Medical Journal of Obstetrics and Gynecology

An Unusual Dual Site Late Recurrence following Surgery for Low-Risk Endometroid Carcinoma: A Report of a Case

Case Report | Open Access | Volume 5 | Issue 3

  • 1. Department of Gynaecological Oncology, Bart health NHS Trust, United Kingdom
  • 2. Department of Clinical Oncology, Barts health NHS Trust, St. Bartholomews Hospital, United Kingdom
  • 3. Department of Radiology, Bart health NHS Trust, St. Bartholomews Hospital, United Kingdom
  • 4. Department of Pathology, Bart health NHS Trust, St. Bartholomews Hospital, United Kingdom
+ Show More - Show Less
Corresponding Authors
Saurabh V Phadnis, Department of Gynaecological Oncology, Bart health NHS Trust, Royal London Hospital, Whitechapel Road E11BB, London, United Kingdom, Tel: 00442035942754; Fax: 00442035942792.

Low grade endometroid endometrial carcinoma has a low recurrence rate. We report diagnosis and management of an unusual case of late recurrence at dual site.


Phadnis SV, Powell M, Hameeduddin A, Singh N, Brockbank E (2017) An Unusual Dual Site Late Recurrence following Surgery for Low-Risk Endometroid Carcinoma: A Report of a Case. Med J Obstet Gynecol 5(3): 1103.


•    Endometroid carcinoma
•    Recurrence


FIGO: International Federation of Gynaecology and Obstetrics; LVSI: Lymphovascular Invasion; GO MDT: Gynaecological Oncology Multidisciplinary Team; DVT: Deep Vein Thrombosis; ALT: Alanine Transaminase; CT: Computed Tomography; PET: Positron Emission Tomography; ER: Estrogen Receptor; ESMO: European Society of Medical Oncology; ER: Estrogen Receptor; PR: Progesterone Receptor


Cancer of the uterus is the fourth most common female cancer in the United Kingdom, with an increasing trend of incidence of approximately 65% since 1970. Most patients with uterine cancer are diagnosed at an early stage, with up to 83% diagnosed at stage 1 or 2 and have a five-year survival of up to 90% [1-3]. Literature review suggests that approximately 10-15 % of patients with early-stage endometrial cancer will recur [4,5]. Most recurrences are loco regional and up to 80% are within three years of the initial diagnosis [6]. We report an unusual case of late dual site recurrence from an initial early stage endometroid carcinoma and discuss the dilemma of diagnosis and management.


A 55-year old postmenopausal woman was referred to our one-stop gynaecology clinic with history of persistent vaginal discharge and was found to have an endometrial thickness of 12 mm on transvaginal ultrasound. She underwent an endometrial biopsy which identified a grade 1 endometroid endometrial carcinoma. On immunohistochemistry, there was normal expression of the DNA mismatch repair gene proteins MLH-1, MSH-2, MSH-6 and focal loss of PMS-2. Her body mass index was 44 with a weight of 123 kg. She had a total laparoscopic hysterectomy and bilateral salpingoopherectomy. There was no evidence of endometriosis. Pathology confirmed International Federation of Gynaecology and Obstetrics (FIGO) stage 1A grade 1 endometroid endometrial carcinoma (Figure 1A). There was no evidence of myometrial invasion and no lymphovascular invasion (LVSI). Therefore, after discussion at the gynaeocological oncology multidisciplinary team meeting (GO MDT), no adjuvant treatment was offered and regular follow up in the surgical clinic was planned.

