Term
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Definition
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Term
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Definition
Ankylosing Spondylitis, Reactive Arthritis |
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Term
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Definition
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Term
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Definition
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Term
Infiltration by inflammatory cells (CD4, T+ B cells),release of cytokines IL-1 & TNF-alpha, increased vascularity, aggregation of fibrin - formation of pannus |
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Definition
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Term
Osteoclastic activity in underlying bone driven by RANKL from T-cells and synovial fibroblasts |
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Definition
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Term
AM stiffness, soft tissue swelling of 3+ jts, PIP, MCP or wrist involvement - symmetric |
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Definition
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Term
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Definition
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Term
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Definition
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Term
Ulnar Deviation of Fingers |
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Definition
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Term
Arthritis, uveitis in a child under 16 |
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Definition
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Term
Triad of: Arthritis, urethritis/ nongonococcal cervicitis, conjunctivitis |
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Definition
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Term
Asymmetrical sterile arthritis following a GU or GI infection |
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Definition
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Term
Symmetric arthritis of the LEs in a pt. with Chron's ds |
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Definition
Arthritis of Inflammatory Bowel Ds |
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Term
AM stiffness in the axial spine, B/L SI involvement |
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Definition
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Term
Loss of flexibility in the spine, loss of chest expansion |
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Definition
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Term
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Definition
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Term
Asymmetric arthritis of the DIP joints in a pt with nail pitting |
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Definition
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Term
Pencil-in-cup appearance of phalanges on X-ray |
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Definition
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Term
RA, splenomegaly, abnormally low WBC count (granulocytopenia) |
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Definition
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Term
Lymphocyte infiltration of exocrine glands (esp. salivary and lacrimal glands) |
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Definition
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Term
Dry eyes, Dry Mouth, B/L Parotid gland swelling |
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Definition
Sjogren's Syndrome (Sicca Syndrome) |
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Term
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Definition
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Term
Rose Bengal Score or Lissamine Green Dye Test |
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Definition
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Term
Most common cause of Non-gonococcal bacterial arthritis |
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Definition
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Term
Acute onset of pain and swelling in the knee, fever in a 60y/o patient |
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Definition
Non-gonococcal Bacterial Arthritis |
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Term
Fever, chills, rash and acute onset of monoarthritis of the knee in a 27 y/o sexually active female |
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Definition
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Term
Insidious, progressive jt/ back pain in a patient with a positive PPD |
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Definition
Tuberculous Arthritis (Pott's Ds when spinal involvement) |
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Term
Acute onset of a symmetrical small joint arthralgia that is self-limiting |
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Definition
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Term
Most common causes of viral arthritis |
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Definition
Parvovirus B19, Rubella (including following a rubella vaccine), Hep B or C |
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Term
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Definition
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Term
Why distal joints are more affected by gout than proximal ones |
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Definition
Temperature - distal jts have a lower temp, so the MSU crystals precipitate out easier there |
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Term
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Definition
MSU crystals are chemotaxic to leukocytes, cytokines are released, inflammation follows; phagocytosis of crystals leads to cell repture and release of lysosomal enzymes furthering the inflammation(/ redness/ warmth?) |
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Term
Acute onset (hours) of monoarthritis of the first MTP jt - typically at night, accompanied by intense redness, heat and swelling |
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Definition
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Term
Associatd with consumption of red meat and EtOH |
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Definition
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Term
Negatively birefringent under polarizing light microscope |
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Definition
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Term
Another name for pseudogout |
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Definition
CPPD arthritis (calcium pyrophosphate dihydrate) |
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Term
At what age do S/S of MSU gout start? |
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Definition
Around age 18 in men, after menopause in women |
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Term
Associated with ANKH gene |
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Definition
Hereditary pseudogout; ANKH is a transmembrane inorganic pyrophosphate transport channel |
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Term
Pathophysiology of pseudogout |
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Definition
Crystals form in the articular matrix, menisci and intervertebral joint; seeding of the jt space induces chemokines, initiating a neutriphil invasion; free-radicals and cytokines are released and macrophages move into the joint with associated fibrosis |
