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            "entidad" => "Universidade Estadual de Campinas &#40;UNICAMP&#41;&#44; Centro de Dados e Estat&#237;stica&#44; Departamento de Hematologia e Hemoterapia&#44; Campinas&#44; SP&#44; Brazil"
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      "pt" => array:1 [
        "titulo" => "Tumores adrenocorticais associados &#224; muta&#231;&#227;o germinativa <span class="elsevierStyleItalic">TP53</span> p&#46;R337H podem ser identificados durante as consultas de puericultura"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#44; B&#41; Comparison of height &#40;A&#41; and BMI &#40;B&#41; <span class="elsevierStyleItalic">Z</span>-score between genders and between endocrine syndromes &#40;virilization and mixed&#41;&#44; at two moments of evaluation&#58; at diagnosis and after therapy of 64 survivors &#40;45 females and 19 males&#41; of childhood ACT&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Adrenocortical tumors &#40;ACT&#41;&#44; common in southern and southeastern Brazil&#44; constitute a spectrum of lesions with a behavior ranging from benign to malignant&#44; affecting mainly children in the first 5 years of life&#46; Early diagnosis and treatment are paramount for survival&#44; since advanced cases can be highly aggressive&#44; with high mortality&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The incidence of adrenocortical tumors &#40;ACT&#41; in the South and Southeast of Brazil reaches 3&#46;4&#8211;4&#46;2 cases per million in children under 15 years of age&#44; representing an 18-fold higher frequency than that found in other regions of Brazil and worldwide&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#8211;3</span></a> In over 90&#37; of cases&#44; they are associated with the germinal mutation of the <span class="elsevierStyleItalic">TP53</span> tumor suppressor gene&#44; located in the exon 10 of the short arm of chromosome 17&#44; called p&#46;R337H&#44; which gives it a hereditary characteristic of predisposition to neoplasms that is&#44; to date&#44; unique to this population&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The results of the neonatal screening studies&#44; carried out in the metropolitan region of Campinas&#44; state of S&#227;o Paulo&#44; and in the state of Paran&#225;&#44; Brazil&#44; demonstrated that this mutation is present in approximately 1&#58;300 newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;6</span></a> The mutation was apparently introduced as a founding effect in this Brazilian region in the 18th century&#44; during the Brazilian colonization period&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> The protein encoded by the <span class="elsevierStyleItalic">TP53</span> gene is crucial to preserve genomic integrity&#44; and mutations in this gene lead to a decrease in this protein activity and&#44; consequently&#44; to an increase in the likelihood of cancer in carrier individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> Due to the strong association between <span class="elsevierStyleItalic">TP53</span> mutation and ACT in children&#44; this tumor is considered a sentinel for the detection of <span class="elsevierStyleItalic">TP53</span> p&#46;R337H mutation in Brazilian patients&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> Other genetic&#44; epigenetic&#44; and environmental factors collaborate to establish the risk in individuals that are susceptible mutation carriers&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical manifestations of ACTs are related to increased secretion of corticosteroids &#40;mineralocorticoids&#44; glucocorticoids&#44; and sex hormones&#41;&#46; The pediatrician can detect signs and symptoms in routine clinical and anthropometric assessments in childcare consultations&#44; since approximately 90&#37; of the tumors are secretory&#59; those non-secretory are discovered at the clinical assessment or in ultrasound examinations for diagnostic investigation of increased abdominal volume&#44; abdominal pain&#44; or mass&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this article&#44; the authors describe the main clinical&#44; epidemiological&#44; and biological characteristics of childhood ACT&#44; with emphasis on family predisposition to cancer and strategies for early diagnosis&#44; patient referral&#44; and counseling to family members at risk of inheriting the mutation&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Eligibility</span><p id="par0030" class="elsevierStylePara elsevierViewall">Between December 1982 and December 2014&#44; 137 patients under 23 years of age were diagnosed with ACT at Centro Infantil Boldrini &#40;CIB&#41;&#44; a referral center in pediatric oncology in Campinas&#47;SP&#46; A total of 103 patients were eligible for the study&#44; excluding patients lost at follow-up &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&#44; perioperative deaths &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; and those with less than three years of diagnosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Longitudinal follow-up</span><p id="par0035" class="elsevierStylePara elsevierViewall">Since 2002&#44; the study patients followed the same clinical and laboratory follow-up protocol for diagnosis of familial mutations&#44; early recurrence detection&#44; treatment sequelae&#44; and occurrence of cancer in family members&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Growth and development measurements were performed at the six-monthly or annual consultations&#44; considering clinical data and anthropometric measures &#40;weight&#44; height and body mass index &#91;BMI&#93;&#41;&#46; The World Health Organization curves were used as reference&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;13</span></a> The Anthro Plus v&#46;1&#46;0&#46;4 program &#40;WHO AnthroPlus software&#44; version 1&#46;0&#46;4&#44; 2011&#41; was used for the analysis of the <span class="elsevierStyleItalic">Z</span>-score of anthropometric measurements&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Genograms were also developed for three generations of the 55 families that participated in the family cancer study &#40;Cyrillic v&#46;2&#46;1 program&#41;&#46; All patients received genetic counseling and psychological support&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Laboratory and imaging diagnosis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Serum levels of total and free testosterone&#44; androstenedione&#44; dehydroepiandrosterone&#44; dehydroepiandrosterone sulfate&#44; aldosterone&#44; cortisol&#44; adrenocorticotrophic hormone&#44; progesterone&#44; and estradiol were analyzed&#59; chest X-ray and tomography&#44; abdominal ultrasound&#44; and magnetic resonance imaging &#40;MRI&#41; exams were performed&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">At diagnosis&#44; patients were classified according to the clinical manifestation of excess corticosteroid hormones secreted by the tumor&#58; virilization syndrome &#40;androgens&#41;&#44; Cushing&#39;s syndrome &#40;cortisol&#41;&#44; mixed syndrome &#40;virilization and Cushing&#39;s&#41;&#44; and asymptomatic &#40;non-secretory&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Tumor volume was measured at the imaging examination&#44; and the surgical specimen was weighted&#46; The pathological diagnosis followed the Weiss classification&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> To