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BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ

Yıl 2015, Cilt: 5 Sayı: 1, 41 - 46, 27.02.2015

Öz

ÖZET
Amaç: Testis kanseri (Tca) erkeklerde görülen ürogenital malignitelerin yaklaşık %20’sini, tüm erkek maligni-
telerinin yaklaşık %1-2’sini oluşturmasına rağmen, 15-35 yaş arası en sık görülen solid kanserlerdir. Kriptorşi- dizm, testiküler mikrolitiasis, Klinifelter ve Down Sendromu Tca için risk faktörleridir. Tca’lerinin %95’i germinal dokudan köken alır. Bu tümörler seminomatöz ve nonseminomatöz (embriyonel hücreli karsinom, teratom, koryokarsinom, yolk kesesi tümörü) olarak iki gruba ayrılmaktadır. Biz bu çalışmada, bölgemizde yaşayan Tca tanısı almış hastaların genel özelliklerini ve tedavi seçeneklerini retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntemler: 01.01.2012-30.07.2013 tarihleri arasında Bolu Abant İzzet Baysal Üniversitesi Tıp Fakülte- si, tıbbi onkoloji polikliniğine başvuran Tca’li hastaların demografik özellikleri ve tedavi seçenekleri retrospektif olarak değerlendirildi.
Bulgular: Bu süre içinde median yaşı 31(22-45) yıl olan 15 hastanın başvurduğu bulundu. İlk başvuru şikayeti olarak 11’nunda (%74) testiste kitle, 2’sinde (%13) ağrı, 2’sinde (%13) kitle ile birlikte ağrı vardı. Hastaların
14’ünde tümör unilateral, 1’inde bilateraldi. Tümör boyutu ortalama 4(0.8-10) cm’di. Hastaların tümörlerinin
7’si seminomatöz, 7’si nonseminomatöz ve bilateral tümörlü hastanın sağ testisi seminomatöz, diğeri nonse- minomatöz histolojiye sahipti. Orşiektomi sonrası seminomatöz evre IA olan 2 hastaya karboplatin, 1 hastaya izlem, evre IB olan 2 hastaya karboplatin, 1 hastaya izlem, evre IIB olan 1 hastaya bleomisin, etoposid, sisplatin (BEP) kemoterapisi verildiği, nonseminomatöz evre IA 2 hastaya izlem, evre II ve üzeri hastalara ise BEP kemo- terapisi verildiği görüldü.
Sonuç: Bolu ilindeki Tca’li hastaların değerlendirildiği bu retrospektif analiz sonuçları literatür ile uyumlu bu- lundu. Türkiye verilerini elde edebilmek için diğer illerinde dahil edileceği, daha fazla hasta katılımıyla yapılacak çalışmaların gerekli olduğunu düşünmekteyiz.
Anahtar kelimeler: Testis kanseri; Kemoterapi; Orşiektomi

ABSTRACT
Objective: ATesticular cancer (Tca) consists of approximately %20 of urogenital malignancy in men, and
approximately %1 to 2 of all male malignancies. Tca is the most common solid tumor in males aged between
15 to 35 years. There are many risk factors related to Tca such as cryptorchidism, testicular microlithiasis, klinefelter and Down syndrome. 95% of Tca is derived from germinal tissue. Germ cell tumor is classified into two groups: seminomatous and nonseminomatous (embryonic carcinoma cell, teratoma, choriocarcinoma, yolk sac tumor). In this study, we aimed to evaluate general characteristics and treatment modalities of the patients with diagnosis of Tca living in our region.
Material and Methods: Demographic characteristics and treatment modalities of the patients with Tca followed at Bolu Abant İzzet Baysal University Medicine Faculty, Medical Oncology outpatient clinic between
01.01.2012 and 30.07.2013 were evaluated retrospectively.
Results: Fifteen patients with median age of 31 (22-45) were included in the study. As the first compliant, 11 patients (%74) reported a mass within the testis, 2 patients (%13) reported pain, and 2 patients (%13) claimed both pain and mass. The tumor was unilateral in 14 patients and bilateral in 1 patient. The median tumor size was 4 (0.8-10) cm. 7 patients had seminomatous histology and 7 patients had nonseminomatous histology. The patient with bilateral tumor had seminomatous histology in the right testis and nonseminomatous histology in the left testis. After orchiectomy, two patients with seminomatous stage IA were given carboplatin and one patient was followed without chemotherapy; two patients with   stage IB were given carboplatin and one patient was followed without chemotherapy; one patient with stage IIB was given bleomycin, etoposide, cisplatin (BEP) chemotherap; 2 patients with nonseminomatous stage IA were followed without chemotherapy; the patientswith stage II and above were given BEP chemotherapy.
Conclusion: We concluded that our results were in consistent with the literature. We assumed that further studies are needed in other part of the country to obtain the data of Turkish population.
Keywords: Testicular cancer; Chemotherapy; Orchiectomy

