheen, S., Vijayvergia, N., Dasari, A., Strosberg, J. R., Kohn, E. C., Kulke, M. H., O'Reilly, E. M., Meyerhardt, J. A. 2024

  Abstract

  BACKGROUND: Treatment options for patients with advanced neuroendocrine tumors are limited. The efficacy of cabozantinib in the treatment of previously treated, progressive extrapancreatic or pancreatic neuroendocrine tumors is unclear.METHODS: We enrolled two independent cohorts of patients - those with extrapancreatic neuroendocrine tumors and those with pancreatic neuroendocrine tumors - who had received peptide receptor radionuclide therapy or targeted therapy or both. Patients were randomly assigned in a 2:1 ratio to receive cabozantinib at a dose of 60 mg daily or placebo. The primary end point was progression-free survival as assessed by blinded independent central review. Key secondary end points included objective response, overall survival, and safety.RESULTS: In the cohort of 203 patients with extrapancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 8.4 months, as compared with 3.9 months with placebo (stratified hazard ratio for progression or death, 0.38; 95% confidence interval [CI], 0.25 to 0.59; P<0.001). In the cohort of 95 patients with pancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 13.8 months, as compared with 4.4 months with placebo (stratified hazard ratio, 0.23; 95% CI, 0.12 to 0.42; P<0.001). The incidence of confirmed objective response with cabozantinib was 5% and 19% among patients with extrapancreatic and pancreatic neuroendocrine tumors, respectively, as compared with 0% with placebo. Grade 3 or higher adverse events were noted in 62 to 65% of the patients treated with cabozantinib, as compared with 23 to 27% of the patients who received placebo. Common treatment-related adverse events of grade 3 or higher included hypertension, fatigue, diarrhea, and thromboembolic events.CONCLUSIONS: Cabozantinib, as compared with placebo, significantly improved progression-free survival in patients with previously treated, progressive advanced extrapancreatic or pancreatic neuroendocrine tumors. Adverse events were consistent with the known safety profile of cabozantinib. (Funded by the National Cancer Institute and others; CABINET ClinicalTrials.gov number, NCT03375320.).

  View details for DOI 10.1056/NEJMoa2403991

  View details for PubMedID 39282913

• Chromogranin A as surveillance biomarker in patients with carcinoids: CASPAR Meng, Q., Halfdanarson, T., Bornhorst, J., Jann, H., Shaheen, S., Shi, R., Halperin, D. M. LIPPINCOTT WILLIAMS & WILKINS. 2023

  View details for Web of Science ID 001053772002272

• Striking Size Reduction of Rapidly Growing Pancreatic Neuroendocrine Carcinoma Metastatic Nodal Conglomerate After Only 2 Cycles of 177Lu-DOTATATE. Clinical nuclear medicine Somoza, E. A., Duan, H., Shaheen, S., Fischer, G. A., Aparici, C. M. 2022

  Abstract

  ABSTRACT: Peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE has shown great treatment efficacy in patients with well-differentiated metastatic neuroendocrine tumors and a metastatic size reduction of ~20% for metastatic lesions <3 cm in size. We present a 66-year-old man with pancreatic neuroendocrine carcinoma, who had a rapidly growing metastatic nodal conglomerate, which measured close to 10 cm in size. After only 2 cycles of PRRT with 177Lu-DOTATATE, the nodal conglomerate had a striking size reduction greater than 75%. This case highlights the potential efficacy of PRRT with 177Lu-DOTATATE for treatment of aggressive neuroendocrine neoplasms.

  View details for DOI 10.1097/RLU.0000000000004262

  View details for PubMedID 35695695

• Evaluation of Liver and Renal Toxicity in Peptide Receptor Radionuclide Therapy for Somatostatin Receptor Expressing Tumors: A 2-Year Follow-Up. The oncologist Duan, H., Ferri, V., Fisher, G. A., Shaheen, S., Davidzon, G. A., Iagaru, A., Mari Aparici, C. 2022