detect the mutation&#44; molecular tests were performed using the polymerase chain reaction &#40;PCR&#41; method&#44; followed by restriction enzyme and agarose gel&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Clinical&#8211;surgical staging</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients were staged according to Sandrini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> as&#58;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">STAGE I</span> &#8211; tumors &#60;100<span class="elsevierStyleHsp" style=""></span>g and &#60;200<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#59; completely resected&#59; normal postoperative hormone levels&#59;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">STAGE II</span> &#8211; tumors &#8805;100<span class="elsevierStyleHsp" style=""></span>g or &#8805;200<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#59; completely resected&#59; normal postoperative hormone levels&#59;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">STAGE III</span> &#8211; non-resectable tumors&#59; macro- or microscopic residual disease&#59; tumor rupture&#59; high hormone levels after surgery&#59; retroperitoneal lymph node involvement&#59;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">STAGE IV</span> &#8211; distant metastases&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Treatment aspects</span><p id="par0090" class="elsevierStylePara elsevierViewall">Patients with localized disease underwent total surgical resection of the tumor&#46; Patients with tumors that were considered inoperable or had non-resectable distant metastases were submitted to biopsy for diagnostic confirmation and received chemotherapy &#40;CT&#41; prior to surgical resection of the primary tumor and metastases&#46; Patients with advanced disease or intraoperative tumor rupture underwent intensive CT with a combination of the drugs cisplatin&#44; etoposide&#44; doxorubicin associated with mitotane &#40;MTT&#41; adrenocorticolytic agent &#40;o&#44; p&#8217;-DDD&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">The following descriptive and association analyzes were performed&#58; frequency tables for categorical variables&#59; position and dispersion measurements for numerical variables&#59; association between variables &#40;chi-squared test or Fisher&#39;s exact test&#41;&#59; for comparing numerical measures between groups &#40;Mann&#8211;Whitney or Kruskal&#8211;Wallis test or ANOVA with rank transformation followed by Tukey&#39;s test&#41;&#59; association between ACT and cancer &#40;quasi-likelihood methods &#91;WQLS&#93; and generalized disequilibrium test &#91;GDT&#93;&#41;&#59; survival analysis &#40;Kaplan&#8211;Meier test&#41; and Log-rank for comparison between curves&#46; The level of significance was set at 5&#37; and the Statistical Analysis System &#40;SAS&#44; software&#44; version 9&#46;4&#44; NC&#44; USA&#41; was used for analysis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical aspects</span><p id="par0100" class="elsevierStylePara elsevierViewall">The study project of ACTs and the germline mutation in patients and their families was approved by the Research Ethics Committees of CIB and UNICAMP&#46; The study subjects signed an informed consent form&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">The patients&#8217; demographic&#44; clinical&#44; and evolution characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The median time between the clinical manifestations and diagnosis was 4 months &#40;0&#46;3&#8211;36&#41;&#46; The median follow-up time was 9 years &#40;0&#8211;33&#46;9&#41;&#46; There was no significant difference regarding age at diagnosis between the genders &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;27&#41;&#46; An association was observed between children under 5 years of age and stages I and II and between children older than 11 years and stages III and IV &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A correlation was observed between the symptoms at diagnosis and clinical staging for patients with virilization and stage I&#44; patients with combined tumor and stages I and II&#44; and asymptomatic patients and stages III and IV &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Tumor weight greater than 200<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> was correlated with advanced stages &#40;III and IV&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Seven patients had an association with congenital syndromes&#58; multiple familial polyposis &#40;2&#41;&#44; pyelocalicial ectopy &#40;1&#41;&#44; NK cell immunodeficiency &#40;1&#41;&#44; double aortic arch &#40;1&#41;&#44; erythroderma variabilis &#40;1&#41;&#44; and Beckwith&#8211;Wiedemann syndrome &#40;1&#41;&#46; Of the 84 patients tested&#44; 76 &#40;90&#46;4&#37;&#41; were carriers of the <span class="elsevierStyleItalic">TP53</span> p&#46;R337H germline mutation&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Two patients with the p&#46;R337H mutation had synchronous neuroblastoma at diagnosis of ACT&#46; There were two cases of second neoplasm&#44; 22 and 10 years after the diagnosis of ACT&#59; one non-smoker patient with lung adenocarcinoma and one patient with osteosarcoma&#44; respectively&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Patients with localized disease were treated with surgery for complete tumor resection&#44; and patients with advanced disease or recurrence received adjuvant therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The overall survival probability of the 103 patients&#44; in a median follow-up period of 26&#46;2 years &#40;95&#37; CI&#44; 23&#46;5&#8211;28&#46;9&#41;&#44; was 76&#46;7&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; There was a significant difference in the overall survival probability between the stages &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#58; stage I&#44; 95&#46;7&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#41;&#59; II&#44; 75&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;2&#41;&#59; III&#44; 55&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1&#41;&#59; and IV&#44; 25&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;3&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Family predisposition to cancer associated with the p&#46;R337H TP53 mutation</span><p id="par0140" class="elsevierStylePara elsevierViewall">Of the 179 first-degree relatives &#40;parents&#44; siblings&#44; and children&#41; of 55 probands&#44; 175 were tested for the p&#46;R337H mutation&#46; Of these&#44; 13 of the 81 carriers and one of the 94 non-carriers were diagnosed with cancer during a median follow-up period of 9&#46;7 years &#40;3&#8211;32&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Among 33 carrier mothers&#44; three developed breast cancer &#40;at 41&#44; 43&#44; and 44 years of age&#41;&#59;one developed adrenal carcinoma &#40;at age 47 years&#41;&#59; and one&#44; leiomyosarcoma of the uterus &#40;at age 61 years&#41;&#46; Among the 22 carrier fathers&#44; one developed a central nervous system tumor &#40;at age 28 years&#41;&#59; one&#44; carcinoma of the larynx &#40;at age 40 years&#41;&#59; one&#44; carcinoma of the esophagus &#40;at age 46 years&#41;&#44; one&#44; lung adenocarcinoma &#40;at age 51 years&#44; non-smoker&#41;&#59; and one&#44; gastric cancer &#40;at age 62 years&#41;&#46; A proband&#39;s sister&#44; who was a