膵体尾部癌に対する術前化学療法と腹腔動脈合併尾側膵切除後にneedle tract seedingによる胃壁転移を来し胃全摘術を施行した1例
症例は63歳の男性で，腹腔動脈周囲神経叢浸潤を伴う切除可能境界膵体尾部癌に対し，超音波内視鏡下針生検で腺癌と診断し，術前化学療法を行い，腹腔動脈合併尾側膵切除術を施行した．術後補助化学療法中の術後10か月で針生検の穿刺経路である胃体部後壁に粘膜下腫瘍が出現し，生検で腺癌と診断され胃全摘術を施行した．免疫組織学的所見が膵癌原発巣と一致し，RAS遺伝子変異陽性も合わせ，needle tract seedingによる膵癌胃壁転移と診断した．胃領域リンパ節に12個の転移を認めた．胃切除から2か月後に無数の多発肝転移が出現し，4か月後に癌死した．膵癌のneedle tract seedingは，術前およ...
Saved in:
| Published in | 日本消化器外科学会雑誌 Vol. 54; no. 11; pp. 813 - 821 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
01.11.2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.2020.0112 |
Cover
| Abstract | 症例は63歳の男性で，腹腔動脈周囲神経叢浸潤を伴う切除可能境界膵体尾部癌に対し，超音波内視鏡下針生検で腺癌と診断し，術前化学療法を行い，腹腔動脈合併尾側膵切除術を施行した．術後補助化学療法中の術後10か月で針生検の穿刺経路である胃体部後壁に粘膜下腫瘍が出現し，生検で腺癌と診断され胃全摘術を施行した．免疫組織学的所見が膵癌原発巣と一致し，RAS遺伝子変異陽性も合わせ，needle tract seedingによる膵癌胃壁転移と診断した．胃領域リンパ節に12個の転移を認めた．胃切除から2か月後に無数の多発肝転移が出現し，4か月後に癌死した．膵癌のneedle tract seedingは，術前および術後化学療法でも防止困難であり，外科切除を企図した膵癌において，穿刺経路が切除範囲外の超音波内視鏡下針生検は，そのリスクを認識して施行する必要がある． |
|---|---|
| AbstractList | 症例は63歳の男性で，腹腔動脈周囲神経叢浸潤を伴う切除可能境界膵体尾部癌に対し，超音波内視鏡下針生検で腺癌と診断し，術前化学療法を行い，腹腔動脈合併尾側膵切除術を施行した．術後補助化学療法中の術後10か月で針生検の穿刺経路である胃体部後壁に粘膜下腫瘍が出現し，生検で腺癌と診断され胃全摘術を施行した．免疫組織学的所見が膵癌原発巣と一致し，RAS遺伝子変異陽性も合わせ，needle tract seedingによる膵癌胃壁転移と診断した．胃領域リンパ節に12個の転移を認めた．胃切除から2か月後に無数の多発肝転移が出現し，4か月後に癌死した．膵癌のneedle tract seedingは，術前および術後化学療法でも防止困難であり，外科切除を企図した膵癌において，穿刺経路が切除範囲外の超音波内視鏡下針生検は，そのリスクを認識して施行する必要がある． |
| Author | 石山, 宏平 尾上, 隆司 田原, 俊哉 清水, 亘 羽田野, 直人 首藤, 毅 鈴木, 崇久 倉岡, 和矢 田代, 裕尊 清水, 洋祐 |
| Author_xml | – sequence: 1 fullname: 羽田野, 直人 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 倉岡, 和矢 organization: 国立病院機構呉医療センター・中国がんセンター病理診断科 – sequence: 1 fullname: 清水, 亘 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 首藤, 毅 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 清水, 洋祐 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 尾上, 隆司 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 田代, 裕尊 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 鈴木, 崇久 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 田原, 俊哉 organization: 国立病院機構呉医療センター・中国がんセンター外科 – sequence: 1 fullname: 石山, 宏平 organization: 国立病院機構呉医療センター・中国がんセンター外科 |
| BookMark | eNo9kEtLw0AUhQdRsD62rvsHUueRx2Qp4gsEN7oO00laG2qVpBuXaa1GWkGtbe1CxHdBREFdiLR_Jp02_RcmKG7u5ZzL_Q6cKTBe2C1YAMwhmFIoIfO2nXVTGGKYggjhMZBARKaSTjQ8DhKQUFXSNZVOglnXzaUhVKgWaZQAnfDws9-ti7feqNwZtmuB9yxee4HXDkrV8KYujk9ErSleHoft0uC9EXidsPIVVi5EtREe-OLU73c_o1_hfUQc4R-N2veiF0MKlmXmrWTRYbyYdCORK2QjOyj5MbhcFnde-H07fPoOSueDq4fAa8VmpTM4u4xiY7PZDW8iUivwrlG_V50BExmWd63Zvz0NtpaXNhdXpfWNlbXFhXXJxlBnkoZUTpHMOaaEqSpXuEmUNNYp5hAyqhNVhulMWlMYMlVdM03VJGZGNjMYUq4xi0yDpV-u7RZZ1jL2nNwOc_YN5hRzPG8ZcdGGIhsIxTNu3Igb_7_zbeYYNiM_6l-xNw |
| ContentType | Journal Article |
| Copyright | 2021 一般社団法人 日本消化器外科学会 |
| Copyright_xml | – notice: 2021 一般社団法人 日本消化器外科学会 |
| DOI | 10.5833/jjgs.2020.0112 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 1348-9372 |
| EndPage | 821 |
| ExternalDocumentID | article_jjgs_54_11_54_2020_0112_article_char_ja |
| GroupedDBID | 2WC ALMA_UNASSIGNED_HOLDINGS EBS EJD JSF KQ8 OK1 RJT |
