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Murphy P, Machlab K, Almohsen S, Fratesi J, Watson G. β-hCG secreting uterine PEComa. BMJ Case Rep 2024; 17:e256641. [PMID: 38216169 PMCID: PMC10806971 DOI: 10.1136/bcr-2023-256641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
A postmenopausal female patient presented with vaginal bleeding. Initial bloodwork revealed an elevated serum beta human chorionic gonadotropin level (β-hCG). Pelvic MRI identified a complex heterogeneous uterine mass with central necrosis. She underwent total abdominal hysterectomy with bilateral saplingo-oopherectomy. Pathology reported a malignant perivascular epithelioid cell tumour (PEComa). Postoperatively, her β-hCG level returned to normal. β-hCG secreting sarcomas are extremely rare, and to our knowledge, there has only been one previously reported case of a β-hCG secreting PEComa. Based on the limited literature, these tumours may have a worse prognosis. The role of β-hCG as a marker of treatment response and disease activity is unclear. Additional studies are required to further ascertain its role as a predictive and prognostic biomarker.
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Affiliation(s)
- Patrick Murphy
- Department of Laboratory Medicine and Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Medical Oncology, Mount Sinai Hospital PLM, Toronto, Ontario, Canada
| | - Karla Machlab
- Medical Oncology, Mount Sinai Hospital PLM, Toronto, Ontario, Canada
| | - Shahd Almohsen
- Department of Laboratory Medicine and Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Pathology, Mount Sinai Hospital PLM, Toronto, Ontario, Canada
| | - Jennifer Fratesi
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Watson
- Medical Oncology, Mount Sinai Hospital PLM, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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2
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Tsakos E, Xydias EM, Ziogas AC, Bimpa K, Sioutas A, Zarampouka K, Tampakoudis G. Uterine malignant leiomyosarcoma associated with high levels of serum beta‐human chorionic gonadotropin: A case report. Clin Case Rep 2022; 10:e6322. [PMID: 36188042 PMCID: PMC9483817 DOI: 10.1002/ccr3.6322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
We present the case of a 54‐year‐old woman diagnosed with uterine leiomyosarcoma that produced beta‐human chorionic gonadotropin (β‐hCG), evident by both serum and immunohistologic examination. Based on this and similar cases from the available literature, β‐hCG‐producing sarcomas tend to have poorer prognosis, indicating that β‐hCG could potentially be used as a marker of disease status and response to the therapy; however, this association is inconsistent and should be further investigated.
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Affiliation(s)
| | - Emmanouil M. Xydias
- Embryoclinic Thessaloniki Greece
- School of Health Sciences, Faculty of Medicine University of Thessaly Larissa Greece
| | - Apostolos C. Ziogas
- School of Health Sciences, Faculty of Medicine University of Thessaly Larissa Greece
| | | | | | | | - Georgios Tampakoudis
- Maternal‐Fetal Medicine and Obstetrics Saint Luke's Hospital Thessaloniki Greece
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3
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Pleomorphic Undifferentiated Uterine Sarcoma in a Young Patient Presenting With Elevated Beta-hCG and Rare Variants of Benign Leiomyoma: A Case Report and Review of the Literature. Int J Gynecol Pathol 2019; 39:362-366. [PMID: 31033798 DOI: 10.1097/pgp.0000000000000606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leiomyosarcoma (LMS) is a malignant mesenchymal neoplasm showing smooth muscle differentiation. Uterine LMS is more frequent that nonuterine LMS, and represents 1% of all malignant neoplasms of the uterus. Pleomorphic undifferentiated uterine sarcoma is a rare entity, and is defined by high-grade sarcoma histology with loss of muscular markers. Several cases of pleomorphic undifferentiated uterine sarcoma have been reported in the literature, with worse clinical outcome when compared with conventional LMS. Here we report the first case of a pleomorphic undifferentiated uterine sarcoma in association with LMS in a 33 yr old woman. The patient presented clinically with recurrent vaginal bleeding and suspicion of a trophoblastic tumor. Ancillary testing revealed moderately elevated beta-hCG (49.7 U/L) and no metastatic disease on imaging. Gross examination of the hysterectomy specimen revealed a large heterogenous necrotic uterine mass infiltrating <50% of the myometrium. Microscopic evaluation showed pleomorphic undifferentiated uterine sarcoma adjacent to a nodule of leiomyoma with bizarre nuclei, with loss of myogenic markers in the high grade component. Other findings included a foci of conventional LMS, and diffuse uterine leiomyomatosis. Although beta-hCG dropped to normal levels during follow-up, the patient developed metastatic lesions to the lung at 6 mo postop. Initial elevation of beta-hCG may have correlated with the aggressive histology of the tumor, as reported by some groups previously. Recognition of pleomorphic undifferentiated uterine sarcoma and its distinction from conventional LMS is essential for patient prognosis and management.