carrier&#44; developed ACT at 1&#46;4 years and one child&#44; a carrier&#44; developed neuroblastoma at 2&#46;8 years&#59; one sister&#44; non-carrier&#44; developed acute myeloid leukemia &#40;at age 23 years&#41;&#46; The median age of the parents at the cancer diagnosis was 45 years &#40;28&#8211;62&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A family history of cancer was available in 50 of the 55 families in the mutation-segregating parental line &#40;SPL&#41; and 49 of the 55 in the mutation non-segregating parental line &#40;NSPL&#41;&#59; 47&#47;50 &#40;94&#37;&#41; and 27&#47;49 &#40;55&#37;&#41; had a history of cancer &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; multiple occurrences of cancer in first&#44; second&#44; and third-degree relatives were observed in 25 of the 47 &#40;53&#46;2&#37;&#41; SPL families and in four of 27 &#40;14&#46;8&#37;&#41; NSPL families &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The most common types of neoplasms were&#58; breast cancer in 22&#47;91 women&#44; 61 gastrointestinal tumors&#44; 17 central nervous system tumors&#44; and 14 laryngeal tumors&#44; in a total of 198 neoplasms detected in families in which the mutation is segregated&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; a family genogram exemplifies cancer predisposition&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Anthropometry</span><p id="par0160" class="elsevierStylePara elsevierViewall">The 64 surviving patients were eligible for anthropometric data assessment&#46; At diagnosis&#44; there was no significant difference for the mean and median age &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;53&#41;&#44; weight <span class="elsevierStyleItalic">Z</span>-score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#41;&#44; height &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;92&#41;&#44; and BMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;27&#41; between the female and male genders&#46; Patients with signs and symptoms of androgen-secreting tumors had above-average height <span class="elsevierStyleItalic">Z</span>-scores for the same age and gender population&#46; A statistical difference was observed for the height <span class="elsevierStyleItalic">Z</span>-score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; between patients with virilization &#40;0&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&#41; and mixed syndromes &#40;&#8722;0&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&#41;&#46; After disease remission&#44; in the follow-up consultations&#44; anthropometric analyses indicated that there was no statistical difference between genders for BMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;67&#41;&#44; but there was a difference regarding a higher height <span class="elsevierStyleItalic">Z</span>-score for the female gender &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#59; in the comparison between patients with virilization and combined syndrome&#44; there was no significant difference for height <span class="elsevierStyleItalic">Z</span>-score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;52&#41; and for BMI <span class="elsevierStyleItalic">Z</span>-score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The analysis of the height catch-down for patients with virilization showed a greater decrease in the <span class="elsevierStyleItalic">Z</span>-score for the male gender &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">In this study&#44; the authors confirmed that early diagnosis of children carrying the p&#46;R337H mutation and ACT is associated with high curability without long-term health impairment&#46; Surgery with complete tumor resection is sufficient to cure approximately 80&#37; of children with small tumors&#46; However&#44; when the diagnosis is late&#44; the tumors are more aggressive and the patients receive adjuvant treatment with intensive chemotherapy and mitotane&#44; compromising prognosis and survival&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The results demonstrated that early signs and symptoms of ACT can be detected in childcare follow-up&#44; as 86&#37; of cases occur before 5 years of age and 93&#37; of patients have somatic growth disorders or age-inappropriate sexual features&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;16</span></a> It should be noted that abnormal steroid secretion occurs early during tumor development and&#44; therefore&#44; subtle clinical manifestations are the first signs of the disease&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Height growth acceleration may be the first sign of high androgen secretion and rapid weight gain&#44; of cortisol secretion&#59; in this study&#44; 75&#37; of the children were above the 75th percentile for weight and height&#46; For children with non-secretory tumors&#44; the <span class="elsevierStyleItalic">Z</span>-score for weight and height were below average&#44; probably due to secondary loss to tumor catabolism&#44; as the diagnosis was attained later&#44; when the disease was advanced&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Most cases present as early pseudopuberty with signs of virilization or as Cushing&#39;s syndrome&#44; isolated or associated&#44; easily mistaken for adrenal gland hyperplasia or central precocious puberty&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18</span></a> The authors emphasize that&#44; particularly in children from South and Southeast Brazil&#44; the possibility of ACT should be the first hypothesis and imaging tests&#44; ultrasound&#44; or preferably MRI of the abdomen should be performed immediately&#44; as the delay in diagnosis compromises prognosis and survival&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> Computed tomography is not indicated&#44; due to the risk of exposure to irradiation&#46; Due to the possible difficulties to perform the MRI&#44; the authors suggest the abdominal ultrasound assessment&#44; with special attention to the adrenal glands&#44; and the measurement of hormones &#40;androgens and cortisol&#41;&#44; in addition to an investigation of the family history of cancer&#46; The presence of virilization before 4 years of age&#44; hypercortisolism before 10 years&#44; disproportion between signs of virilization and testicular volume in boys&#44; and presence of signs of two steroid chains are highly suggestive of ACT&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> In these cases and&#47;or in the presence of adrenal mass&#44; the child should be sent to the referral center as a matter of urgency&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Arterial hypertension was observed at diagnosis in approximately 22&#37; of the patients and&#44; in most cases&#44; it was associated with cortisol production&#46; Hypertension was more common in patients with Cushing and mixed syndrome&#59; however&#44; 7&#37; of patients with virilization or non-secreting tumor had hypertension&#44; probably due to compression of the renal artery by the tumor or increased aldosterone production&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Other signs and symptoms related to secretory tumors that may be present are&#58; pubarche or premature axillary hair &#40;92&#37;&#41;&#44; clitoromegaly &#40;92&#37;&#41;&#44; phallumegaly &#40;91&#37;&#41;&#44; hirsutism &#40;62&#37;&#41;&#44; increased volume or palpable mass in the abdomen &#40;55&#37;&#41;&#44; acne &#40;47&#37;&#41;&#44; facial plethora &#40;42&#37;&#41;&#44; moon facies &#40;35&#37;&#41;&#44; and increased voice pitch &#40;32&#37;&#41;&#59; early thelarche is not a common sign&#44; as estrogen-producing tumors are rare&#46; Hypertension secondary to aldosterone secretion is generally a manifestation associated with virilization or hypercortisolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#44;20&#44;21</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">In this study&#44; non-secreting ACTs represented 6&#46;8&#37; of the cases and were diagnosed late through imaging tests&#44; with advanced disease and reserved prognosis&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Prolonged exposure to androgens accelerates bone age and development&#44; sometimes leading to precocious puberty requiring hormonal blockade&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;20</span></a> The present series included three girls in need of pubertal block at 6 and 7 years of age&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">ACT prognosis is associated with disease staging at diagnosis&#46; In this study&#44; the survival probability for patients with localized disease&#44; which could be surgically resected&#44; was above 75&#37;&#46; Mitotane &#40;o-p&#8217;DDD&#41;&#44; an adrenocorticolytic agent&#44; has been used as adjuvant to surgery&#44; associated or not with conventional chemotherapy&#44; but its true efficacy still needs to be demonstrated&#46; Furthermore&#44; mitotane has significant side effects&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> Radiation therapy is not recommended because&#44; in over 90&#37; of cases in southern Brazil&#44; adrenal carcinoma is associated with <span class="elsevierStyleItalic">TP53</span> mutations&#44; which may predispose to secondary neoplasms in the irradiated area&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">TP53</span> p&#46;R337H mutation is associated with other neoplasms in childhood and adulthood&#46; This study group demonstrated an association of p&#46;R337H with other pediatric tumors in children treated at CIB&#44; showing that&#44; in addition to ACT&#44; p&#46;R337H is strongly associated with choroid plexus carcinoma &#40;69&#37;&#41;&#44; osteosarcoma &#40;7&#37;&#41; and neuroblastoma &#40;8&#46;4&#37;&#41; and in three out of 123 women with breast cancer in the Southeast region of Brazil&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#8211;25</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">In all cases of patients with p&#46;R337H mutation&#44; the inheritance was confirmed by the presence of the mutation in one of the parents&#44; corroborating the observation that&#44; to date&#44; in the South of Brazil&#44; no cases of <span class="elsevierStyleItalic">de novo</span> mutations have been reported&#46; In 2001&#44; Ribeiro et al&#46; described for the first time the missense mutation in exon 10 of the <span class="elsevierStyleItalic">TP53</span> gene&#44; originating the protein variant with substitution of an arginine by a histidine called p&#46;R337H&#44; and proved the association of this mutation with ACT&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Other authors have reported the association of this mutation with families that have familial predisposition to cancer syndromes&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">In the prospective study of 55 families of children treated for ACT and carrying the mutation&#44; the authors found 13 new cases of cancer among 81 tested first-degree relatives that were carriers and one case among 94 non-carrier relatives&#46; In the literature&#44; other non-p&#46;R337H mutations of <span class="elsevierStyleItalic">TP53</span> are associated with familial cancer syndrome&#44; such as the classic Li-Fraumeni syndrome and its Li-Fraumeni-like variants &#40;OMIM &#35; 151623&#41;&#44; but with a spectrum of different tumors &#40;sarcomas&#44; breast carcinoma&#44; central nervous system tumors&#44; and leukemia&#41; than those found in the family members of this study and different age at cancer occurrence in younger individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">27&#8211;29</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">The authors advise including the family history of cancer in the anamnesis and the three-generation genogram to alert for the presence of the mutation&#44; as&#44; because it is hereditary&#44; individuals in the segregating line are at risk of developing cancer&#46; The presence of cancer in more than one first or second-degree relative&#44; or multiple tumors in the same individual or cancer in young individuals indicate family predisposition&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The authors of this study demonstrated the high frequency of ACT in a reference center in Southeast Brazil&#44; which was associated with the hereditary <span class="elsevierStyleItalic">TP53</span> p&#46;R337H mutation in more than 90&#37; of the cases&#46; Most cases can be detected early through signs and symptoms of elevated corticosteroid secretion&#59; and survival is associated with early diagnosis and localized disease&#46; ACT diagnosis in a child represents an alert for family predisposition to cancer&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">The pediatrician&#44; in primary health care&#44; is the fundamental link between diagnostic suspicion and appropriate treatment&#46; It is up to the referral centers to develop therapeutic protocol strategies that provide the pediatrician with new forms of prevention and predictive measures for children and families at risk of developing cancer&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0245" class="elsevierStylePara elsevierViewall">Project coordinated by Prof&#46; Jos&#233; Andr&#233;s Yunes with grants from Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;<span class="elsevierStyleGrantSponsor" id="gs1">CNPq</span>&#41;&#44; Number <span class="elsevierStyleGrantNumber" refid="gs1">401991&#47;2010</span> and <span class="elsevierStyleGrantSponsor" id="gs2">Funda&#231;&#227;o Capes&#44; Ministry of Education</span>&#46; PROCAD N&#46; 247&#47;2007&#44; for molecular biology analyses&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Family predisposition to cancer associated with the p&#46;R337H TP53 mutation"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the clinical features associated with adrenocortical hormone overexpression and familial cancer profiling as potential markers for early detection of adrenocortical tumors in children from South and Southeast Brazil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The clinical manifestations and anthropometric measurements of 103 children diagnosed with adrenocortical tumors were analyzed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Between 1982 and 2011&#44; 69 girls and 34 boys diagnosed with adrenocortical tumors were followed-up for a median time of 9&#46;0 years &#40;0&#8211;34 years&#41;&#46; Signs of androgen overproduction alone &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#41; or associated with cortisol &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41; were present in 90&#46;3&#37;&#46; <span class="elsevierStyleItalic">TP53</span> p&#46;R337H mutation was found in 90&#46;5&#37; of patients&#46; Stages I&#44; II&#44; III&#44; and IV were observed in 45&#46;6&#37;&#44; 27&#46;2&#37;&#44; 