| ID | FETCH-LOGICAL-j209a-716c814cc283a66c5cd35b2982c00a893640bfb75a1d697dd6d3df4df208c7ae3 |
| ISSN | 0386-9768 |
| IngestDate | Wed Sep 03 06:31:06 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 11 |
| Language | Japanese |
| License | https://creativecommons.org/licenses/by-nc/4.0/deed.ja |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j209a-716c814cc283a66c5cd35b2982c00a893640bfb75a1d697dd6d3df4df208c7ae3 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/jjgs/54/11/54_2020.0112/_article/-char/ja |
| PageCount | 9 |
| ParticipantIDs | jstage_primary_article_jjgs_54_11_54_2020_0112_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2021/11/01 |
| PublicationDateYYYYMMDD | 2021-11-01 |
| PublicationDate_xml | – month: 11 year: 2021 text: 2021/11/01 day: 01 |
| PublicationDecade | 2020 |
| PublicationTitle | 日本消化器外科学会雑誌 |
| PublicationTitleAlternate | 日消外会誌 |
| PublicationYear | 2021 |
| Publisher | 一般社団法人 日本消化器外科学会 |
| Publisher_xml | – name: 一般社団法人 日本消化器外科学会 |
| References | 6) Hirooka Y, Goto H, Itoh A, Hashimoto S, Niwa K, Ishikawa H, et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol. 2003 Nov;18(11):1323–1324. 25) Sato N, Takano S, Yoshitomi H, Furukawa K, Takayashiki T, Kuboki S, et al. Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy: a case report and literature review. BMC Gastroenterol. 2020 Jan;20(1):13. 2) 山内 淳一郎，小林 信，宮崎 健人，安食 隆，土原 一生，石山 秀一．EUS-FNA後のneedle tract seedingにより胃壁転移した膵体部癌の1例．日本臨床外科学会雑誌．2016;77(12):2994–2999. 15) Minaga K, Kitano M, Yamashita Y. Surgically resected needle tract seeding following endoscopic ultrasound-guided fine-needle aspiration in pancreatic cancer. J Hepatobiliary Pancreat Sci. 2015 Sep;22(9):708–709. 10) Ahmed K, Sussman JJ, Wang J, Schmulewitz N. A case of EUS-guided FNA-related pancreatic cancer metastasis to the stomach. Gastrointest Endosc. 2011 Jul;74(1):231–233. 23) Yasumoto M, Okabe Y, Ishikawa H, Kisaki J, Akiba J, Naito Y, et al. A case of gastric wall implantation caused by EUS-FNA 22 months after pancreatic cancer resection. Endosc Ultrasound. 2018 Jan–Feb;7(1):64–66. 17) Tomonari A, Katanuma A, Matsumori T, Yamazaki H, Sano I, Minami R, et al. Resected tumor seeding in stomach wall due to endoscopic ultrasonography-guided fine needle aspiration of pancreatic adenocarcinoma. World J Gastroenterol. 2015 Jul;21(27):8458–8461. 19) Minaga K, Kitano M, Enoki E, Kashida H, Kudo M. Needle tract seeding on the proximal gastric wall after EUS-guided fine-needle aspiration of a pancreatic mass. Am J Gastroenterol. 2016 Nov;111(11):1515. 9) 日本膵臓学会，膵癌診療ガイドライン改訂委員会．膵癌診療ガイドライン．東京：金原出版；2019. p. 176–179. 22) Matsumoto K, Kato H, Tanaka N, Okada H. Preoperative detection of tumor seeding after endoscopic ultrasonography-guided fine needle aspiration for pancreatic cancer. Intern Med. 2018 Jun;57(12):1797–1798. 14) Sakurada A, Hayashi T, Ono M, Ishiwatari H, Ogino J, Kimura Y, et al. A case of curatively resected gastric wall implantation of pancreatic cancer caused by endoscopic ultrasound-guided fine-needle aspiration. Endoscopy. 