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Priyadharshini G, Phansalkar M, Ambroise M, Ramdas A. Binucleate Cells in Cytosmears: What do They Signify? J Cytol 2021; 38:38-43. [PMID: 33935390 PMCID: PMC8078617 DOI: 10.4103/joc.joc_178_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/14/2021] [Indexed: 11/04/2022] Open
Abstract
Background Although the classic Reed-Sternberg (RS) cell is considered a diagnostic of Hodgkin's disease, RS-like cells have been noted in various benign and malignant conditions. The presence of these cells can be a diagnostic challenge. Aims Our aim was to see if cells morphologically resembling or identical to RS cells occur in conditions other than Hodgkin lymphoma (HL) and what proportion of cases show binucleate cells in various benign and malignant conditions. We also want to discuss the diagnostic utility of cytomorphological features in predicting HL. Material and Methods This study is a retrospective analysis of 2086 cytology cases. The cytosmears were screened for the presence of binucleate cells. A detailed cytomorphological analysis of cytosmears with binucleate cells was performed, and the diagnostic utility of cytomorphological criteria in delineating HL was examined. Results Out of 2086 smears, 55 (2.6%) cytosmears showed binucleated RS/RS-like cells. Out of these 55 cases, 6 were HL, 3 cases were non-HL (NHL), 3 were sarcoma, 32 were carcinoma, and 11 were benign/inflammatory lesions. The presence of prominent eosinophilic nucleoli, granulomas, and eosinophils had good sensitivity and specificity in predicting the diagnosis of HL. Conclusion A detailed cytomorphological analysis is of limited value in categorizing the RS and RS-like cells. However, few cytomorphological features such as prominent eosinophilic nucleoli, eosinophils, granulomas, and lack of clustering of atypical cells can help us in predicting HL.
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Affiliation(s)
| | - Manjiri Phansalkar
- Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Moses Ambroise
- Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Anita Ramdas
- Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India
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Cozzolino I, Vitagliano G, Caputo A, Montella M, Franco R, Ciancia G, Selleri C, Zeppa P. CD15, CD30, and PAX5 evaluation in Hodgkin's lymphoma on fine-needle aspiration cytology samples. Diagn Cytopathol 2019; 48:211-216. [PMID: 31825183 DOI: 10.1002/dc.24366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/16/2019] [Accepted: 12/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The phenotypical identification of diagnostic cells is crucial for the diagnosis of Hodgkin's lymphoma (HL) on fine-needle aspiration cytology (FNAC). The aim of this study is to evaluate the immunocytochemical (ICC) expression of CD30, CD15, and PAX5 in Hodgkin's cells (HC) and Reed-Sternberg cells (RSC) on smears and cell-blocks (CB) of HL and to compare the performance of each antibody on smears and CB. METHODS In 21 FNAC cases of histologically confirmed classical HL, ICC identification of HC and RSC was performed using CD15, CD30, and PAX5 on smears and CB, respectively. RESULTS CD30 was positive in 19/21 cases (90.5%; 11/11 smears and 8/10 CB), CD15 was positive in 14/21 cases (66.7%; 5/11 smears and 9/10 CB), and PAX5 was positive in 13/21 cases (61.9%; 9/11 smears and 4/10CB). CONCLUSIONS CD15, CD30, and PAX5 are useful to the FNAC identification of HC and RSC. CD30 is the most sensitive, followed by CD15 and PAX5, which are more effective on CB and smears, respectively.