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Maryamchik E, Lyapichev KA, Halliday B, Rosenberg AE. Dedifferentiated Liposarcoma With Rhabdomyosarcomatous Differentiation Producing HCG: A Case Report of a Diagnostic Pitfall. Int J Surg Pathol 2018. [PMID: 29532681 DOI: 10.1177/1066896918760192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report a first case of paraneoplastic human chorionic gonadotropin (HCG) production in a dedifferentiated liposarcoma with rhabdosarcomatous differentiation in an 83-year-old man with a retroperitoneal mass, unilateral scrotal enlargement, and a serum HCG level of 843 IU/L. Core biopsy of the retroperitoneal mass revealed rhabdomyosarcoma. Orchiectomy revealed a paratesticular dedifferentiated liposarcoma with rhabdosarcomatous differentiation. Fluorescence in situ hybridization analysis performed on both the retroperitoneal and paratesticular masses revealed amplification of MDM2. The retroperitoneal tumor was interpreted as metastatic dedifferentiated liposarcoma with the dedifferentiated component represented by rhabdomyosarcoma. HCG production is a common feature of testicular germ cell tumors, less common in carcinomas, and extremely rare in sarcomas. Accordingly, sarcomas secreting HCG are a potential diagnostic pitfall, and raise the differential diagnosis of germ cell tumors and a variety of carcinomas. HCG production by carcinomas is a known poor prognostic finding, however the significance of its production in sarcomas is unknown.
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Affiliation(s)
- Elena Maryamchik
- 1 Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kirill A Lyapichev
- 2 University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | | | - Andrew E Rosenberg
- 2 University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
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5
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Leostic A, Tran P, Fagot H, Boukerrou M. Elevated human chorionic gonadotrophin without pregnancy: A case of gallbladder carcinoma. J Gynecol Obstet Hum Reprod 2018; 47:141-143. [DOI: 10.1016/j.jogoh.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022]
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6
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Mustafa A, Bozdag Z, Tepe NB, Ozcan HC. An unexpected reason for elevated human chorionic gonadotropin in a young woman. Cervical squamous carcinoma. Saudi Med J 2017. [PMID: 27464870 PMCID: PMC5018710 DOI: 10.15537/smj.2016.8.14529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Human chorionic gonadotropin has been used for decades, in addition to specific investigations, to detect pregnancy, trophoblastic tumors, as well as congenital defects. Rarely, it can be elevated in non-trophoblastic tumors such as squamous cell cancers and germ cell tumors. A 33-year-old Asian Syrian female had irregular menses accompanied with feelings of heaviness in the vagina. In addition to routine investigations, we measured the serum beta human chorionic gonadotropin (ß-HCG) level (based on the patient's complaint of amenorrhea), which was 50.05 ml UI/ml. Cervical biopsy revealed a non-keratinized large cell squamous carcinoma. After excluding other causes, ß-hCG elevation was explained by the ectopic secretion of cancer cells line. Cervical biopsy was suggestive of large cell non-keratinizing squamous cell carcinoma and positive for human chorionic gonadotropin on immunohistochemistry. As a result, we manage the possibility of ectopic secretion of ß-HCG from non- trophoblastic disease.
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Affiliation(s)
- Aynur Mustafa
- Department of Obstetrics and Gynecology, Medical School, Gaziantep University, Gaziantep, Turkey. E-mail.