19&#46;4&#37;&#44; and 7&#46;8&#37; of patients&#44; respectively&#46; At diagnosis&#44; there were no significant differences in height &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;92&#41; and weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#41; among children with adrenocortical tumors&#44; but children with virilization alone had significantly higher height-for-age <span class="elsevierStyleItalic">Z</span>-scores &#40;0&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&#41; than children with hypercortisolism alone or combined &#40;&#8722;0&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46; The five-year overall survival was 76&#46;7&#37; &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&#41;&#46; Patients with advanced-stage disease had a significantly worse prognosis than those with limited disease &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; During follow-up&#44; ten of 55 p&#46;R337H carrier parents developed cancer&#44; whereas none of the 55 non-carriers did&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Signs of adrenocortical hormone overproduction appear early&#44; even in cases with early-stage&#46; These signs can be identified at the physical examination and anthropometric measurements&#46; In southern Brazil&#44; pediatric adrenocortical tumor is a sentinel cancer for detecting families with germline p&#46;R337H mutation in <span class="elsevierStyleItalic">TP53</span> gene&#46;</p></span>"
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            "titulo" => "Methods"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar as manifesta&#231;&#245;es cl&#237;nicas da hiperexpress&#227;o de horm&#244;nios do c&#243;rtex da adrenal e c&#226;ncer familiar como marcadores para a detec&#231;&#227;o precoce de tumores adrenocorticais em crian&#231;as do Sul e Sudeste do Brasil&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes e m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram analisadas as manifesta&#231;&#245;es cl&#237;nicas e antropom&#233;tricas de 103 crian&#231;as diagnosticadas com tumores adrenocorticais&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Entre 1982 e 2011&#44; 69 meninas e 34 meninos diagnosticados com tumores adrenocorticais foram acompanhados por um tempo mediano de nove anos &#40;0-34&#41;&#46; Ao diagn&#243;stico&#44; sinais de viriliza&#231;&#227;o isolada &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#41; ou associada ao cortisol &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41; estavam presentes em 90&#44;3&#37; dos pacientes&#59; a muta&#231;&#227;o&#160;do gene <span class="elsevierStyleItalic">TP53</span> p&#46;R337H foi identificada em 90&#44;5&#37; dos pacientes&#46; Os pacientes foram classificados em est&#225;dio I &#40;45&#44;6&#37;&#41;&#44; II &#40;27&#44;2&#37;&#41;&#44; III &#40;19&#44;4&#37;&#41; e IV &#40;7&#44;8&#37;&#41;&#46; Ao diagn&#243;stico&#44; n&#227;o houve diferen&#231;a significativa para as medidas de altura &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;92&#41; e de peso &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;22&#41; entre as crian&#231;as com tumores adrenocorticais&#44; mas crian&#231;as com viriliza&#231;&#227;o tiveram escore-Z mais elevado para a idade &#40;0&#44;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&#41; do que aquelas com hipercortisolismo isolado ou combinado &#40;&#8722;0&#44;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; A sobrevida global de cinco anos foi de 76&#44;7&#37; &#40;DP<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;2&#41;&#46; Pacientes com est&#225;dios avan&#231;ados tiveram pior progn&#243;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Durante o seguimento&#44; 10 dos 55 genitores portadores da p&#46;R337H desenvolveram c&#226;ncer&#44; enquanto que nenhum caso ocorreu entre os 55 n&#227;o portadores&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Os sinais de hiperprodu&#231;&#227;o de horm&#244;nios adrenocorticais aparecem precocemente no desenvolvimento do tumor e podem ser identificados pelo exame f&#237;sico e medidas antropom&#233;tricas na consulta pedi&#225;trica de rotina&#46; O tumor adrenocortical pedi&#225;trico &#233; sentinela para a detec&#231;&#227;o de c&#226;ncer em fam&#237;lias que segregam a muta&#231;&#227;o germinativa p&#46;R337H do gene <span class="elsevierStyleItalic">TP53</span>&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Mastellaro MJ&#44; Ribeiro RC&#44; Oliveira-Filho AG&#44; Seidinger AL&#44; Cardinalli IA&#44; Miranda EC&#44; et al&#46; Adrenocortical tumors associated with the <span class="elsevierStyleItalic">TP53</span> p&#46;R337H germline mutation can be identified during child-care consultations&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;432&#8211;9&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan Meier curves for the probability of survival of 103 patients with ACT in childhood&#46; &#40;A&#41; Overall survival&#59; &#40;B&#41; stratified survival according to stage of the disease at diagnosis&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Illustrative genogram of the family of a proband with ACT and family predisposition to cancer in the mutation-segregating parental line of p&#46;R337H TP53&#46;</p>"
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        "identificador" => "fig0015"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#44; B&#41; Comparison of height &#40;A&#41; and BMI &#40;B&#41; <span class="elsevierStyleItalic">Z</span>-score between genders and between endocrine syndromes &#40;virilization and mixed&#41;&#44; at two moments of evaluation&#58; at diagnosis and after therapy of 64 survivors &#40;45 females and 19 males&#41; of childhood ACT&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Ethnicity</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>White&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Black&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mixed-race&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not informed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">State of origin</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#227;o Paulo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Minas Gerais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Paran&#225;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age group</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#8211;5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6&#8211;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;11 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">TP53 gene</span> p&#46;R337H mutation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Endocrine syndrome</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Virilization &#40;androgen&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mixed &#40;androgen and cortisol&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cushing &#40;cortisol&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asymptomatic &#40;non-secreting&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Blood pressure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not informed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Tumor weight</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;100<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>100&#8211;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;200<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not