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Affiliation(s)
- Immacolata Cozzolino
- Department of Physical and Mental Health and Preventive Medicine School of Medicine and Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulio Vitagliano
- Department of Pathology, University of Salerno, University of Napoli "Federico II", Fisciano SA, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
| | - Marco Montella
- Department of Physical and Mental Health and Preventive Medicine School of Medicine and Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Franco
- Department of Physical and Mental Health and Preventive Medicine School of Medicine and Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Ciancia
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
| | - Carmine Selleri
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
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Choy B, Venkataraman G, Biernacka A, Lastra RR, Mueller J, Setia N, Reeves W, Antic T. Correlation of cytopathology with flow cytometry and histopathology for the diagnosis of hematologic malignancies in young adults presenting with cervical lymphadenopathy. Diagn Cytopathol 2019; 47:579-583. [PMID: 30794347 DOI: 10.1002/dc.24157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/31/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is frequently utilized in the diagnostic workup of lymphadenopathy. We evaluated the correlation of cytopathology with flow cytometry and tissue biopsy results and assessed the prevalence of specific malignancies in young adults presenting with cervical lymphadenopathy. METHODS Database was searched for cervical lymph node FNA performed by a cytopathologist in patients aged 18-30 years from 2005 to 2017. RESULTS Cervical lymph node FNA was performed on 48 patients without prior history of malignancy. Nineteen patients had cytology results only, of which all were interpreted as benign reactive lymph node. None developed subsequent malignancies. The remaining 29 patients had cytology with flow cytometry and/or tissue biopsy results. A benign reactive cytology diagnosis was rendered in 18 (62%) cases, of which 11 had concordant diagnosis on flow cytometry, 2 had tissue biopsy, and 3 had both. Eleven (38%) patients had cytology results concerning for a hematologic malignancy, of which 7 were confirmed by flow cytometry and 3 by both flow cytometry and tissue biopsy. Cervical lymph node FNA has 94.1% sensitivity, 83.3% specificity, 88.9% positive predictive value, and 90.9% negative predictive value. The most common hematologic malignancy in our young adult population presenting with cervical lymphadenopathy was Hodgkin lymphoma. CONCLUSION FNA is a useful first-line diagnostic procedure for assessing cervical lymphadenopathy in young adults to allow for better triage of specimens for flow cytometry and/or tissue biopsy concerning for a hematologic malignancy and potentially avoid invasive excisional biopsy in a proportion of cases.
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Affiliation(s)
- Bonnie Choy
- Department of Pathology, University of Chicago, Chicago, Illinois.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Anna Biernacka
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Jeffery Mueller
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Namrata Setia
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Ward Reeves
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, Illinois
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Pasvolsky O, Berger T, Bernstine H, Hayman L, Raanani P, Vidal L. Spontaneous Regression of Hodgkin Lymphoma: Case Report and Review of the Literature. Acta Haematol 2018; 141:14-18. [PMID: 30439716 DOI: 10.1159/000494422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/25/2018] [Indexed: 12/16/2022]
Abstract
Spontaneous regression of Hodgkin lymphoma (HL) is a rare event. We describe a 32-year-old woman with spontaneous regression of HL and review the literature. The patient presented with cervical lymphadenopathy and was diagnosed with stage IIA classical HL. The patient refused to receive any treatment for her disease. Positron emission tomography/computed tomography carried out 2 years later showed complete regression of the lymphadenopathy, without pathological uptake of fluorodeoxyglucose. At the last follow-up, 3.5 years after the initial presentation, the patient is with no evidence of disease. During workup for the HL, concomitant papillary thyroid carcinoma was diagnosed, for which the patient refused treatment as well. The thyroid malignancy has remained stable throughout the follow-up.
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Affiliation(s)
- Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel,
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lucille Hayman
- Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Vidal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Subhawong AP, Ali SZ, Tatsas AD. Nodular lymphocyte-predominant Hodgkin lymphoma: cytopathologic correlates on fine-needle aspiration. Cancer Cytopathol 2012; 120:254-60. [PMID: 22367911 DOI: 10.1002/cncy.21186] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/15/2011] [Accepted: 01/09/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), a rare subtype of Hodgkin lymphoma, is an indolent tumor with frequent instances of disease recurrence but a favorable prognosis. To the best of the authors' knowledge, there are only limited descriptions of NLPHL in the cytology literature because it was only formally recognized as a distinct entity in 1994. METHODS In the current study, all cases of NLPHL diagnosed on excisional biopsy (n = 6 cases) at the study institution between 2000 and 2011 that had undergone previous fine-needle aspiration (FNA) were reviewed, with a focus on cytomorphologic features. RESULTS Four of 6 cases were termed benign on FNA; however, there was retrospective recognition of characteristic LP cells in all cases. Unlike classical Hodgkin lymphoma, the tumor cells of NLPHL were often found to be mononucleate and presented in a background of small lymphocytes. Other features identified included epithelioid histiocytes and numerous bare atypical nuclei. CONCLUSIONS Cases of NLPHL are commonly misdiagnosed as benign reactive lymphoid tissue and therefore a careful search using high magnification for LP cells is recommended in the evaluation of lymph node FNAs.