Five years from her initial diagnosis of endometrial cancer, she presented to her general practitioner with upper abdominal pain. She had a laparoscopic cholecystectomy for gallstones in the previous year, which was complicated by post-operative deep vein thrombosis (DVT). Liver function test were requested, which revealed slight increase in serum alanine transaminase (ALT), 37unit/L. This prompted an ultrasound examination of the liver, which showed calcifications within liver parenchyma and she was referred to a Hepatologist. A triple-phase liver computed tomography (CT) scan suggested a lesion in the right liver dome. There was evidence of concentric wall thickening at the recto sigmoid junction and suspicion of malignancy was raised. Her case was discussed in the lower gastrointestinal tract multidisciplinary meeting. Further Positron Emission Tomography with 2-deoxy-2(fluorine-18) fluoro-D-glucose integrated with computed tomography (F-FDG PET/CT) scan and colonoscopy to investigate the recto sigmoid lesion was organised. Colonoscopy revealed a distal ulcerated polypoid sigmoid lesion 20 cm from the anus, biopsies of which were obtained. The F-FDG PET/CT scan revealed a metabolically active lesion along the right dome of the liver (Figure 2A) and a further metabolically active lesion extrinsic to the rectosigmoid junction (Figure 2B). Histopathology of the biopsy from the sigmoid lesion taken at colonoscopy was re-reviewed by our pathologist with interest in gynaecological malignancy and immunohistochemistry was strongly positive for estrogen receptor (ER) and progesterone receptor (PR) as well as CK7. Staining was negative for CK20 and CDX2. Paradoxically the background colonic crypts were CK20, CDX2 positive and ER, PR, CK7 negative which confirmed recurrent endometroid endometrial carcinoma. Immunohistochemistry Biopsy of the liver lesion under ultrasound guidance was performed which confirmed metastatic adenocarcinoma with strong estrogen receptor (ER) positivity and patchy CK7 expression. This was consistent with recurrence of endometrial carcinoma.

Her case, including imaging and histopathology, was reviewed at the GO MDT and decision to offer surgical resection of the recurrent disease was made. She underwent a laparotomy with recto sigmoid resection with division of large bowel 10 cm above and below the visible tumors, primary colorectal anastomosis with defunctioning ileostomy and non-anatomical liver resection from the right dome of the liver, after complete liver mobilization and pringle manoeuvre (Figure 1B). This was a joint surgical procedure between the gynaecological oncology, colorectal and hepatobiliary surgical team. She had an uncomplicated post-operative recovery.

A post-operative review was completed in the GO MDT. Pathology confirmed presence of grade 2 metastatic endometroid carcinoma in both the recto sigmoid and liver resection specimens. She was reviewed by the clinical oncology team and is to receive six cycles of adjuvant chemotherapy with carboplatin and paclitaxel.


Our case report highlights an unusual pattern of recurrence, both in relation to the time interval from the initial treatment and the sites of involved recurrence. After her initial surgery, our patient was deemed to be in the low risk group for recurrence as per the clinical and pathologic prognostic factors defined by European Society of Medical Oncology (ESMO), including the age at diagnosis, FIGO stage, depth of myometrial invasion, tumour differentiation grade, tumour type and LVSI [7-9]. Following evidence from large randomized control trials including PORTEC, ASTEC and EN.5 it is clear that patients with low-risk endometrial cancer have no benefit from adjuvant vault brachytherapy, likely because the risk of recurrence after surgery alone is < 5%. Therefore, current recommendations are that no adjuvant treatment is indicated for patients with low-risk endometrial cancer [10-14]. Our patient was initially diagnosed with a grade 1 stage 1A endometroid carcinoma and therefore had surgery alone as curative treatment without any adjuvant treatment.

A large multicentre study from France reported 9% recurrence rate in 256 patients with low-risk endometrial cancer group. Most recurrences were either the vaginal vault or nodal (either pelvic and/or para-aortic). The mean time interval to regional recurrence was 28 months [15]. In literature, the reported rates of loco-regional, distant and mixed recurrences vary widely from 2.1 to 14% in the background of a low-risk endometrial carcinoma [16,17]. Our patient had unusual sites of recurrence potentially causing minimal symptoms and hence the dilemma in diagnosis. Moreover, the time interval between the initial diagnosis and recurrence was more than five years, which is when patients of low-risk endometrial cancer are discharged from routine follow up in the surgical clinic. There is much controversy in literature regarding optimal postoperative follow up strategies. Some have suggested intensive and prolonged follow up regimens to aid early diagnosis of recurrence [18-20]. It is worth noting that the ESMO-ESGO-ESTRO guidelines do not suggest specific follow up regimen whilst the NCCN guidelines recommend physical examination every 3 to 6 months for 2-3 years and then every 6 months or annually [21,22]. Moreover, there is now evidence that a nurse-led telephone follow up is as effective as hospital follow up with equivalent patient satisfaction for patients following surgery for low-risk endometrial carcinoma [23].

For patients with recurrent disease, surgery is recommended only if optimal cyto reduction (no residual disease) can be achieved. Retrospective data from 14 publications including 672 patients with advanced or recurrent disease who underwent surgical resection had overall survival benefit which was positively associated with an increasing proportion of patients with no residual disease (each 10% increase improved survival by 9.3 months). Exenteration is considered for central pelvic relapse [24]. Our GO MDT suggested surgical resection for recurrence in this patient as after careful evaluation it was thought that complete cyto reduction was achievable.