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7
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Mustafa A, Bozdag Z, Tepe NB, Ozcan HC. An unexpected reason for elevated human chorionic gonadotropin in a young woman. Cervical squamous carcinoma. Saudi Med J 2017; 37:905-7. [PMID: 27464870 DOI: 10.15537/2016.8.14529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Human chorionic gonadotropin has been used for decades, in addition to specific investigations, to detect pregnancy, trophoblastic tumors, as well as congenital defects. Rarely, it can be elevated in non-trophoblastic tumors such as squamous cell cancers and germ cell tumors. A 33-year-old Asian Syrian female had irregular menses accompanied with feelings of heaviness in the vagina. In addition to routine investigations, we measured the serum beta human chorionic gonadotropin (ß-HCG) level (based on the patient's complaint of amenorrhea), which was 50.05 ml UI/ml. Cervical biopsy revealed a non-keratinized large cell squamous carcinoma. After excluding other causes, ß-hCG elevation was explained by the ectopic secretion of cancer cells line. Cervical biopsy was suggestive of large cell non-keratinizing squamous cell carcinoma and positive for human chorionic gonadotropin on immunohistochemistry. As a result, we manage the possibility of ectopic secretion of ß-HCG from non- trophoblastic disease.
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Affiliation(s)
- Aynur Mustafa
- Department of Obstetrics and Gynecology, Medical School, Gaziantep University, Gaziantep, Turkey. E-mail.
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8
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Brandt MP, Hoefner T, Gust KM, Ahrens M, Boettcher M, Kvasnicka HM, Bartsch G, Thomas C, Haferkamp A, Tsaur I. Rare Case of Excessive Beta-Human Chorionic Gonadotropin Producing Intrascrotal Leiomyosarcoma: Diagnostic Pitfalls and Therapeutic Implications. Clin Genitourin Cancer 2016; 14:e409-12. [PMID: 26873434 DOI: 10.1016/j.clgc.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Maximilian Peter Brandt
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Thomas Hoefner
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Kilian Martin Gust
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marit Ahrens
- Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Marie Boettcher
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Hans-Michael Kvasnicka
- Dr. Senckenberg Institute for Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Georg Bartsch
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Thomas
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Axel Haferkamp
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Igor Tsaur
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
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Weinberg BD, Newell KL, Wang F. A case of a Beta-human chorionic gonadotropin secreting sinonasal teratocarcinosarcoma. J Neurol Surg Rep 2014; 75:e103-7. [PMID: 25083366 PMCID: PMC4110143 DOI: 10.1055/s-0034-1373667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/10/2014] [Indexed: 10/26/2022] Open
Abstract
Background and Importance Sinonasal teratocarcinosarcoma (SNTCS) is an unusual and aggressive neoplasm characterized by the combination of teratoma and carcinosarcoma features that is often misdiagnosed based on a biopsy sample. Approximately 60 cases have been reported in the English literature, but none have been associated with serum tumor markers. We report a case of SNTCS with elevation of serum β-human chorionic gonadotropin (hCG) level. Clinical Presentation The patient was a 22-year-old pregnant woman at diagnosis, and her β-hCG level was appropriately elevated. Her initial treatment was a surgical resection followed by radiation therapy (RT). Two years later, the patient had a pregnancy work-up after a sexual assault. Her serum β-hCG was elevated, but a nongravid uterus was seen on ultrasound. Magnetic resonance imaging (MRI) of the head revealed an intracranial tumor recurrence in the right frontal lobe. During salvage RT, β-hCG decreased rapidly to normal levels, with a complete tumor response on MRI. Retrospective examination of the initial surgical specimen showed expression of β-hCG associated with the anaplastic mesenchymal component. Conclusion This is the first reported case of a β-hCG secreting SNTCS. The source of β-hCG production was traced to a neoplastic smooth muscle component of the tumor.
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Affiliation(s)
- Benjamin D Weinberg
- Department of Radiation Oncology, Wayne State University, Detroit, Michigan, United States
| | - Kathy L Newell
- Department of Pathology, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Fen Wang
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, United States
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10
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Kelley BC, Arnold PM, Grant JA, Newell KL. Primary intracranial β-human chorionic gonadotropin-producing leiomyosarcoma in a 2-year-old immunocompetent child. J Neurosurg Pediatr 2012; 10:121-5. [PMID: 22747091 DOI: 10.3171/2012.4.peds1216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a rare case of primary intracranial leiomyosarcoma (LMS) in a young, immunocompetent boy. The patient presented with an expanding right forehead mass. Diagnostic workup revealed multiple large intracranial tumors. The largest mass was resected, and pathological analysis revealed LMS. Given the poor prognosis of this tumor, the family declined further care, and the child died 3 months later. Primary LMSs are extremely rare tumors in the pediatric population, especially in patients who are not immunocompromised.