Kaynakça

  • Parkin DM, Ferlay J, Curado MP, Bray F, Edwards B, Shin HR, et al. Fifty years of cancer incidence: CI5 I–IX. International Journal of Cancer. 2010;127(12):2918-27.
  • Garner MJ, Turner MC, Ghadirian P, Krewski D. Epidemiology of testicular cancer: an overview. International Journal of Cancer. 2005;116(3):331-9.
  • Huyghe E, Matsuda T, Thonneau P. Increasing incidence of testicular cancer worldwide: a review. The Journal of Urology. 2003;170(1):5-11.
  • Ekbom A, Richiardi L, Akre O, Montgomery SM, Sparen P. Age at immigration and duration of stay in relation to risk for testicular cancer among Finnish immigrants in Sweden. Journal of the National Cancer Institute. 2003;95(16):1238
  • Zheng T, Holford TR, Ma Z, Ward BA, Flannery J, Boyle P. Continuing increase in incidence of germ-cell testis cancer in young adults: experience from Connecticut, USA, 1935- 19 International Journal of Cancer. 1996;65(6):723-9.
  • Batata MA, Chu FC, Hilaris BS, Whitmore WF, Golbey RB. Testicular cancer in cryptorchids. Cancer. 1982;49(5):1023
  • Hemminki K, Chen B. Familial risks in testicular cancer as aetiological clues. International journal of andrology. 2006;29(1):205-10.
  • Lyter DW, Bryant J, Thackeray R, Rinaldo CR, Kingsley LA. Incidence of human immunodeficiency virus-related and nonrelated malignancies in a large cohort of homosexual men. Journal of Clinical Oncology. 1995;13(10):2540-6.
  • Dieckmann KP, Rube C, Henke RP. Association of Down’s syndrome and testicular cancer. The Journal of Urology. 1997;157(5):1701-4.
  • Hasle H, Mellemgaard A, Nielsen J, Hansen J. Cancer incidence in men with Klinefelter syndrome. British Journal of Cancer. 1995;71(2):416-20.
  • Tan IB, Ang KK, Ching BC, Mohan C, Toh CK, Tan MH. Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. Cancer. 2010;116(19):4520-32.
  • Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11-30.
  • Nikzas D, Champion A, Fox M. Germ cell tumours of testis: prognostic factors and results. European urology. 1989;18(4):242-7.
  • Holmes L, Jr., Escalante C, Garrison O, Foldi BX, Ogungbade GO, Essien EJ, et al. Testicular cancer incidence trends in the USA (1975-2004): plateau or shifting racial paradigm? Public Health. 2008;122(9):862-72.
  • Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Sogaard H, et al. Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases. Acta radiologica Oncology. 1984;23(4):239-47.
  • Wood HM, Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. The Journal of Urology. 2009;181(2):452-61.
  • Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World Journal of Urology. 2004;22(1):2-14.
  • Campbell HE. Incidence of malignant growth of the undescended testicle: a critical and statistical study. Archives of Surgery. 1942;44(2):353.
  • Germa-Lluch JR, Garcia del Muro X, Maroto P, Paz-Ares L, Arranz JA, Guma J, et al. Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish Germ-Cell Cancer
  • Group (GG). Eur Urol. 2002;42(6):553-63.
  • La Vecchia C, Bosetti C, Lucchini F, Bertuccio P, Negri E, Boyle P, et al. Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975. Annals of Oncology. 2010;21(6):1323-60.
  • Dieckmann KP, Boeckmann W, Brosig W, Jonas D, Bauer HW. Bilateral testicular germ cell tumors. Report of nine cases and review of the literature. Cancer. 1986;57(6):1254
  • Bulent A, Taner DR, Tolga T, Sertac Y, Celik T, Ferruh Z, et al. Bilateral testicular germ cell tumors in Turkey: increase in incidence in last decade and evaluation of risk factors in 30 patients. The Journal of urology. 2007;178(1):129-33.
  • Coli A, Bigotti G, Dell’Isola C, Castri F, Rulli F, Massi G. Synchronous bilateral testicular germ cell tumor with different histology. Case report and review of the literature. Urologia internationalis. 2003;71(4):412-7.
  • Bahrami A, Ro JY, Ayala AG. An overview of testicular germ cell tumors. Arch Pathol Lab Med. 2007;131(8):1267
  • Deotra A, Mathur DR, Vyas MC. A 18 years study of testicular tumours in Jodhpur, western Rajasthan. Journal of Postgraduate Medicine. 1994;40(2):68-70.
  • Javadpour N. The role of biologic tumor markers in testicular cancer. Cancer. 1980;45(7 Suppl):1755-61.
  • Mencel PJ, Motzer RJ, Mazumdar M, Vlamis V, Bajorin DF, Bosl GJ. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. Journal of clinical oncology: 1994 Jan;12(1):120-6.
  • Mostofi FK, Sesterhenn IATumours of the Testis and Paratesticular Tissue. In Epstein J, Eble J, Sauter G, Sesterhenn IA, eds. World Health Organization Classification of tumors: pathology and genetics of tumours of the urinary system and male genital organs, World Health Organization Classification of tumors. Lyon. IARCpress. 2004. p. 217-58.
  • Mead GM, Fossa SD, Oliver RT, Joffe JK, Huddart RA, Roberts JT, et al. Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up. Journal of the National Cancer Institute. 2011;103(3):241-9.
  • Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366(9482):293-300.
  • Jones WG, Fossa SD, Mead GM, Roberts JT, Sokal M, Horwich A, et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). Journal of clinical oncology. 2005;23(6):1200-8.
  • Detti B, Livi L, Scoccianti S, Gacci M, Lapini A, Cai T, et al. Management of Stage II testicular seminoma over a period of 40 years. Urologic oncology. 2009;27(5):534-8.
  • Sturgeon JF, Moore MJ, Kakiashvili DM, Duran I, Anson-Cartwright LC, Berthold DR, et al. Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital’s experience. Eur Urol. 2011;59(4):556-62.
  • Stephenson AJ, Bosl GJ, Motzer RJ, Bajorin DF, Stasi JP, Sheinfeld J. Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer. Journal of clinical oncology. 2007;25(35):5597-602.
Yıl 2015, Cilt: 5 Sayı: 1, 41 - 46, 27.02.2015