informed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Tumor volume</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;200<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;200<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not informed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Stage</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Therapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgery<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgery<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Chemotherapy<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Mitotane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chemotherapy<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Mitotane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deaths&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Disease progression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertensive encephalopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Encephalopathy due to toxicity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics of 103 patients with adrenocortical tumors in childhood and adolescence&#46;</p>"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood adrenocortical tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Sandrini"
                            1 => "R&#46;C&#46; Ribeiro"
                            2 => "L&#46; DeLacerda"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1210/jcem.82.7.4057"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1997"
                        "volumen" => "82"
                        "paginaInicial" => "2027"
                        "paginaFinal" => "2031"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9215267"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0155"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality rate of adrenocortical tumors in children under 15 years of age in Curitiba&#44; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Pianovski"
                            1 => "E&#46;M&#46; Maluf"
                            2 => "D&#46;S&#46; de Carvalho"
                            3 => "R&#46;C&#46; Ribeiro"
                            4 => "C&#46; Rodriguez-Galindo"
                            5 => "P&#46; Boffetta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/pbc.20624"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Blood Cancer"
                        "fecha" => "2006"
                        "volumen" => "47"
                        "paginaInicial" => "56"
                        "paginaFinal" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16200634"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of survival in pediatric adrenocortical carcinoma&#58; a surveillance&#46; Epidemiology&#44; and End Results &#40;SEER&#41; program study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; McAteer"
                            1 => "J&#46;A&#46; Huaco"
                            2 => "K&#46;W&#46; Gow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpedsurg.2013.02.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Surg"
                        "fecha" => "2013"
                        "volumen" => "48"
                        "paginaInicial" => "1025"
                        "paginaFinal" => "1031"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23701777"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "An inherited <span class="elsevierStyleItalic">p53</span> mutation that contributes in a tissue-specific manner to pediatric adrenal cortical carcinoma"
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                            3 => "G&#46;P&#46; Zambetti"
                            4 => "E&#46; Michalkiewicz"
                            5 => "A&#46;R&#46; Lafferty"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1073/pnas.161479898"
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                        "tituloSerie" => "Proc Natl Acad Sci U S A"
                        "fecha" => "2001"
                        "volumen" => "98"
                        "paginaInicial" => "9330"
                        "paginaFinal" => "9335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11481490"
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                        "editorialLocalizacion" => "Campinas &#40;SP&#41;"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Impact of neonatal screening and surveillance for the TP53 R337H mutation on early detection of childhood adrenocortical tumors"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Cust&#243;dio"
                            1 => "G&#46;A&#46; Parise"
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                            3 => "H&#46; Komechen"
                            4 => "C&#46;C&#46; Sabbaga"
                            5 => "R&#46; Rosati"
                          ]
                        ]
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                    0 => array:2 [
                      "doi" => "10.1200/JCO.2012.46.3711"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "2619"
                        "paginaFinal" => "2626"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23733769"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Founder effect for the highly prevalent R337H mutation of tumor suppressor p53 in Brazilian patients with adrenocortical tumors"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;M&#46; Pinto"
                            1 => "A&#46;E&#46; Billerbeck"
                            2 => "M&#46;C&#46; Villares"
                            3 => "S&#46; Domenice"
                            4 => "B&#46;B&#46; Mendon&#231;a"
                            5 => "A&#46;C&#46; Latronico"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Arq Bras Endocrinol Metabol"
                        "fecha" => "2004"
                        "volumen" => "48"
                        "paginaInicial" => "647"
                        "paginaFinal" => "650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15761534"
                            "web" => "Medline"
                          ]
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                ]
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                          "autores" => array:1 [
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                    0 => array:2 [
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                        "tituloSerie" => "J Cell Physiol"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17671971"
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                        "tituloSerie" => "Best Pract Res Clin Endocrinol Metab"
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                        "paginaInicial" => "477"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genomic landscape of paediatric adrenocortical tumours"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;M&#46; Pinto"
                            1 => "X&#46; Chen"
                            2 => "J&#46; Easton"
                            3 => "D&#46; Finkelstein"
                            4 => "Z&#46; Liu"
                            5 => "S&#46; Pounds"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1038/ncomms7302"
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                        "tituloSerie" => "Nat Commun"
                        "fecha" => "2015"