2015;47:E198–9. 16) 成瀬 宏仁，大和 弘明，山本 義也，畑中 一映，山本 桂子，下山 則彦，ほか．剖検にてEUS-FNAによる播種を確認した膵癌の1例．日本消化器内視鏡学会雑誌．2015;57(8):1616–1622. 3) Mikata R, Ishihara T, Tada M, Tawada K, Saito M, Kurosawa J, et al. Clinical usefulness of repeated pancreatic juice cytology via endoscopic naso-pancreatic drainage tube in patients with pancreatic cancer. J Gastroenterol. 2013 Jul;48(7):866–873. 7) Yamao K. Complications of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) for pancreatic lesions. J Gastroenterol. 2005 Sep;40(9):921–923. 13) Ngamruengphong S, Xu C, Woodward TA, Raimondo M, Stauffer JA, Asbun HJ, et al. Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration. Endoscopy. 2013 Aug;45(8):619–626. 26) Ogura T, Yamao K, Sawaki A, Mizuno N, Hara K, Hijioka S, et al. Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses. Gastrointest Endosc. 2012 Apr;75(4):769–774. 5) Eloubeidi MA, Tamhane A, Varadarajulu S, Wilcox CM. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc. 2006 Apr;63(4):622–629. 1) Paquin SC, Gariépy G, Lepanto L, Bourdages R, Raymond G, Sahai AV. A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc. 2005 Apr;61(4):610–611. 12) Katanuma A, Maguchi H, Hashigo S, Kaneko M, Kin T, Yane K, et al. Tumor seeding after endoscopic ultrasound-guided fine-needle aspiration of cancer in the body of the pancreas. Endoscopy. 2012;44:E160–1. 18) Kita E, Yamaguchi T, Sudo K. A case of needle tract seeding after EUS-guided FNA in pancreatic cancer, detected by serial positron emission tomography/CT. Gastrointest Endosc. 2016 Nov;84(5):869–870. 21) Sakamoto U, Fukuba N, Ishihara S, Sumi S, Okada M, Sonoyama H, et al. Postoperative recurrence from tract seeding after use of EUS-FNA for preoperative diagnosis of cancer in pancreatic tail. Clin J Gastroenterol. 2018 Jun;11(3):200–205. 20) Iida T, Adachi T, Ohe Y, Nakagaki S, Yabana T, Kondo Y, et al. Re-recurrence after distal gastrectomy for recurrence caused by needle tract seeding during endoscopic ultrasound-guided fine-needle aspiration of a pancreatic adenocarcinoma. Endoscopy. 2016;48:E304–5. 24) Matsui T, Nishikawa K, Yukimoto H, Katsuta K, Nakamura Y, Tanaka S, et al. Needle tract seeding following endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a report of two cases. World J Surg Oncol. 2019 Aug;17(1):134. 4) Hewitt MJ, McPhail MJW, Possamai L, Dhar A, Vlavianos P, Monahan KJ. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012 Feb;75(2):319–331. 8) Motoi F, Kosuge T, Ueno H, Yamaue H, Satoi S, Sho M, et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol. 2019 Feb;49(2):190–194. 11) Chong A, Venugopal K, Segarajasingam D, Lisewski D. Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia. Gastrointest Endosc. 2011 Oct;74(4):933–935. 27) Arber N, Shapira I, Ratan J, Stern B, Hibshoosh H, Moshkowitz M, et al. Activation of c-K-ras mutations in human gastrointestinal tumors. Gastroenterology. 2000 Jun;118(6):1045–1050. |