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Term
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Definition
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Term
Calcium phosphate crystals, often deposited on vessels |
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Definition
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Term
Accumulation of iron in body tissues (esp. liver and pancreas) accompanied by osteoarthritis-like sxs |
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Definition
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Term
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Definition
The hemochromatosis gene, located on the short arm of chr.6, which encodes a molecule regulating iron absorption across the intestinal epithelium |
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Term
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Definition
Osteophytes in the DIP jts in patients with OA |
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Term
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Definition
Osteophytes in the PIP jts of patients with OA |
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Term
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Definition
Early changes involve a decrease in proteoglycans and an increase in water content with weakening of the collagen; IL1, TNF alpha and NO levels increase in the cartilage; chondrocyte apoptosis of the articular cartilage; eventually - thinning of the cartilage, subchondral sclerosis and osteophyte formation |
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Term
Deep, achy joint pain that worsens with use; jt enlargement; involvement of the DIP + PIP jts with MCP sparing |
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Definition
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Term
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Definition
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Term
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Definition
Alignment of bones, Bone integrity, Cartilage/ jt space, Deformities, Erosions, Soft Tissue involvement |
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Term
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Definition
Alignment of bones, Bone integrity, Cartilage/ jt space, Deformities, Erosions, Soft Tissue involvement |
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Term
Deep, achy pain referred to the paraspinal region that doesn't radiate and worsens on extension of the spine |
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Definition
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Term
Gold Standard in Dx of Facet Jt Syndrome |
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Definition
Diagnostic Nerve Block - blocking the n. to the joint with anesthetic and then blocking the joint iteself with anesthetic to determine which causes the pain to go away |
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Term
Fragments of bone and cartilage debris released into the joints with chronic synovitis |
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Definition
Pathognomonic for Neuropathic (Charcot) Joints |
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Term
Severely degenerated joints secondary to loss of innervation to the joint |
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Definition
Neuropathic (Charcot) Joints |
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Term
Ganglion v. Synovial Cyst |
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Definition
Ganglion cysts are typically small and located near a joint; synovial cysts represent herniated synovial membrane from a joint |
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Term
A cyst arising from a cystic or myxoid degeneration of CT; the cystic cavity lacks a true lining of cells |
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Definition
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Term
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Definition
A ganglion cyst on the dorsum of the wrist |
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Term
A cyst arising from synovial lining that has herniated thru the jt capsule |
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Definition
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Term
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Definition
A synovial cyst that develops in the popliteal space, often in the setting of an arthritis |
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Term
Benign neoplasms that develop in the synovial linings of jts, tendon sheaths, and bursae |
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Definition
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Term
Proliferation of synovial lining; contains chromosomal abnormalities |
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Definition
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Term
Patient presents wtih a slow-growing painless mass on the flexor surface of the middle finger |
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Definition
Giant cell Tumor of the Tendon Sheath (AKA: Localized nodular tenosynovitis) - the most common soft tissue tumor of the hand |
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Term
Pain, joint locking and recurrent swelling of the knee; a tangled mat of red-brown folds is seen in the synovium |
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Definition
Pigmented Villonodular Synovitis |
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Term
A dysraphism involving complete destruction of the SC |
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Definition
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Term
Adduction of the forefoot (causing the lateral border of the foot to appear convex) |
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Definition
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Term
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Definition
Metatarsus adductus(most common cause in kids <18mos), internal tibial torsion (most common cause in kids 18mos-3 yrs), internal femoral torsion (most common cuase in kids >3yrs) |
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Term
Cause of ~10% of scoliosis cases |
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Definition
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Term
Scoliosis appearing during or right after a growth spurt (ex: ~10 y/o) |
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Definition
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Term
Causes of Congenital Scoliosis |
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Definition
Partial or complete failure in vertebral formation; partial or complete failure in body segment formation |
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Term
B/L low/ absent longitudinal arch; arch flattens when weight bearing and foot becomes pronated |
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Definition
Hypermobile Pes Planus (rigid flat feet indicates a more concerning pathology) |
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Term
Autosomal dominant disorder of skeletal development with deficient/ imperfect ossification of bones such as the clavicle, cranium and pelvis |
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Definition
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Term
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Definition
Osteoblast specific transcription factor 2/ core binding factor activity 1 - two genes associated with Cleidocranial dysotsis; located on Chr. 6p21 |