Thus, we have managed an unusual case of recurrence of a low-risk endometrial carcinoma with a multidisciplinary approach.


1. National Cancer Intelligence Network. Stage breakdown by CCG 2014, London, NCIN. 2016.

2. Northern Ireland Cancer Registry, Queens University Belfast, Incidence by stage 2010-2014, Belfast, NICR. 2016.

3. National Cancer Registration and Analysis Service. Routes to diagnosis of cancer by stage 2012-2013 workbooks, London, NCRAS. 2016.

4. Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991; 40: 55-65.

5. Hirahatake K, Hareyama H, Sakuragi N, Nishiya M, Makinoda S, Fujimoto S. A clinical and pathologic study on para-aortic lymph node metastasis in endometrial carcinoma. J Surg Oncol. 1997; 65: 82-87.

6. Sohaib SA, Houghton SL, Meroni R, Rockall AG, Blake P, Reznek RH. Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis. Clin Radiol. 2007; 62: 28-34; discussion 35- 36.

7. Colombo N, Preti E, Landoni F, Carinelli, Colombo A, Marini C, et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24: vi33-vi38.

8. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987; 60: 2035-2041.

9. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005; 366: 491-505.

10. Blake P, Swart AM, Orton J, Kitchener H, Whelan T, Lukka H, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer [MRC ASTEC and NCIG CTG EN.5 randomised trials]: pooled trial results, systematic review, and meta-analysis. Lancet. 2009; 373: 137-146.

11. Creutzberg CL, Van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage 1 endometrial carcinoma: multicentre randomised trial. PORTEC study group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000; 355: 1404-1411.

12. Keys HM, Roberts JA, Zaino RJ, Spirtos NM, Bloss JD, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004; 92: 744- 751.

13. Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012; 104: 1625-1634.

14. Sorbe B, Nordström B, Mäenpää J, Kuhelj J, Kuhelj D, Okkan S, et al. Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer. 2009; 19: 873-878.

15. Bendifallah S, Ouldamer L, Lavoue V, Canlorbe G, Raimond E, Coutant C, et al. Patterns of recurrence and outcomes in surgically treated women with endometrial cancer according to ESMO-ESGO-ESTRO Consensus Conference risk groups: Results from the FRANCOGYN study Group. Gynecol Oncol. 2017; 144: 107-112.

16. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gyneco. Gynecol Oncol. 2004; 92: 744-751.

17. Murali R, Soslow RA, Weigelt B. Classification of endometrial carcinoma: more than two types. Lancet Oncol. 2014; 15: 268-278.

18. Ben Arie A, Lavie O, Gdalevich M, Voldarsky M, Barak F, Schneider D, et al. Temporal pattern of recurrence of stage I endometrial cancer in relation to histological risk factors. Eur J Surg Oncol. 2012; 38: 166- 169.

19. Dunn EF, Geye H, Platta CS, Gondi V, Rose S, Bradley KA, et al. Predictive factors of recurrence following adjuvant vaginal cuff brachytherapy alone for stage I endometrial cancer. Gynecol Oncol. 2014; 133: 494- 498.

20. Kondalsamy-Chennakesavan S, Yu C, Kattan MW, Leung Y, Sykes P, Nascimento M, et al. Nomograms to predict isolated loco-regional or distant recurrence among women with uterine cancer. Gynecol Oncol. 2012; 125: 520-525.

21. Colombo N, Creutzberg C, Amant F, Bosse, A. González-Martín, J. Ledermann, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow up. Ann Oncol. 2016; 27: 16-41.

22. Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Chan J, et al. Uterine neoplasms, version 1.2014. J Natl Compr Canc Netw. 2014; 12: 248-280.

23. Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer [ENDCAT trial]: a randomised, multicentre, non-inferiority trial. BJOG. 2017; 124: 150-160.

24. Barlin JN, Puri I, Bristow RE. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis. Gynecol Oncol. 2010; 118: 14-18.

Phadnis SV, Powell M, Hameeduddin A, Singh N, Brockbank E (2017) An Unusual Dual Site Late Recurrence following Surgery for Low-Risk Endometroid Carcinoma: A Report of a Case. Med J Obstet Gynecol 5(3): 1103.

Received : 03 Apr 2017
Accepted : 10 May 2017
Published : 13 May 2017
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X