| References_xml | – reference: 19) Minaga K, Kitano M, Enoki E, Kashida H, Kudo M. Needle tract seeding on the proximal gastric wall after EUS-guided fine-needle aspiration of a pancreatic mass. Am J Gastroenterol. 2016 Nov;111(11):1515. – reference: 24) Matsui T, Nishikawa K, Yukimoto H, Katsuta K, Nakamura Y, Tanaka S, et al. Needle tract seeding following endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a report of two cases. World J Surg Oncol. 2019 Aug;17(1):134. – reference: 4) Hewitt MJ, McPhail MJW, Possamai L, Dhar A, Vlavianos P, Monahan KJ. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012 Feb;75(2):319–331. – reference: 15) Minaga K, Kitano M, Yamashita Y. Surgically resected needle tract seeding following endoscopic ultrasound-guided fine-needle aspiration in pancreatic cancer. J Hepatobiliary Pancreat Sci. 2015 Sep;22(9):708–709. – reference: 17) Tomonari A, Katanuma A, Matsumori T, Yamazaki H, Sano I, Minami R, et al. Resected tumor seeding in stomach wall due to endoscopic ultrasonography-guided fine needle aspiration of pancreatic adenocarcinoma. World J Gastroenterol. 2015 Jul;21(27):8458–8461. – reference: 27) Arber N, Shapira I, Ratan J, Stern B, Hibshoosh H, Moshkowitz M, et al. Activation of c-K-ras mutations in human gastrointestinal tumors. Gastroenterology. 2000 Jun;118(6):1045–1050. – reference: 12) Katanuma A, Maguchi H, Hashigo S, Kaneko M, Kin T, Yane K, et al. Tumor seeding after endoscopic ultrasound-guided fine-needle aspiration of cancer in the body of the pancreas. Endoscopy. 2012;44:E160–1. – reference: 5) Eloubeidi MA, Tamhane A, Varadarajulu S, Wilcox CM. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc. 2006 Apr;63(4):622–629. – reference: 11) Chong A, Venugopal K, Segarajasingam D, Lisewski D. Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia. Gastrointest Endosc. 2011 Oct;74(4):933–935. – reference: 3) Mikata R, Ishihara T, Tada M, Tawada K, Saito M, Kurosawa J, et al. Clinical usefulness of repeated pancreatic juice cytology via endoscopic naso-pancreatic drainage tube in patients with pancreatic cancer. J Gastroenterol. 2013 Jul;48(7):866–873. – reference: 16) 成瀬 宏仁，大和 弘明，山本 義也，畑中 一映，山本 桂子，下山 則彦，ほか．剖検にてEUS-FNAによる播種を確認した膵癌の1例．日本消化器内視鏡学会雑誌．2015;57(8):1616–1622. – reference: 6) Hirooka Y, Goto H, Itoh A, Hashimoto S, Niwa K, Ishikawa H, et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol. 2003 Nov;18(11):1323–1324. – reference: 1) Paquin SC, Gariépy G, Lepanto L, Bourdages R, Raymond G, Sahai AV. A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc. 2005 Apr;61(4):610–611. – reference: 9) 日本膵臓学会，膵癌診療ガイドライン改訂委員会．膵癌診療ガイドライン．東京：金原出版；2019. p. 176–179. – reference: 14) Sakurada A, Hayashi T, Ono M, Ishiwatari H, Ogino J, Kimura Y, et al. A case of curatively resected gastric wall implantation of pancreatic cancer caused by endoscopic ultrasound-guided fine-needle aspiration. Endoscopy. 2015;47:E198–9. – reference: 21) Sakamoto U, Fukuba N, Ishihara S, Sumi S, Okada M, Sonoyama H, et al. Postoperative recurrence from tract seeding after use of EUS-FNA for preoperative diagnosis of cancer in pancreatic tail. Clin J Gastroenterol. 