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Term
Cause of Cleidocranial Dystosis |
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Definition
A mutation in the transcription factor CBFA1, which controls osteoblast differentiation |
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Term
4 common UE congenital Limb Abnormalities |
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Definition
1)hypoplasia or absence of the thumb; 2)radial deficiency; 3) ulnar deficiency; 4)transverse deficiency of the forearem (complete absence fo the hand and wrist can occur) |
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Term
3 common LE congenital abnormalities |
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Definition
1)fibular deficiency; 2)tibial deficiency; 3)longitudinal deficiency of the femur |
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Term
Abnormally high-positioned scapula |
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Definition
Sprengel Deformity- congenital, may see webbing of skin btwn neck and scap.; may be assoc. with a Klippel-Feil Abnormality (fusion of any 2 cervical vert.) |
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Term
Capital femoral epiphysis |
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Definition
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Term
Obese teenage male presents with knee pain |
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Definition
Slipped Capital Femoral Epiphysis (SCFE) |
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Term
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Definition
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Term
Widening of the femoral epiphysis followed by slippage (femoral head stays in the acetabulum, femoral neck roates -usu anteriorly) |
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Definition
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Term
Muscle loss and wasting, thought to be caused by death of the ventral horn motor neurons |
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Definition
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Term
Congenital contractures and rigid jt deformities of multiple jts (LE>UE) |
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Definition
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Term
Degeneration of the anterior longitudinal ligament followed by ossification of the ALL; spans at least 4 segments |
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Definition
Diffuse Idiopathic Skeletal Hyperotosis (DISH) |
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Term
Most common cause of Pyogenic Osteomyelitis |
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Definition
S.aureus (followed by H.influenza and GBS) |
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Term
Small interosseous abscesses involving the cortex of bone that are walled off by reactive bone |
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Definition
Brodie Abscesses - seen in pyogenic osteomyelitis |
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Term
Fever, malaise, chills, unrelenting pain, immobilization/ protection of the limb (ex -pt won't bear weight) |
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Definition
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Term
Newborn with more folds on one leg than the other |
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Definition
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Term
Tests for Congental Hip Dysplasia |
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Definition
Barlow Test, Ortolani Test, Galeazzi Sign |
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Term
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Definition
A Test for hip instability with dislocation occurring with flexion, adduction and a posterior force/ push |
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Term
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Definition
A test for hip dysplasia involving abduction and anterior pressure/ pull; "click/ clunk" |
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Term
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Definition
A test for hip dysplasia invovling flexing the infant's knees while they're supine so that the feet are flat on the table; looking to see if the knees are level - unlevel knees = positive test |
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Term
Patient has a "W" style seated posture |
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Definition
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Term
Foot exhibits: plantar flexion (equines) of the ankle, adduction (varus) of the heel/ hindfoot, high arch (cavus), and adduction of the forefoot |
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Definition
Talipes Equinovarum (AKA Club Foot) |
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Term
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Definition
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Term
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Definition
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Term
Results from a lack of Vit. D |
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Definition
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Term
Pathophysiology of Rickets |
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Definition
Vit. D deficiency results in hypocalcemia and a secondary hyperparathyroidism; the hyperparathyroidism leads to hypophosphatemia, which affects the growth plate (there's an enlargement of the hypertrophic zone of cartilage in response to the hypophosphatemia); newly formed bone is also poorly mineralized |
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Term
Muscular hypotonia, soft/ thin skull, knobby deformities of jts and ribs |
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Definition
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Term
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Definition
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Term
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Definition
Sternal deformity seen in Rickets/ Osteomalacia |
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Term
Lab Tests for Osteomalacia/ Rickets |
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Definition
Serum vit. D, PTH, Calcium, phosphorous and alk.phos. levels |
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Term
Overactive osteoclastic bone resorption with resultant new bone formation |
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Definition
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Term
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Definition
Receptor Activator of Nuclear Factor-KB; chr. 18; a factor critical in controlling osteoclast function - assoc. with Paget's Ds |
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Term
Elevated alk.phos level, pain, facial deformities and fractures |
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Definition
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Term
An autosomal dominant disorder that manifests with fragility of the skeletal system due to structural or quantitative defects in collagen type I |
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Definition
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Term
Fragile bones, blue sclera, and early deafness |
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Definition
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Term
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Definition
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Term