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Affiliation(s)
- Brian C Kelley
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160, USA
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11
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Dedifferentiated Liposarcoma of the Retroperitoneum with Extensive Leiomyosarcomatous Differentiation and beta-Human Chorionic Gonadotropin Production. Sarcoma 2011; 2008:658090. [PMID: 18382626 PMCID: PMC2276869 DOI: 10.1155/2008/658090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 11/04/2007] [Accepted: 02/12/2008] [Indexed: 11/29/2022] Open
Abstract
Dedifferentiated liposarcomas may display a variety of “heterologous” lines of differentiation, including osseous, vascular, skeletal, and/or smooth muscular. There have been six previously reported examples of leiomyosarcomas associated with high levels of serum human chorionic gonadotropin (hCG) production, comprised of cases originating from the retroperitoneum, spermatic cord, small intestine, and uterus. This report describes the first example of a dedifferentiated liposarcoma that combined both of the aforementioned features: extensive heterologous (leiomyosarcomatous) differentiation and
β-hCG production (maximum serum levels 1046 mIU/ml, reference <5 mIU/ml). The tumor, which originated in the retroperitoneum in the region of the right kidney, was rapidly progressive and ultimately fatal within three months of its diagnosis. In addition to characteristic morphologic features, lipogenic and smooth muscle differentiation were confirmed with immunohistochemical stains for MDM2 and smooth muscle actin, respectively. The tumor also displayed diffuse immunoreactivity for β-hCG in both primary and metastatic sites. This case further expands the clinicopathologic spectrum of lipogenic tumors.
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12
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Brown L. Pathology of uterine malignancies. Clin Oncol (R Coll Radiol) 2008; 20:433-47. [PMID: 18499412 DOI: 10.1016/j.clon.2008.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 04/22/2008] [Indexed: 01/17/2023]
Abstract
This overview covers epithelial, stromal and mesenchymal malignancies of the body of the uterus, excluding the cervix. The distinction of type I and type II endometrial adenocarcinoma with the morphological variants of this tumour is discussed and some molecular aspects are explored. The concept of carcinosarcoma representing a metaplastic adenocarcinoma of the endometrium that behaves more like a carcinoma than a sarcoma is explained. Some types of mixed epithelial and stromal neoplasm are described and contrasted with carcinosarcoma. The concept of stromal sarcoma and high-grade uterine sarcoma is described and an outline of malignant smooth muscle tumours of the uterus includes a description of smooth muscle tumours of uncertain malignant potential and worrying benign smooth muscle lesions.
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Affiliation(s)
- L Brown
- Department of Histopathology, Leicester Royal Infirmary, Infirmary Square, Leicester, UK.
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13
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Abstract
When connective tissue undergoes malignant transformation, glioblastomas and sarcomas arise. However, the ancient biochemical mechanisms, which are now operational in sarcomas distorted by mutations and gene fusions in misaligned chromosomes, were originally acquired by those cells that emerged during the Cambrian explosion. Preserved throughout evolution up to the genus Homo, these mechanisms dictate the apoptosis- and senescence-resistant immortality of malignant cells. A 'retroviral paradox' distinguishes human sarcomas from those of the animal world. In contrast to the retrovirally induced sarcomatous transformation of animal (avian, murine, feline and simian) cells, human sarcomas have so far failed to yield a causative retroviral isolate. However, the proto-oncogenes/oncogenes transduced from their host cells by retroviruses of animals are the same that are active in human sarcomas. Since the encoded oncoproteins arise after birth, they are recognized frequently by the immune system of the host. Immune lymphocytes that kill autologous sarcoma cells in vitro commonly fail to do so in vivo. Sarcoma vaccines generate immune T- and natural killer cell reactions; even when vaccinated patients do not show a clinical response, their tumors become more sensitive to chemotherapy. The aim of this review is to lay a solid molecular biological foundation for the conclusion that targeting the sarcoma oncogenes will result in regression of the disease.
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Affiliation(s)
- Joseph G Sinkovics
- Cancer Institute of St. Joseph's Hospital Affiliated with the HL Moffitt Cancer Center, The University of South Florida College of Medicine, Department of Medical Microbiology and Immunology, Tampa, Florida, USA.
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