2018 Jun;11(3):200–205. – reference: 23) Yasumoto M, Okabe Y, Ishikawa H, Kisaki J, Akiba J, Naito Y, et al. A case of gastric wall implantation caused by EUS-FNA 22 months after pancreatic cancer resection. Endosc Ultrasound. 2018 Jan–Feb;7(1):64–66. – reference: 26) Ogura T, Yamao K, Sawaki A, Mizuno N, Hara K, Hijioka S, et al. Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses. Gastrointest Endosc. 2012 Apr;75(4):769–774. – reference: 10) Ahmed K, Sussman JJ, Wang J, Schmulewitz N. A case of EUS-guided FNA-related pancreatic cancer metastasis to the stomach. Gastrointest Endosc. 2011 Jul;74(1):231–233. – reference: 20) Iida T, Adachi T, Ohe Y, Nakagaki S, Yabana T, Kondo Y, et al. Re-recurrence after distal gastrectomy for recurrence caused by needle tract seeding during endoscopic ultrasound-guided fine-needle aspiration of a pancreatic adenocarcinoma. Endoscopy. 2016;48:E304–5. – reference: 25) Sato N, Takano S, Yoshitomi H, Furukawa K, Takayashiki T, Kuboki S, et al. Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy: a case report and literature review. BMC Gastroenterol. 2020 Jan;20(1):13. – reference: 18) Kita E, Yamaguchi T, Sudo K. A case of needle tract seeding after EUS-guided FNA in pancreatic cancer, detected by serial positron emission tomography/CT. Gastrointest Endosc. 2016 Nov;84(5):869–870. – reference: 2) 山内 淳一郎，小林 信，宮崎 健人，安食 隆，土原 一生，石山 秀一．EUS-FNA後のneedle tract seedingにより胃壁転移した膵体部癌の1例．日本臨床外科学会雑誌．2016;77(12):2994–2999. – reference: 7) Yamao K. Complications of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) for pancreatic lesions. J Gastroenterol. 2005 Sep;40(9):921–923. – reference: 8) Motoi F, Kosuge T, Ueno H, Yamaue H, Satoi S, Sho M, et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol. 2019 Feb;49(2):190–194. – reference: 13) Ngamruengphong S, Xu C, Woodward TA, Raimondo M, Stauffer JA, Asbun HJ, et al. Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration. Endoscopy. 2013 Aug;45(8):619–626. – reference: 22) Matsumoto K, Kato H, Tanaka N, Okada H. Preoperative detection of tumor seeding after endoscopic ultrasonography-guided fine needle aspiration for pancreatic cancer. Intern Med. 2018 Jun;57(12):1797–1798. |
| SSID | ssib005879761 ssib000936942 ssib023160767 ssib058493923 ssj0000491391 ssib002223853 |
| Score | 2.3081167 |
| Snippet | 症例は63歳の男性で，腹腔動脈周囲神経叢浸潤を伴う切除可能境界膵体尾部癌に対し，超音波内視鏡下針生検で腺癌と診断し，術前化学療法を行い，腹腔動脈合併尾側膵切除... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 813 |
| SubjectTerms | needle tract seeding 胃壁転移 膵癌 |
| Title | 膵体尾部癌に対する術前化学療法と腹腔動脈合併尾側膵切除後にneedle tract seedingによる胃壁転移を来し胃全摘術を施行した1例 |
| URI | https://www.jstage.jst.go.jp/article/jjgs/54/11/54_2020.0112/_article/-char/ja |
| Volume | 54 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 日本消化器外科学会雑誌, 2021/11/01, Vol.54(11), pp.813-821 |