                        "volumen" => "6"
                        "paginaInicial" => "6302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25743702"
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                    0 => array:2 [
                      "titulo" => "The international pediatric adrenocortical tumor registry initiative&#58; contributions to clinical&#44; biological&#44; and treatment advances in pediatric adrenocortical tumors"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "E&#46;M&#46; Pinto"
                            2 => "G&#46;P&#46; Zambetti"
                            3 => "C&#46; Rodriguez-Galindo"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.mce.2011.10.015"
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                        "tituloSerie" => "Mol Cell Endocrinol"
                        "fecha" => "2012"
                        "volumen" => "351"
                        "paginaInicial" => "37"
                        "paginaFinal" => "43"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22040600"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0205"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "A health professional&#39;s guide for using the new WHO growth charts"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Child Health"
                        "fecha" => "2010"
                        "volumen" => "15"
                        "paginaInicial" => "84"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21286296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0210"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Minist&#233;rio da Sa&#250;de&#46; Orienta&#231;&#245;es para coleta e an&#225;lise de dados antropom&#233;tricos em servi&#231;os de sa&#250;de&#58; norma t&#233;cnica do sistema de Vigil&#226;ncia Alimentar e Nutricional &#8211; SISVAN"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Brasil"
                          ]
                        ]
                      ]
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                      "Libro" => array:3 [
                        "fecha" => "2011"
                        "editorial" => "Minist&#233;rio da Sa&#250;de"
                        "editorialLocalizacion" => "Bras&#237;lia"
                      ]
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                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;M&#46; Weiss"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "1984"
                        "volumen" => "8"
                        "paginaInicial" => "163"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6703192"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            14 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood adrenocortical tumours&#58; a review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Marques-Pereira"
                            1 => "L&#46; DeLacerda"
                            2 => "H&#46;M&#46; Lacerda"
                            3 => "E&#46; Michalkiewicz"
                            4 => "F&#46; Sandrini"
                            5 => "R&#46; Sandrini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1897-4287-4-2-81"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hered Cancer Clin Pract"
                        "fecha" => "2006"
                        "volumen" => "4"
                        "paginaInicial" => "81"
                        "paginaFinal" => "89"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20223012"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0225"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and outcome characteristics of children with adrenocortical tumors&#58; a report from the International Pediatric Adrenocortical Tumor Registry"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Michalkiewicz"
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                            2 => "B&#46; Figueiredo"
                            3 => "E&#46;C&#46; Miranda"
                            4 => "E&#46; Caran"
                            5 => "A&#46;G&#46; Oliveira-Filho"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1200/JCO.2004.08.085"
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                        "tituloSerie" => "J Clin Oncol"
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                        "volumen" => "22"
                        "paginaInicial" => "838"
                        "paginaFinal" => "845"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14990639"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0230"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Update on the etiology&#44; diagnosis and therapeutic management of sexual precocity"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;N&#46; Brito"
                            1 => "A&#46;C&#46; Latronico"
                            2 => "I&#46;J&#46; Arnhold"
                            3 => "B&#46;B&#46; Mendon&#231;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arq Bras Endocrinol Metabol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "15"
                        "paginaFinal" => "31"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0235"
              "etiqueta" => "18"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagn&#243;stico laboratorial da puberdade precoce"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Damiani"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arq Bras Endocrinol Metab"
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                        "volumen" => "46"
                        "paginaInicial" => "85"
                        "paginaFinal" => "90"
                      ]
                    ]
                  ]
                ]
              ]
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            18 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging findings in pediatric adrenocortical carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Ribeiro"
                            1 => "R&#46;C&#46; Ribeiro"
                            2 => "B&#46;D&#46; Fletcher"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s002470050013"
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                        "tituloSerie" => "Pediatr Radiol"
                        "fecha" => "2000"
                        "volumen" => "30"
                        "paginaInicial" => "45"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10663510"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            19 => array:3 [
              "identificador" => "bib0245"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Adrenocortical carcinoma in children&#58; a study of 40 cases"
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                            1 => "R&#46;S&#46; Sandrini Neto"
                            2 => "M&#46;J&#46; Schell"
                            3 => "L&#46; Lacerda"
                            4 => "G&#46;A&#46; Sambaio"
                            5 => "I&#46; Cat"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1200/JCO.1990.8.1.67"
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                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "1990"
                        "volumen" => "8"
                        "paginaInicial" => "67"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2295912"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adrenocortical tumors in children"