  Abstract

  Peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin receptor (SSR) analogs is now an established systemic treatment for neuroendocrine tumors (NET). However, more short- and long-term data about renal and hepatotoxicity is needed. Here we present our experience in this clinical scenario.Eighty-six patients with progressive SSR-expressing malignancies underwent PRRT with Lu-177 Dotatate and were followed up for up to 2 years. Laboratory tests were done 1 week before each cycle and every 2 months at follow-up. Hepatic and renal toxicity was determined based on NCI CTCAE V5.0.55/86 (64%) patients completed all 4 cycles of PRRT; 18/86 (20.9%) are currently being treated; 13/86 (15.1%) had to discontinue PRRT: 4/13 (31%) due to hematologic toxicity, 9/13 (69%) due to non-PRRT-related comorbidities. Out of the patients who finished treatment, only transient grade 2 toxicities were observed during PRRT: hypoalbuminemia in 5.5% (3/55), and renal toxicity (serum creatinine and estimated glomerular filtration rate) in 1.8% (1/55). No grade 3 or 4 liver and renal toxicity occurred. Patients presenting with impaired liver or renal function prior to PRRT, either improved or had stable findings. No deterioration was observed.Peptide receptor radionuclide therapy does not have a negative impact on liver and renal function, even in patients with pre-existing impaired parameters. No grade 3 or 4 hepatic or renal toxicity was identified. Only transient grade 2 hypoalbuminemia in 5.5% and nephrotoxicity in 1.8% of patients were seen during PRRT.

  View details for DOI 10.1093/oncolo/oyab072

  View details for PubMedID 35641196

• Evaluation of Liver and Renal Toxicity in Peptide Receptor Radionuclide Therapy for Somatostatin Receptor Expressing Tumors: A 2-Year Follow-Up ONCOLOGIST Duan, H., Ferri, V., Fisher, G., Shaheen, S., Davidzon, G., Iagaru, A., Aparici, C. 2022

  View details for DOI 10.1093/oncolo/oyab072

  View details for Web of Science ID 000769640100001

• Peptide Receptor Radionuclide Therapy (PRRT) in Advanced Pheochromocytoma and Paraganglioma From a Single Institution Experience Duan, H., Ferri, V., Fisher, G. A., Shaheen, S., Davidzon, G. A., Moradi, F., Nguyen, J., Franc, B. L., Iagaru, A., Aparici, C. LIPPINCOTT WILLIAMS & WILKINS. 2022: E42-E43

  View details for Web of Science ID 000819123700057

• Phase II trial of organ preservation program using short-course radiation and folfoxiri for rectal cancer (SHORT-FOX) Pollom, E. L., Shelton, A., Fisher, G. A., Bien, J., King, D., Johnson, T., Chen, C., Shaheen, S., Chong, C., Vitzthum, L., Kirilcuk, N., Morris, A. M., Kin, C., Dawes, A., Sheth, V., Sundaram, V., Brown, E., Chang, D. LIPPINCOTT WILLIAMS & WILKINS. 2022

  View details for DOI 10.1200/JCO.2022.40.4_suppl.TPS218

  View details for Web of Science ID 000770995900213

• Neuroendocrine and Adrenal Tumors, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network : JNCCN Shah, M. H., Goldner, W. S., Benson, A. B., Bergsland, E., Blaszkowsky, L. S., Brock, P., Chan, J., Das, S., Dickson, P. V., Fanta, P., Giordano, T., Halfdanarson, T. R., Halperin, D., He, J., Heaney, A., Heslin, M. J., Kandeel, F., Kardan, A., Khan, S. A., Kuvshinoff, B. W., Lieu, C., Miller, K., Pillarisetty, V. G., Reidy, D., Salgado, S. A., Shaheen, S., Soares, H. P., Soulen, M. C., Strosberg, J. R., Sussman, C. R., Trikalinos, N. A., Uboha, N. A., Vijayvergia, N., Wong, T., Lynn, B., Hochstetler, C. 2021; 19 (7): 839-868

  Abstract

  The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Neuroendocrine and Adrenal Gland Tumors focus on the diagnosis, treatment, and management of patients with neuroendocrine tumors (NETs), adrenal tumors, pheochromocytomas, paragangliomas, and multiple endocrine neoplasia. NETs are generally subclassified by site of origin, stage, and histologic characteristics. Appropriate diagnosis and treatment of NETs often involves collaboration between specialists in multiple disciplines, using specific biochemical, radiologic, and surgical methods. Specialists include pathologists, endocrinologists, radiologists (including nuclear medicine specialists), and medical, radiation, and surgical oncologists. These guidelines discuss the diagnosis and management of both sporadic and hereditary neuroendocrine and adrenal tumors and are intended to assist with clinical decision-making. This article is focused on the 2021 NCCN Guidelines principles of genetic risk assessment and counseling and recommendations for well-differentiated grade 3 NETs, poorly differentiated neuroendocrine carcinomas, adrenal tumors, pheochromocytomas, and paragangliomas.