Slow-growing benign tumor located on the subperiosteal or endosteal surfaces of skull or facial bones |
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Definition
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Term
Small (<2cm) benign tumors in the appendicular skeleton; night-time pain that is relieved by ASA |
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Definition
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Term
Cause of the pain in Osteoid Osteomas/ the reason the pain is relieved by ASA |
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Definition
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Term
Benign bone tumors that produce a dull pain unresponsive to ASA |
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Definition
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Term
Mushroom-shaped bony cartilage-capped growth |
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Definition
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Term
Benign tumor of interosseous hyaline cartilage |
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Definition
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Term
Benign, aggressive tumor containing multinucleated giant cells that look like osteoclasts |
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Definition
Giant Cell Tumor - typically involves the knee |
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Term
A mesenchymal tumor involving the overproduction of bone matrix |
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Definition
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Term
Painful, aggressively enlargin masses, soft-tissue swelling, Codman's triangle, pulmonary metastases |
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Definition
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Term
Painful, progressively enlarging masses in the central portion of the skeleton including pelvis, shoulders and ribs |
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Definition
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Term
Enlarged, painful masses in the metaphyses of long bones and plevic flat bones; can occur in bones that were previously irradiated |
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Definition
Fibrosarcomas + Malignant fibrous histocytomas |
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Term
5 Most common primary origins of neoplastic metastasis to bone |
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Definition
Lung, Breast, Thyroid, Kidney, Prostate |
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Term
Common sites of metastasis to bone |
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Definition
Axial skeleton and to a lesser extent the proximal appendicular bones |
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Term
Bony tumor seen in kids that presents with painful, enlarging masses and local tenderness and swelling accompanied by fever, elevated ESR, anemia and leukocytosis (elevated WBC count) |
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Definition
Ewing Sarcoma/ Primitive Neuroectodermal Tumors (PNET) |
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Term
Avascular necrosis of the femoral head in kids <15 years old |
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Definition
Legg-Calve-Perthes Disease |
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Term
Grade I Legg-Calve-Perthes Ds |
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Definition
Less than 1/3 of epiphysis involved, cystic appearance, epiphyseal height maintained, viable tongue of epiphysis |
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Term
Grade II Legg-Calve-Perthes Ds |
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Definition
Rarified bone, avascular segment, Gage's Sign (a small osteoporotic region on radiographs that forms a transradiant V on the lateral side of the epiphysis), Metaphyseal rarefaction |
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Term
Grade III Legg-Calve-Perthes Ds |
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Definition
Most of the epiphysis is avascular, viable bone posterior and anterior, metaphyseal changes |
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Term
Grade IV Legg-Calve-Perthes Ds |
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Definition
Total epiphyseal involvement, diffuse metaphyseal changes, no viable bone posterior, epiphyseal consolidation |
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Term
Degeneration/ aseptic necrosis of a portion of bone or growth center followed by reossificaion |
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Definition
Osteochondritis dissicans - commonly involves the femoral condyle in the knee |
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Term
Gradual onset of vague pain in jt, catching/ locking of the joint, possibly jt effusion |
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Definition
Osteochondritis dissicans |
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Term
Swelling, tenderness and increased prominence of the tibial tubercle |
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Definition
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Term
Vascular infarction leading to the cellular death of bone tissue |
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Definition
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Term
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Definition
Defect in this gene (for type II collagen) is seen in familial cases of osteonecrosis |
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Term
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Definition
The process of new bone laid down on the scaffolding of old dead bone in osteonecrosis |
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Term
A young, female patient presents with a butterfly rash, fever, jt pain, pleuritic pain and photosensitivity |
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Definition
SLE - may also have oral ulcers, pericarditis, proteinuria, seizures/ psychosis, hemolytic anemia, leukopenia, etc. |
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Term
Test for ANA, dsDNA, Smith, SSA and SSB antibodies |
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Definition
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Term
Acute onset of tender, nodular, erythematous eruption usually found on the extensor aspects of the LEs |
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Definition
Erythema nodosum - associated with sarcoidosis |
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Term
Pathogenesis of Scleroderma |
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Definition
Abnormal immune response from CD4 T cells and TH2 cells - abnl secretion of growth factors & cytokines, t-cell mediated fibrogenesis and vascular injury, abnl humeral response |
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Term
Wide-spread skin thickening and rapid progression to fibrosis of visceral organs (GI, heart, kidneys, skeletal muscle and lungs) |
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Definition
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Term
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Definition
Calcinosis, Raynaud's Synd., Esophageal dysmotility, Sclerodactyly, Telangectasisa --seen in limited scleroderma |
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Term
Skin thickening confined to fingers, forearms and face, accompanied by CREST Syndrome |
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Definition
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Term
ANA, anticentromere antibodies |