| journalDatabaseRights | – providerCode: PRVAFT databaseName: Open Access Digital Library customDbUrl: eissn: 1348-9372 dateEnd: 99991231 omitProxy: true ssIdentifier: ssj0000491391 issn: 0386-9768 databaseCode: KQ8 dateStart: 19690101 isFulltext: true titleUrlDefault: http://grweb.coalliance.org/oadl/oadl.html providerName: Colorado Alliance of Research Libraries |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV3Nb9RGFLcQXLhUrQAVWlAOnRNa6s_xzAXJ3jhCIJAqgcRtZXu9SKsqIEgu3DZpICggUb5zqCqgH5GqqpVKDihK_pmNk81_0d97Y-86iEOBXqzRzHvP7_feeN57lsdjWd8govfo97ctW2duy-91sQ4iTWgphJNUFY6SXChevCTPXfHPXw2uHjjkNL5amp_LzuS337uv5GO8ij74lXbJfoBnx0LRgTb8iys8jOt_8rFIlFBSxIFIfBFPC-2JJBCxLeJEJFooT0RKJKHQaLdF4iFtFFFMNNEM03APRqnhChWTwMip5ChwTXOjLbRkrmkRyVqgKxLc2hM6qCUr1gcK6KqhfWaPmQY9yFsV9WibG6wzKT_WOSA5sd_AFRClCgkObhqxQFA24Mwi_n5f0FkX-dzpWyYYN7AaZGofRBhGMcSIydATxyJyCVkUUtsQa4aoAbqGqMN97IBIoEGDIdUwXpNdEkozNNaa5JjGjMN2AKK4WScwZ8g3RqMtojZbW1YGHHuEbMI9sIyWFQBoM3EWhIM4YgPGPARVIkioHzViwv1JyZA8BlfQ3AmF4g9luTdmp2AsEpMXO6yITdOEfOISQKYPCDlBBeMMzDqhBwKeF9SwSSTTs1itJmSaFCc0im1QkUmatObgpfo1letU-zXrhYWFKdKK3KTYbCzBTC7ggMcn07YCdPp_t3YjvHpKtpCMG3iFCf-ej_DvhfvyA_OT83oddBrRXplt1HXiaLb6v5uT0LZGykn61-h0ANc-g4jqTrKv8Tex1SrSIcJO4KM0pytxdIijU4_TbsxOHyXhITeUkg5tufBdo6KiAzr9xocSSP-bGXmgQmAeh3RUd9IOJxUIyhHt1W9U-uYFAmpEPne0tpf59S3B-nY_KCTxfZS09eewnKFf_tz6rCqtpyKD4AvrQD89Yq2N7qxvbz4u_97aW1zbXb0_HPxR_rU1HKwOF1ZGLx-X9x6U95-Vf_62u7qw88_T4WBttPR2tPSkXHk6-mG5fLi8vbkO3nLwBnLK5bt7q7-UWyTErDpTvOpMVasOuocLyyR4cbF8PRhtvNr9fWO48Gjnp1-Hg-fUubS28-ML3JY6n22OXkLS8-HgZ2d7a-WodWUmudw-16pOp2n1XVunrdCRuXL8PEeBlkqZB3nXCzJXKze37RQBT_p21svCIHW6Uod0cp_X7fndnmurPEwL75h1cPb6bPGlNaVA2y0CVLZZ17d7Tmq7MtNBWvSKLPSkfdw6awzbuWF-QdT5wMly4lMFfGUdnjzUX1sH527OFydRjc1lp3j-_Qu7VEkI |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E8%86%B5%E4%BD%93%E5%B0%BE%E9%83%A8%E7%99%8C%E3%81%AB%E5%AF%BE%E3%81%99%E3%82%8B%E8%A1%93%E5%89%8D%E5%8C%96%E5%AD%A6%E7%99%82%E6%B3%95%E3%81%A8%E8%85%B9%E8%85%94%E5%8B%95%E8%84%88%E5%90%88%E4%BD%B5%E5%B0%BE%E5%81%B4%E8%86%B5%E5%88%87%E9%99%A4%E5%BE%8C%E3%81%ABneedle+tract+seeding%E3%81%AB%E3%82%88%E3%82%8B%E8%83%83%E5%A3%81%E8%BB%A2%E7%A7%BB%E3%82%92%E6%9D%A5%E3%81%97%E8%83%83%E5%85%A8%E6%91%98%E8%A1%93%E3%82%92%E6%96%BD%E8%A1%8C%E3%81%97%E3%81%9F1%E4%BE%8B&rft.jtitle=%E6%97%A5%E6%9C%AC%E6%B6%88%E5%8C%96%E5%99%A8%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A%E9%9B%91%E8%AA%8C&rft.au=%E7%BE%BD%E7%94%B0%E9%87%8E%2C+%E7%9B%B4%E4%BA%BA&rft.au=%E5%80%89%E5%B2%A1%2C+%E5%92%8C%E7%9F%A2&rft.au=%E6%B8%85%E6%B0%B4%2C+%E4%BA%98&rft.au=%E9%A6%96%E8%97%A4%2C+%E6%AF%85&rft.date=2021-11-01&rft.pub=%E4%B8%80%E8%88%AC%E7%A4%BE%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E6%B6%88%E5%8C%96%E5%99%A8%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A&rft.issn=0386-9768&rft.eissn=1348-9372&rft.volume=54&rft.issue=11&rft.spage=813&rft.epage=821&rft_id=info:doi/10.5833%2Fjjgs.2020.0112&rft.externalDocID=article_jjgs_54_11_54_2020_0112_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0386-9768&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0386-9768&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0386-9768&client=summon |