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Finally, some tumors, particularly those of the brain and the lung 120, 169–171, 191 , may synthesize and excrete glutamine, and it is still not known how this increased glutamine in the microenvironment may affect the physiology of neighboring cells

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Clinical suspicion plays a fundamental role in the diagnostic process, and is higher in patients at higher risk, including vegetarians, malnourished patients, older people, and patients who have malabsorption syndromes or have undergone gastrectomy or bariatric surgery