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Definition
Seen in patients with Limited Scleroderma |
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Term
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Definition
Seen in patients with Diffuse Scleroderma |
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Term
Generalized mm. pain increased with exertion, fatigue, perception of swollen jt not present on PE |
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Definition
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Term
Increase tryptophan containing foods |
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Definition
May help prevent fibromyalgia flares |
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Term
Pain/ stiffness in the neck, shoulders and pelvic region, low-grade fever and weight loss, malaise, arthralgias & myalgias |
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Definition
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Term
ESR > 50 mm/h with normochromic, normocytic anemia |
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Definition
Seen in 50% of polymyalgia rheumatica patients |
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Term
Often associated with Giant Cell Arteritis |
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Definition
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Term
Often associated with Polymyalgia rheumatica |
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Definition
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Term
Treatment for sarcoidosis |
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Definition
First line- glucocorticoids; second line- methotrexate (MTX) |
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Term
Insidious onset of shortness of breath, cough, chest pain and hemoptysis; may also see constitutional s/s, eye involvement, splenomegaly & hepatomegaly |
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Definition
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Term
Associated with Sarcoidosis |
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Definition
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Term
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Definition
Light chain amyloid - derived from plasma cells and contains immunoglobulin light chains |
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Term
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Definition
Amyloid associated protein - secreted by liver |
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Term
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Definition
Involves AL and immunocyte dyscrasias |
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Term
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Definition
Involves AA; reactive amyloidosis due to chronic disease |
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Term
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Definition
Performed on bx specimens to dx amyloidosis |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
Pain in elbow with wrist extension |
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Definition
Lateral epicondylitis (tennis elbow) |
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Term
Pain in elbow with wrist flexion |
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Definition
Medial epicondylitis (golfer's elbow) |
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Term
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Definition
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Term
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Definition
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Term
Pain and tenderness localized to the radial aspect of the wrist, pain with thumb movement |
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Definition
Tenosynovitis (DeQuervain's tenosynovitis) |
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Term
Inflammation of the thin inner synovial lining surrounding the tendons of the adductor policis longus and extensor policis brevis as they pass thru a common sheath at the base of the thumb and distal end of the radius |
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Definition
DeQuervain's tenosynovitis |
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Term
Most common form of systemic vasculitis in adults |
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Definition
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Term
Granulomatous inflammation of the media, fragmentation of the interal elastic membrane and mononuclear infiltrate with multinucleated giant cells and langhans cells of medium and large sized arteries (aorta, temporal a., etc.) |
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Definition
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Term
Necrotizing vasculitis of arterioles, capillaries and venules (commonly involves the lung and kidney) |
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Definition
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|
Term
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Definition
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Term
Fever, wt loss, muscle pain, rapidly progressing renal disease, hemoptysis |
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Definition
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Term
Necrotizing vasculitis of small and medium sized vessels, typically involves renal and other visceral organs (NO lung involvement) |
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Definition
Polyarteritis Nodosa (PAN) |
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Term
Hypergammaglobulinemia and positive Hep B surface antigens in 30% of patients |
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Definition
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Term
Pathogenesis of polyarteritis nodosa |
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Definition
PMNs infiltrate all layers of a vessel and perivascular areas, intimal proliferation and degeneration of the vascular wall, fibroid necrosis, luminal compromise, thrombosis and infarction/ hemorrhage of the vessel; healing involves collagen deposition and aneurysmal formation |
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Term
A widespread granulomatous inflammatory reaction leading to stenosis in the walls of medium and large size vessles (typically involves the aortic arch and its branches) |
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Definition
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|
Term
Disease progresses rapidly at first, then halts after 1-2 years, alowing for long-term survival |
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Definition
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Term
A necrotizing vasculitis most commonly affecting the respiratory and renal systems |
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Definition
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Term
Triad of acute necrotizing granulomas of the mucosa in the upper and lower respiratory tract, necrotizing granulomatous vasculitis affecting small to medium sized vessels,and focal necrotizing renal disease |
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Definition
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|
Term
|
Definition
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Term
Fever, malaise, weakness, arthralgias, anorexia + wt loss, persistent pneumonia, chronic sinusitis |
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Definition
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|
Term
A small, firm nodule in ther dermis or subcutaneous tissue, typically occurring in mid-adult life |