  View details for DOI 10.6004/jnccn.2021.0032

  View details for PubMedID 34340212

• Prevalence of Bone Metastases in Neuroendocrine Neoplasms by 68Ga DOTATATE PET Scan Shaheen, S., Gardner, R., Sundaram, V., Hornbacker, K., Moradi, F., Wu, J., Kunz, P. LIPPINCOTT WILLIAMS & WILKINS. 2020: 486

  View details for Web of Science ID 000526823600114

• Patient Selection and Toxicities of PRRT for Metastatic Neuroendocrine Tumors and Research Opportunities. Current treatment options in oncology Shaheen, S. n., Moradi, F. n., Gamino, G. n., Kunz, P. L. 2020; 21 (4): 25

  Abstract

  Neuroendocrine tumors (NETs) are a heterogenous group of neoplasms characterized by varied biological hallmarks and behavior, ranging from indolent to aggressive. For many decades, somatostatin analogues and few targeted therapies were available for NETs and these therapies had minimal response rates. However, there have been a number of recent treatment advances. Peptide receptor radionuclide therapy (PRRT) is a novel approach to treatment of NETs and has changed the landscape of treatment for NETs. It is a form of targeted therapy in which a radiolabeled somatostatin analogue delivers radiation specifically to tumor cells expressing the somatostatin receptor.

  View details for DOI 10.1007/s11864-020-0711-9

  View details for PubMedID 32172368

• Targeted and novel therapy in advanced gastric cancer EXPERIMENTAL HEMATOLOGY & ONCOLOGY Selim, J. H., Shaheen, S., Sheu, W., Hsueh, C. 2019; 8 (1): 25

  Abstract

  The systemic treatment options for advanced gastric cancer (GC) have evolved rapidly in recent years. We have reviewed the recent data of clinical trial incorporating targeted agents, including inhibitors of angiogenesis, human epidermal growth factor receptor 2 (HER2), mesenchymal-epithelial transition, epidermal growth factor receptor, mammalian target of rapamycin, claudin-18.2, programmed death-1 and DNA. Addition of trastuzumab to platinum-based chemotherapy has become standard of care as front-line therapy in advanced GC overexpressing HER2. In the second-line setting, ramucirumab with paclitaxel significantly improves overall survival compared to paclitaxel alone. For patients with refractory disease, apatinib, nivolumab, ramucirumab and TAS-102 have demonstrated single-agent activity with improved overall survival compared to placebo alone. Pembrolizumab has demonstrated more than 50% response rate in microsatellite instability-high tumors, 15% response rate in tumors expressing programmed death ligand 1, and non-inferior outcome in first-line treatment compared to chemotherapy. This review summarizes the current state and progress of research on targeted therapy for advanced GC.

  View details for DOI 10.1186/s40164-019-0149-6

  View details for Web of Science ID 000489720300002

  View details for PubMedID 31632839

  View details for PubMedCentralID PMC6788003

• Concomitant KRAS and BRAF mutations in colorectal cancer JOURNAL OF GASTROINTESTINAL ONCOLOGY Midthun, L., Shaheen, S., Deisch, J., Senthil, M., Tsai, J., Hsueh, C. 2019; 10 (3): 577–81

  View details for DOI 10.21037/jgo.2019.01.10

  View details for Web of Science ID 000467428500026

• Conservative management of nivolumab-induced pericardial effusion: a case report and review of literature. Experimental hematology & oncology Shaheen, S., Mirshahidi, H., Nagaraj, G., Hsueh, C. T. 2018; 7: 11

  Abstract

  Nivolumab is an immune checkpoint inhibitor targeting programmed death-1 protein and has been approved for the treatment of multiple advanced malignancies. Adverse effects of immune checkpoint inhibitors are distinct from conventional cytotoxic chemotherapy and can be life-threatening if left unrecognized. Here, we present a case of nivolumab-induced pericardial effusion successfully managed with high-dose corticosteroids.A 70-year-old Caucasian female with a history of 50-pack-year cigarette smoking was diagnosed of recurrent adenocarcinoma of lung after initial surgery. She progressed through multiple lines of chemotherapy and was eventually started on nivolumab. She developed a large pericardial effusion, grade 3 by Common Terminology Criteria for Adverse Events v4.0, about 4 days after receiving first nivolumab treatment. She was treated with oral prednisone at 1 mg/kg daily with gradual resolution of pericardial effusion over 5 weeks while she still received nivolumab every 2 weeks. Prednisone treatment was eventually tapered off about 10 weeks from initial nivolumab treatment. However 1 week after stopping prednisone, she again presented with shortness of breath and bilateral ankle edema, imaging confirmed recurrent pericardial effusion measuring 2.8 cm. Nivolumab was stopped and patient was again started back on prednisone 1 mg/kg daily which resulted in complete resolution of pericardial effusion in 3 weeks. Nivolumab was resumed 1 week afterwards while patient was on tapering dose of prednisone. There was no recurrent pericardial effusion when she continued low-dose prednisone during the remaining course of nivolumab treatment.With increasing use of immune checkpoint inhibitors, clinicians need to be aware of the unusual immune-related adverse events in order to provide timely management and effective patient care. To our knowledge, this is the first reported case of immune-related pericardial effusion from nivolumab successfully managed with high-dose corticosteroids. Furthermore, recurrent pericardial effusion was prevented by using low-dose corticosteroids as maintenance in order for patient to continue nivolumab treatment.