Öz

Objective: ATesticular cancer (Tca) consists of approximately %20 of urogenital malignancy in men, and approximately %1 to 2 of all male malignancies. Tca is the most common solid tumor in males aged between 15 to 35 years. There are many risk factors related to Tca such as cryptorchidism, testicular microlithiasis, klinefelter and Down syndrome. 95% of Tca is derived from germinal tissue. Germ cell tumor is classified into two groups: seminomatous and nonseminomatous (embryonic carcinoma cell, teratoma, choriocarcinoma, yolk sac tumor). In this study, we aimed to evaluate general characteristics and treatment modalities of the patients with diagnosis of Tca living in our region.Material and Methods: Demographic characteristics and treatment modalities of the patients with Tca followed at Bolu Abant İzzet Baysal University Medicine Faculty, Medical Oncology outpatient clinic between 01.01.2012 and 30.07.2013 were evaluated retrospectively.Results: Fifteen patients with median age of 31 were included in the study. As the first compliant, 11 patients (%74) reported a mass within the testis, 2 patients (%13) reported pain, and 2 patients (%13) claimed both pain and mass. The tumor was unilateral in 14 patients and bilateral in 1 patient. The median tumor size was 4 cm. 7 patients had seminomatous histology and 7 patients had nonseminomatous histology. The patient with bilateral tumor had seminomatous histology in the right testis and nonseminomatous histology in the left testis. After orchiectomy, two patients with seminomatous stage IA were given carboplatin and one patient was followed without chemotherapy; two patients with stage IB were given carboplatin and one patient was followed without chemotherapy; one patient with stage IIB was given bleomycin, etoposide, cisplatin (BEP) chemotherap; 2 patients with nonseminomatous stage IA were followed without chemotherapy; the patientswith stage II and above were given BEP chemotherapy. Conclusion: We concluded that our results were in consistent with the literature. We assumed that further studies are needed in other part of the country to obtain the data of Turkish population