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Definition
Benign Fibrous Histiocytoma |
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|
Term
Slowly progressing contracture of the palmar fascia in the hand |
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Definition
Dupuytren's contracture - a form of fibromatosis |
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|
Term
Rare, aggressive neoplasm of the soft tissue |
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Definition
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|
Term
|
Definition
Lipoma - soft, mobile and painless |
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Term
|
Definition
Liposarcoma - one of the most common sarcomas of adulthood |
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|
Term
An aggressive, malignant tumor that usually arises in the musculature of the proximal extremities or in the mediastinum |
|
Definition
Malignant fibrous histiocytoma |
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|
Term
Fibrotic proliferation and formation of metaplastic bone in skeletal muscle (usually following a trauma) |
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Definition
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Term
Patient initially presents with an area of pain and swelling in the muscle, that evolves into a painless mass and may eventually calcify to become a painful mass in the muscle |
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Definition
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|
Term
Patient presents between ages 3 and 5 with delayed motor milestones with progressively worsening loss of strength and Gower's Sign, and joint contractures |
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Definition
Duchenne's Muscular Dystrophy |
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Term
Dx of Duchenne's Muscular Dystrophy |
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Definition
Serum CK levels, EMG and a bx (Western blot demonstrating decreased dystrophin) |
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Term
A less common, later onset and slower progressing form of muscular dystrophy than Duchenne's Muscular Dystrophy |
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Definition
Becker Muscular Dystrophy |
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|
Term
Most common adult muscular dystrophy |
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Definition
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|
Term
Associated with a trinucleotide CTG repeat expansion on chr. 19 (the DMPK gene)and anticipation |
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Definition
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|
Term
Insidious onset of gait abnormalities in late childhood, sustained muscular contractions, progresses to weakness in the hands and then face, frontal balding, ptosis and "hatchet-face" |
|
Definition
Classic form (DM1) of Myotonic Dystrophy |
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Term
|
Definition
Associated with Myotonic Dystrophy - a narrowing of the face due to loss of mass in the masster mm. |
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|
Term
Patient has normal or slightly elevated CK levels and EMG changes; bx reveals nuclei positioned centrally in m. fibers |
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Definition
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|
Term
Reason the nucleus is in the center of the m. in Centronuclear Myopathy |
|
Definition
Most likely involves a defect in the cytoskeleton of the m. cells, preventing marginalization of the nucleus |
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|
Term
Severe hypotonia and weakness at birth |
|
Definition
Neonatal form of centronuclear myopathy |
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|
Term
Delayed motor milestones, marfanoid body type |
|
Definition
Late Infancy- Early Childhood form of Centronuclear Myopathy |
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|
Term
Onset of mild, non-progressive limb weakness in the second or third decade of life |
|
Definition
Late childhood- Early Adult form of Centronuclear Myopathy |
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Term
A chronic inflammatory myopathy that also involves dermatologic manifestations |
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Definition
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Term
Heliotropic rash in upper eyelids and periorbital edema that can worsen with sun exposure, B/L symmetrical proximal muscle weakness, erythema of knuckles with raised scaly eruptions (Grotton Lesions) |
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Definition
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Term
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Definition
Seen in pts with Polymyositis and Dermatomyositis (more specific for PM than DM) |
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Term
Lab studies for Dermatomyositis |
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Definition
CPK, Aldolase, LDH, SGOT, SGPT, RF, ANA, Anti-Jo1, Anti-pMi-2,Anti-SRP |
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Term
Symmetric proximal muscle weakness in the UE and LE, muscle pain/ tenderness, fatigue |
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Definition
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Term
Lab Studies for Polymyositis |
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Definition
Serum CK, LDH, Alanine Aminotransferase, Aldolase, CBC (leukocytosis or thrombocytosis), elevated ESR, ANA positive in 1/3 of patients, Anti-Jo1, Anti-signal recognition particles (Anti-SRP) |
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Term
Weakness, poor endurance, discomfort, exertional dyspnea and tachycardia |
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Definition
S/S of Mitochondrial Myopathy - mitochondrial myopathy is a myopathy due to mutations occurring in the mitochondrial genome |
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Term
A benign tumor of smooth m. |
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Definition
Leiomyoma - think uterine fibroids |
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Term
Most common neoplasm in women |
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Definition
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Term
A malignant tumor of smooth muscle |
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Definition
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Term
Most common site for leiomyosarcomas |
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Definition
Retroperitoneum or intra-abdominal; other common places include skin and deep soft tissue of extremities (typically associated wtih vv.) |
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Term
Rare, aggressive, malignant tumors of skeletal m. |
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Definition
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Term
Most common soft tissue sarcoma of childhood and adolescence |
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Definition
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Term
3 Subtypes of Rhabdomyosarcoma |
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Definition
1)embryonal (most common); 2)alveolar; 3)pleimorphic |
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Term
PAX3- FKHR gene fusion dysregulating m. differentiation |
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Definition
Pathogenesis of Rhabdomyosarcoma |
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