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                        0 => array:2 [
                          "etal" => true
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                            3 => "L&#46; DeLacerda"
                            4 => "F&#46; Sandrini"
                            5 => "M&#46;D&#46; Pianovsky"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "2000"
                        "volumen" => "33"
                        "paginaInicial" => "1225"
                        "paginaFinal" => "1234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11004724"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0255"
              "etiqueta" => "22"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Tumores adrenocorticais na crian&#231;a&#58; da abordagem cl&#237;nica &#224; avalia&#231;&#227;o molecular"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;R&#46; Antonini"
                            1 => "L&#46;M&#46; Colli"
                            2 => "L&#46; Ferro"
                            3 => "L&#46; Mermejo"
                            4 => "M&#46; Castro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arq Bras Endocrinol Metab"
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                        "volumen" => "55"
                        "paginaInicial" => "599"
                        "paginaFinal" => "606"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0260"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of the highly prevalent TP53 R337H mutation with pediatric choroid plexus carcinoma and osteosarcoma in southeast Brazil"
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                        0 => array:2 [
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                            2 => "F&#46;F&#46; Paschoal"
                            3 => "J&#46;G&#46; Assump&#231;&#227;o"
                            4 => "I&#46;A&#46; Cardinalli"
                            5 => "M&#46;A&#46; Ganazza"
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                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.25826"
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                        "tituloSerie" => "Cancer"
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                        "volumen" => "117"
                        "paginaInicial" => "2228"
                        "paginaFinal" => "2235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21192060"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Occurrence of neuroblastoma among TP53 p&#46;R337H carriers"
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                            5 => "S&#46;S&#46; Aguiar"
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                        "tituloSerie" => "PLOS ONE"
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                        "volumen" => "10"
                        "paginaInicial" => "e0140356"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26452166"
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                    0 => array:2 [
                      "titulo" => "Association of the germline TP53 R337H mutation with breast cancer in southern Brazil"
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                          "etal" => true
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                    ]
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                        "tituloSerie" => "BMC Cancer"
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                        "volumen" => "8"
                        "paginaInicial" => "357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19046423"
                            "web" => "Medline"
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                        0 => array:2 [
                          "etal" => true
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                            3 => "M&#46;I&#46; Achatz"
                            4 => "M&#46; Olivier"
                            5 => "G&#46; Martel-Planche"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.canlet.2007.10.044"
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                        "tituloSerie" => "Cancer Lett"
                        "fecha" => "2008"
                        "volumen" => "261"
                        "paginaInicial" => "21"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18248785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0280"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A cancer family syndrome in twenty-four kindreds"
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                        0 => array:2 [
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                            3 => "W&#46;A&#46; Blattner"
                            4 => "M&#46;G&#46; Dreyfus"
                            5 => "M&#46;A&#46; Tucker"
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                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "1988"
                        "volumen" => "48"
                        "paginaInicial" => "5358"
                        "paginaFinal" => "5362"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3409256"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0285"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and diversity of constitutional mutations in the p53 gene among 21 Li-Fraumeni families"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Birch"
                            1 => "A&#46;L&#46; Hartley"
                            2 => "K&#46;J&#46; Tricker"
                            3 => "J&#46; Prosser"
                            4 => "A&#46; Condie"
                            5 => "A&#46;M&#46; Kelsey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "1994"
                        "volumen" => "1"
                        "paginaInicial" => "1298"
                        "paginaFinal" => "1304"
                      ]
                    ]
                  ]
                ]
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                      "titulo" => "Beyond Li Fraumeni syndrome&#58; clinical characteristics of families with p53 germline mutations"
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                            0 => "K&#46;D&#46; Gonzalez"
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                            2 => "C&#46;H&#46; Buzin"
                            3 => "D&#46; Gu"
                            4 => "C&#46;Y&#46; Wen-Fong"
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                      "doi" => "10.1200/JCO.2008.16.6959"
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                        "tituloSerie" => "J Clin Oncol"
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        "texto" => "<p id="par0255" class="elsevierStylePara elsevierViewall">The authors would like to thank Gisele Miniussi de Assis&#44; data manager of the Study Program of Adrenocortical Tumors in Childhood and the Research protocol ARAR0332 of the Children&#39;s Oncology Group&#44; developed at Centro Infantil Boldrini and UNICAMP&#46;</p> <p id="par0260" class="elsevierStylePara elsevierViewall">The authors would also like to thank Cleide Aparecida Moreira Silva&#44; statistician of the Statistics Department of Faculdade de Ci&#234;ncias M&#233;dicas da UNICAMP&#46;</p>"
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