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Affiliation(s)
- Andrea P Subhawong
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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6
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Florentine BD, Cohen AN. Nodular sclerosing classical Hodgkin lymphoma masquerading as acute suppurative-necrotizing lymphadenitis. Diagn Cytopathol 2011; 42:238-41. [PMID: 21965120 DOI: 10.1002/dc.21829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/09/2011] [Indexed: 11/07/2022]
Abstract
The diagnosis of nodular sclerosing classical Hodgkin lymphoma (NSCHL) by fine-needle aspiration (FNA) biopsy has historically been a diagnostic challenge due to the usual paucicellularity of the specimen. This case report, and other previously published reports, suggests that there is another facet to the potentially challenging diagnosis of this particular variant of Hodgkin lymphoma (HL): the presence of suppurative-necrotizing changes mimicking an infectious etiology. The patient presented here underwent FNA biopsy of an acutely enlarged supraclavicular lymph node and cytologic smears showed marked acute inflammation in a background of necrosis. A diagnosis of infectious suppurative lymphadenitis was made at that time. After a negative infectious work-up with infectious disease consultation, an excisional biopsy was performed and the patient was definitively diagnosed with NSCHL. The presence of neoplastic Hodgkin and Reed-Sternberg cells in the purulent exudate was minimal and only appropriately identified after retrospective review. This particular subtype of classical HL represents a potential pitfall in FNA biopsy cytology. Consequently, the cytopathologist and surgeon should always consider this entity in the differential diagnosis of a suppurative, lymphadenitis-like aspirate, and pursue repeat FNA or an excisional biopsy if there is any clinical index of suspicion.
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Affiliation(s)
- Barbara D Florentine
- FNA Specialists of the Valley, Valley Village, California; Department of Pathology, Keck School of Medicine, University of Southern California, California
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Seegmiller AC, Karandikar NJ, Kroft SH, McKenna RW, Xu Y. Overexpression of CD7 in classical Hodgkin lymphoma-infiltrating T lymphocytes. CYTOMETRY PART B-CLINICAL CYTOMETRY 2009; 76:169-74. [DOI: 10.1002/cyto.b.20459] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Park IS, Kim L, Han JY, Kim JM, Chu YC, Choi SJ. Syncytial variant of nodular sclerosis Hodgkin’s lymphoma assessed by fine needle aspiration cytology. Cytopathology 2008; 19:394-7. [DOI: 10.1111/j.1365-2303.2007.00533.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zeppa P, Picardi M, Cozzolino I, Troncone G, Lucariello A, De Renzo A, Pane F, Rotoli B, Vetrani A, Palombini L. Fine-needle aspiration cytology in the follow-up of Hodgkin lymphoma. Diagn Cytopathol 2008; 36:467-72. [PMID: 18528892 DOI: 10.1002/dc.20844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hodgkin lymphoma (HL) is characterized by long survival and risk of relapse and second neoplasm. The aim of this study is to evaluate the possibility of improving the accuracy of fine-needle cytology (FNC) in HL follow-up using Power Doppler ultrasound (US) assistance and immediate microscopic evaluation (ICE). The study was performed in two consecutive groups of 200 FNC in HL patients. In the first group FNC of palpable lymph-nodes or extra lymph-nodal masses were performed without US assistance except for impalpable and/or deep located masses (nonassisted group); In the second group, all the FNC were performed under Power Doppler US assistance with ICE and immediately repeated in inadequate cases (assisted group). Cytological diagnoses were controlled by histology (61) or clinical follow-up (69); sensitivity and specificity were calculated in the two groups and to evaluate the effect of Power Doppler alone, adequate cases were compared with the total number of FNC in each of the two groups.FNC identified 90 negative cases, 3 false negatives, 70 HL relapse, 16 inadequate and 14 suspicious; second neoplasia were diagnosed in 12 cases and all histologically confirmed. Sensitivity and specificity were 64 and 84% in the nonassisted group and 86 and 94% in the assisted group and there were significant differences between the number of adequate cases v.s. the total number of FNC in each of the two groups. Sensitivity and specificity in assisted FNC are higher than in nonassisted ones. The main advantage of assisted FNC in the follow-up of HL is to produce accurate diagnoses avoiding invasive biopsies.
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Affiliation(s)
- Pio Zeppa
- Dipartimento di Scienze Biomorfologiche e Funzionali, Facoltà di Medicina e Chirurgia, Università di Napoli Federico II, Napoli, Italia.