Kaynakça

  • Parkin DM, Ferlay J, Curado MP, Bray F, Edwards B, Shin HR, et al. Fifty years of cancer incidence: CI5 I–IX. International Journal of Cancer. 2010;127(12):2918-27.
  • Garner MJ, Turner MC, Ghadirian P, Krewski D. Epidemiology of testicular cancer: an overview. International Journal of Cancer. 2005;116(3):331-9.
  • Huyghe E, Matsuda T, Thonneau P. Increasing incidence of testicular cancer worldwide: a review. The Journal of Urology. 2003;170(1):5-11.
  • Ekbom A, Richiardi L, Akre O, Montgomery SM, Sparen P. Age at immigration and duration of stay in relation to risk for testicular cancer among Finnish immigrants in Sweden. Journal of the National Cancer Institute. 2003;95(16):1238
  • Zheng T, Holford TR, Ma Z, Ward BA, Flannery J, Boyle P. Continuing increase in incidence of germ-cell testis cancer in young adults: experience from Connecticut, USA, 1935- 19 International Journal of Cancer. 1996;65(6):723-9.
  • Batata MA, Chu FC, Hilaris BS, Whitmore WF, Golbey RB. Testicular cancer in cryptorchids. Cancer. 1982;49(5):1023
  • Hemminki K, Chen B. Familial risks in testicular cancer as aetiological clues. International journal of andrology. 2006;29(1):205-10.
  • Lyter DW, Bryant J, Thackeray R, Rinaldo CR, Kingsley LA. Incidence of human immunodeficiency virus-related and nonrelated malignancies in a large cohort of homosexual men. Journal of Clinical Oncology. 1995;13(10):2540-6.
  • Dieckmann KP, Rube C, Henke RP. Association of Down’s syndrome and testicular cancer. The Journal of Urology. 1997;157(5):1701-4.
  • Hasle H, Mellemgaard A, Nielsen J, Hansen J. Cancer incidence in men with Klinefelter syndrome. British Journal of Cancer. 1995;71(2):416-20.
  • Tan IB, Ang KK, Ching BC, Mohan C, Toh CK, Tan MH. Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. Cancer. 2010;116(19):4520-32.
  • Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11-30.
  • Nikzas D, Champion A, Fox M. Germ cell tumours of testis: prognostic factors and results. European urology. 1989;18(4):242-7.
  • Holmes L, Jr., Escalante C, Garrison O, Foldi BX, Ogungbade GO, Essien EJ, et al. Testicular cancer incidence trends in the USA (1975-2004): plateau or shifting racial paradigm? Public Health. 2008;122(9):862-72.
  • Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Sogaard H, et al. Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases. Acta radiologica Oncology. 1984;23(4):239-47.
  • Wood HM, Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. The Journal of Urology. 2009;181(2):452-61.
  • Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World Journal of Urology. 2004;22(1):2-14.
  • Campbell HE. Incidence of malignant growth of the undescended testicle: a critical and statistical study. Archives of Surgery. 1942;44(2):353.
  • Germa-Lluch JR, Garcia del Muro X, Maroto P, Paz-Ares L, Arranz JA, Guma J, et al. Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish Germ-Cell Cancer
  • Group (GG). Eur Urol. 2002;42(6):553-63.
  • La Vecchia C, Bosetti C, Lucchini F, Bertuccio P, Negri E, Boyle P, et al. Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975. Annals of Oncology. 2010;21(6):1323-60.
  • Dieckmann KP, Boeckmann W, Brosig W, Jonas D, Bauer HW. Bilateral testicular germ cell tumors. Report of nine cases and review of the literature. Cancer. 1986;57(6):1254
  • Bulent A, Taner DR, Tolga T, Sertac Y, Celik T, Ferruh Z, et al. Bilateral testicular germ cell tumors in Turkey: increase in incidence in last decade and evaluation of risk factors in 30 patients. The Journal of urology. 2007;178(1):129-33.
  • Coli A, Bigotti G, Dell’Isola C, Castri F, Rulli F, Massi G. Synchronous bilateral testicular germ cell tumor with different histology. Case report and review of the literature. Urologia internationalis. 2003;71(4):412-7.
  • Bahrami A, Ro JY, Ayala AG. An overview of testicular germ cell tumors. Arch Pathol Lab Med. 2007;131(8):1267
  • Deotra A, Mathur DR, Vyas MC. A 18 years study of testicular tumours in Jodhpur, western Rajasthan. Journal of Postgraduate Medicine. 1994;40(2):68-70.
  • Javadpour N. The role of biologic tumor markers in testicular cancer. Cancer. 1980;45(7 Suppl):1755-61.
  • Mencel PJ, Motzer RJ, Mazumdar M, Vlamis V, Bajorin DF, Bosl GJ. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. Journal of clinical oncology: 1994 Jan;12(1):120-6.
  • Mostofi FK, Sesterhenn IATumours of the Testis and Paratesticular Tissue. In Epstein J, Eble J, Sauter G, Sesterhenn IA, eds. World Health Organization Classification of tumors: pathology and genetics of tumours of the urinary system and male genital organs, World Health Organization Classification of tumors. Lyon. IARCpress. 2004. p. 217-58.
  • Mead GM, Fossa SD, Oliver RT, Joffe JK, Huddart RA, Roberts JT, et al. Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up. Journal of the National Cancer Institute. 2011;103(3):241-9.
  • Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366(9482):293-300.
  • Jones WG, Fossa SD, Mead GM, Roberts JT, Sokal M, Horwich A, et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). Journal of clinical oncology. 2005;23(6):1200-8.
  • Detti B, Livi L, Scoccianti S, Gacci M, Lapini A, Cai T, et al. Management of Stage II testicular seminoma over a period of 40 years. Urologic oncology. 2009;27(5):534-8.
  • Sturgeon JF, Moore MJ, Kakiashvili DM, Duran I, Anson-Cartwright LC, Berthold DR, et al. Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital’s experience. Eur Urol. 2011;59(4):556-62.
  • Stephenson AJ, Bosl GJ, Motzer RJ, Bajorin DF, Stasi JP, Sheinfeld J. Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer. Journal of clinical oncology. 2007;25(35):5597-602.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Bölüm Orjinal Çalışma
Yazarlar