  View details for DOI 10.1186/s40164-018-0104-y

  View details for PubMedID 29761026

  View details for PubMedCentralID PMC5941729

• Characterization of disease progression in ovarian cancer by utilizing 'chemograms' of ovarian cancer stem cells. Journal of chemotherapy (Florence, Italy) Guddati, A. K., Shaheen, S. 2013; 25 (3): 184-91

  Abstract

  Ovarian cancer is one of the leading causes of death in women with cancer. First-line chemotherapy with platinum compounds and taxane compounds has been effective, but most patients develop a relapse of the disease due to drug resistance. There is growing evidence that this resistance may be due to the presence of ovarian cancer stem cells.Cells with properties of cancer stem cells have been isolated from the ascitic fluid of ovarian cancer patients. This subset of cells is highly tumourigenic compared to the rest of the cells in the ascitic fluid. They are known to exude harmful chemicals from their cytoplasm and have been found to be resistant to chemotherapeutic agents. This property has been utilized to purify them by fluorescence assisted cytometry to yield a subset of cells which are called 'side population'. These cells exhibit the properties of cancer stem cells and their role in disease progression is being currently investigated. The course of the disease can be potentially characterized at the cellular level by closely studying this cell population. They can also be cultured in different combinations of chemotherapeutic agents at varying concentrations to obtain 'chemograms' which are sensitivity charts. Chemotherapeutic agents which produce the most effective kill curves can then be rationally used as a second-line chemotherapy if the disease relapses. These sensitivity charts can provide insight into emerging patterns of chemoresistance and also help discover surface markers that accurately identify ovarian cancer stem cells.The high rate of disease relapse in patients with ovarian cancer requires a new and different approach utilizing the sensitivity of cancer stem cells. Isolating and characterizing the resistance patterns of ovarian cancer stem cells may provide a rational approach towards an effective and individualized chemotherapeutic regimen.

  View details for DOI 10.1179/1973947812Y.0000000058

  View details for PubMedID 23783145

• Secondary mucosa-associated lymphoid tissue (MALT) lymphoma of the colon. Medical oncology (Northwood, London, England) Shaheen, S., Guddati, A. K. 2013; 30 (2): 502

  Abstract

  Mucosa-associated lymphoid tissue (MALT)-type lymphomas most commonly occur in the stomach and have been associated with Helicobacter pylori infection. However, MALT-type lymphoma of the colon is a rare entity. It commonly manifests with symptoms of weight loss, low-grade fever, constipation, melena, and hematochezia. Unlike gastric lymphoma, it is difficult to detect MALT-type lymphoma of the colon by imaging. Colonoscopy may reveal lesions whose biopsy most commonly shows abundant B lymphocytes. There is no universal immunohistochemistry profile for MALT-type lymphoma but CD 20 staining is commonly seen. Trisomies and translocations have been described and their presence has been correlated with treatment response. Due to the rarity of colonic MALT-type lymphoma, no standard guidelines are available for its management. It often occurs individually and rarely occurs simultaneously with concurrent colon adenocarcinoma. This case report describes the presentation and clinical course of a secondary MALT-type lymphoma in a patient who underwent colectomy for a prior colon adenocarcinoma.

  View details for DOI 10.1007/s12032-013-0502-2

  View details for PubMedID 23423787

• Gastrointestinal stromal tumor: a rare abdominal tumor. Case reports in oncology Shaheen, S., Guddati, A. K. 2013; 6 (1): 148-53

  Abstract

  Gastrointestinal stromal tumors (GISTs) are rare abdominal tumors which arise from the interstitial cells of Cajal in the gastrointestinal tract. Gastric GISTs are the most commonly seen GIST tumors and may grow to a very large size. They are often associated with abdominal pain, anorexia and weight loss. Most of them can be detected by CT. These tumors have been found to harbor mutations in CD117 which causes constitutional activation of the tyrosine kinase signaling pathway and is considered to be pathognomic. Tyrosine kinase inhibitors such as imatinib have revolutionized the treatment of these tumors, which are otherwise resistant to conventional chemotherapy and radiotherapy. Although surgical resection is the mainstay of treatment, tyrosine kinase inhibitors have been useful in prolonging the recurrence-free survival of these patients. Resistance to imatinib has been reported in GISTs with specific mutations. We present a case of gastric GIST which grew to a very large size and was associated with abdominal pain and weight loss. It was successfully resected and the patient was commenced on imatinib therapy.