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Khan G. Epstein-Barr virus, cytokines, and inflammation: a cocktail for the pathogenesis of Hodgkin's lymphoma? Exp Hematol 2006; 34:399-406. [PMID: 16569586 DOI: 10.1016/j.exphem.2005.11.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 10/20/2005] [Accepted: 11/08/2005] [Indexed: 01/08/2023]
Abstract
The association between chronic inflammation and cancer has been known for well over a century. However, direct evidence detailing the role of inflammation in carcinogenesis has been slow in forthcoming. A number of recent studies suggest that the gaps in our understanding of the molecular pathways bridging the link between inflammation and cancer are slowly beginning to close and that this relationship is more deep-rooted than had been previously believed. This review addresses the link between inflammation and Hodgkin's lymphoma (HL), a malignancy which has many features reminiscent of chronic inflammation. The role of Epstein-Barr virus (EBV) in the pathogenesis of HL is discussed, along with an outline of our current understanding of the cellular nature and development of Reed-Sternberg cells, the malignant cells of HL. The involvement of cytokines and chemokines as orchestrators of inflammation and vehicles for chemical cross-talk between the malignant cells and the reactive inflammatory infiltrate forms a major part of the review. It is suggested that chronic inflammation, triggered by factors such as EBV, is likely to contribute to tumor cell proliferation, progression, and inhibition of apoptosis. Furthermore, it is proposed that the pro-inflammatory transcription factor NF-kappaB plays a central role in many of these processes.
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Affiliation(s)
- Gulfaraz Khan
- Kingston University, Kingston upon Thames, Surrey, UK.
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Martins MR, Santos GDC. Fine-needle aspiration cytology in the diagnosis of superficial lymphadenopathy: a 5-year Brazilian experience. Diagn Cytopathol 2006; 34:130-4. [PMID: 16511850 DOI: 10.1002/dc.20373] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To determine the accuracy of fine-needle aspiration (FNA) in the diagnostic assessment of lymphadenopathies, a retrospective study was conducted on 627 cases of FNA of the lymph nodes performed at Department of Pathology, UNIFESP (Federal University of São Paulo), between 1997 and 2001. Cytology results were compared to the results of biopsies if available. The cytological diagnosis was unsatisfactory in 14.7% of cases, positive in 46%, and negative in 39.3%. Among the positive cases, 79.4% were classified as metastases, 14.2% as lymphoma, and 6.4% as indeterminate. Anatomopathological exams for the determination of cytohistological correlation were available in 218 of the 627 cases. There were three (1.88%) false-negative and two (1.25%) false-positive cases. Accuracy tests revealed 97.41% sensitivity, 95.45% specificity, and 96.88% efficacy, with cytohistological agreement being almost perfect (kappa = 0.92). The high accuracy of this study based only on cytomorphological criteria associated to the variety of malignant neoplasias diagnosed by the procedure demonstrates its relevance on patient care, especially in areas of limited financial resources.
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Affiliation(s)
- Marcos Roberto Martins
- Discipline of Special Pathology, Department of Medicine, University of Taubaté, São Paulo, Brazil
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Mukhopadhyay S, Mukhopadhyay S, Banki K, Mahajan S. Leukemoid reaction: a diagnostic clue in metastatic carcinoma mimicking classic Hodgkin lymphoma. Arch Pathol Lab Med 2005; 128:1445-7. [PMID: 15578894 DOI: 10.5858/2004-128-1445-lradci] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report on 2 patients who were initially suspected to have classic Hodgkin lymphoma because of lymphadenopathy and the presence of Reed-Sternberg-like cells. Both patients had an associated leukemoid reaction (using a threshold leukocyte count of 50 000/microL) and were eventually diagnosed with metastatic carcinoma. Disseminated carcinoma can mimic Hodgkin lymphoma clinically, radiologically, and histologically. Reed-Sternberg-like cells may be found in carcinomas, and they represent a particularly challenging diagnostic pitfall for the unwary. When these cells lead to a suspicion of Hodgkin lymphoma, the presence of a leukemoid reaction should prompt the pathologist to question the diagnosis. Misdiagnosis can be avoided by the use of cytokeratin whenever a leukemoid reaction is present in a suspected case of Hodgkin lymphoma.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, State University of New York Upstate Medical University, Syracuse 13210, USA.
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Ranganathan S, Jaffe R. Is there a difference between Hodgkin's disease and a Hodgkin's-like post-transplant lymphoproliferative disorder, and why should that be of any interest? Pediatr Transplant 2004; 8:6-8. [PMID: 15009835 DOI: 10.1046/j.1397-3142.2003.00142.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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