Uğur Üyetürk Bu kişi benim

Ümmügül Üyetürk Bu kişi benim

Ahmet Metin Bu kişi benim

Yayımlanma Tarihi 27 Şubat 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 5 Sayı: 1

Kaynak Göster

APA Üyetürk, U., Üyetürk, Ü., & Metin, A. (2015). BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ. Bozok Tıp Dergisi, 5(1), 41-46.
AMA Üyetürk U, Üyetürk Ü, Metin A. BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ. Bozok Tıp Dergisi. Şubat 2015;5(1):41-46.
Chicago Üyetürk, Uğur, Ümmügül Üyetürk, ve Ahmet Metin. “BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ”. Bozok Tıp Dergisi 5, sy. 1 (Şubat 2015): 41-46.
EndNote Üyetürk U, Üyetürk Ü, Metin A (01 Şubat 2015) BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ. Bozok Tıp Dergisi 5 1 41–46.
IEEE U. Üyetürk, Ü. Üyetürk, ve A. Metin, “BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ”, Bozok Tıp Dergisi, c. 5, sy. 1, ss. 41–46, 2015.
ISNAD Üyetürk, Uğur vd. “BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ”. Bozok Tıp Dergisi 5/1 (Şubat 2015), 41-46.
JAMA Üyetürk U, Üyetürk Ü, Metin A. BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ. Bozok Tıp Dergisi. 2015;5:41–46.
MLA Üyetürk, Uğur vd. “BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ”. Bozok Tıp Dergisi, c. 5, sy. 1, 2015, ss. 41-46.
Vancouver Üyetürk U, Üyetürk Ü, Metin A. BOLU İLİNDEKİ TESTİS KANSERLİ HASTALARIN RETROSPEKTİF ANALİZİ. Bozok Tıp Dergisi. 2015;5(1):41-6.
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