  View details for DOI 10.1159/000350061

  View details for PubMedID 23569450

  View details for PubMedCentralID PMC3618098

• Uterine leiomyosarcoma manifesting as a tricuspid valve mass. Case reports in oncology Marak, C. P., Ponea, A. M., Alappan, N., Shaheen, S., Guddati, A. K. 2013; 6 (1): 119-26

  Abstract

  Uterine leiomyosarcoma is a rare malignancy and carries a poorer prognosis when compared to endometrial carcinoma. It has been observed to metastasize to all the major organs. It presents with symptoms of abdominal distension, vaginal bleeding and may pass unnoticed until an advanced stage in patients with leiomyomas. Surgery is a viable option in patients with disease limited to the uterus, but metastasis to the heart may require surgery to prevent acute and catastrophic complications. The case described here involves metastasis to the tricuspid valve, which caused severe tricuspid regurgitation in the setting of acute pulmonary embolism. Surgical resection restored cardiac function and stabilized the patient. This case illustrates a rare site of metastasis of leiomyosarcoma which required immediate intervention and resulted in a favorable outcome.

  View details for DOI 10.1159/000346935

  View details for PubMedID 23569446

  View details for PubMedCentralID PMC3618104

• Extracavitary manifestation of primary effusion lymphoma as a right atrial mass. Case reports in oncology Marak, C. P., Ponea, A. M., Shim, C., Shaheen, S., Guddati, A. K. 2013; 6 (1): 114-8

  Abstract

  Primary effusion lymphoma (PEL) is a subset of large B cell lymphomas and has been mostly associated with human immunodeficiency virus infection. Rare cases have been reported in organ transplant recipients and chronic hepatitis C patients. It typically presents as an effusion in the pleural and pericardial spaces but rarely disseminates. However, involvement of the gastrointestinal tract, lymph nodes and bone marrow has been reported. Diagnosis is based on characteristic clinical, histopathological and immunohistochemical features. We present a case with a right atrial mass which tested positive for human herpes virus 8 (HHV-8), CD20, CD30 and lambda light chains and negative for CD138, kappa light chain, PAX5, Epstein-Barr virus, latent membrane protein 1, CD2, CD3, CD8 and CD56. Bilateral pleural effusions and pericardial effusions were noted which tested positive for HHV-8, CD30 and CD45. The patient responded well to the R-EPOCH regimen with complete resolution of the effusions and a significant decrease in the size of the right atrial mass. This case report illustrates the atypical manifestation of PEL as a right atrial mass.

  View details for DOI 10.1159/000346838

  View details for PubMedID 23569445

  View details for PubMedCentralID PMC3618032

• Cutaneous metastasis of uterine adenocarcinoma: a case report and review of the literature. Cutis Selim, A. A., Shaheen, S., Lockshin, N., Khachemoune, A. 2009; 84 (1): 33-8

  Abstract

  Cutaneous metastases from cancer are relatively uncommon in clinical practice but when present may herald the diagnosis of internal malignancy. The most common sources of primary cancer are the breasts, lungs, large bowel, oral cavity, kidneys, stomach, ovaries, and malignant melanoma. Despite the high incidence of uterine adenocarcinoma, cutaneous metastases are uncommon. The most common presentation of cutaneous metastases is rapidly developing nodules or tumors. The diagnosis of cutaneous metastatic carcinoma hinges on histopathologic evaluation of the involved skin. We discuss and review the diagnosis and management of cutaneous metastasis of uterine adenocarcinoma.

  View details for PubMedID 19743722

• Melanotic neuroectodermal tumor of infancy: review of literature and case report. Journal of pediatric surgery Selim, H., Shaheen, S., Barakat, K., Selim, A. A. 2008; 43 (6): E25-9

  Abstract

  Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon, fast-growing, pigmented neoplasm of neural crest origin. It primarily affects the maxilla of the infants during the first year of life. Approximately, a few hundred of these tumors have been reported in medical literature. We present a case of a newborn with MNTI involving the anterior maxillary region. The treatment included surgical excision of the lesion with safe margins, using an intraoral approach and removal of associated developing tooth buds. We made no attempt at immediate bone grafting. The patient had no recurrence at 1 year postoperatively. The diagnostic features and management alternatives of MNTI are discussed.

  View details for DOI 10.1016/j.jpedsurg.2008.02.068

  View details for PubMedID 18558161