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Gan W, Han X, Gong Y, Yang Y, Wang C, Zhang Z. Diagnostic and prognostic assessments of adrenocortical carcinomas by pathological features, immunohistochemical markers and reticular histochemistry staining. Diagn Pathol 2024; 19:71. [PMID: 38802933 PMCID: PMC11131238 DOI: 10.1186/s13000-024-01496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Current diagnostic criteria of adrenocortical neoplasms are mostly based on morphology. The utility of immunohistochemistry (IHC) and histochemistry is limited. MATERIALS AND METHODS To evaluate the diagnostic and prognostic utility of clinicopathological features, morphology, ancillary biomarkers, and reticular histochemistry in adrenocortical neoplasms. We examined 28 adrenocortical carcinomas (ACCs) and 50 adrenocortical adenomas (ACAs) obtained from pathology archives. Clinical data were retrieved from medical records. Two pathologists independently assessed hematoxylin and eosin-stained slides, employing modified Weiss criteria for all tumors and Lin-Weiss-Bisceglia criteria for oncocytic variants. Immunohistochemical markers (Calretinin, alpha-inhibin, MelanA, SF-1, Ki-67, PHH3, IGF-2, β-catenin, P53, CYP11B1, CYP11B2, MLH1, MSH2, MSH6, PMS2, EPCAM) and Gomori's Silver histochemistry were applied. Statistical analysis utilized SPSS Statistics 26. RESULTS ACCs exhibited larger tumor sizes (P<0.001) and symptomatic presentations (P = 0.031) compared to ACAs. Parameters of modified Weiss criteria and angioinvasion demonstrated diagnostic value for ACCs. Six immunohistochemical antibodies((MelanA, Ki-67, IGF-2, β-catenin, P53 and CYP11B1) and reticulin framework alterations showed diagnostic value. Notably, Ki-67 and reticulin staining were most recommended. Evident reticulin staining was frequently present in ACCs (P<0.001). Ki-67 was significantly higher in ACCs (P<0.001). Twenty-one conventional and seven oncocytic entities showed different necrosis frequencies. Symptoms and Ki-67 index ≥ 30% were prognostic for ACCs, correlating with shorter survival. CONCLUSIONS This study emphasizes the diagnostic value of reticulin framework alterations and a high Ki-67 index. Markers such as CYP11B1, IGF2, P53, β-catenin and MelanA also contribute to the diagnosis of ACCs. Symptoms and Ki-67 index ≥ 30% predict shorter survival. These findings encourges the use of ancillary markers such as reticulin histochemistry and Ki-67 in the workup of evaluations of adrenocortical neoplasms.
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Affiliation(s)
- Wenting Gan
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, China
| | - Xue Han
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, China
| | - Yuxi Gong
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, China
| | - Yefan Yang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, China
| | - Cong Wang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, China.
| | - Zhihong Zhang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, China.
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Matrone A, De Napoli L, Torregrossa L, Aghababyan A, Papini P, Ambrosini CE, Cervelli R, Ugolini C, Basolo F, Molinaro E, Elisei R, Materazzi G. Core Needle Biopsy Can Early and Precisely Identify Large Thyroid Masses. Front Oncol 2022; 12:854755. [PMID: 35463338 PMCID: PMC9022105 DOI: 10.3389/fonc.2022.854755] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Large thyroid masses, particularly if rapidly growing, are often characterized by compression and infiltration of the vital structures of the neck. Therefore, an early and precise diagnosis, not only of malignancy but also of histotype, is mandatory to set up the right therapy. The aim of this study was to evaluate the diagnostic performance of fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in this setting. Patients and Methods We prospectively evaluated 95 patients with large and rapidly growing thyroid masses admitted to the University Hospital of Pisa between April 2014 and January 2020. All patients were submitted to FNAC and CNB in the same session. The ability of both procedures to diagnose the malignancy of the lesions, particularly the histotype, and to obtain sufficient material to perform molecular analysis was evaluated. Results FNAC obtained adequate tumor sample to reach a diagnosis in 76 of 95 (80%) patients, while a higher percentage was obtained with CNB (92/95, 96.8%). FNAC was able to identify the malignancy of the lesion in 74 of 95 (77.9%) cases, but only in 16 of 74 (21.6%) cases was it able to define the histotype. CNB was able to define the malignancy of the lesion in all but three cases (92/95, 96.8%), and in all specimens, the histotype was identified. Moreover, in all cases, the material extracted from CNB was optimal to perform molecular analysis. No surgery-related complications were experienced with both procedures. Conclusions CNB is a rapid and safe procedure with higher performance compared to FNAC in identifying the histotype of large and rapidly growing thyroid masses. Moreover, adequate material can be obtained to characterize the molecular profile for the treatment of potentially lethal cancers. In the era of precision medicine, CNB should be introduced in routine clinical practice as a key procedure for an early diagnosis and therapy of these diseases.
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Affiliation(s)
- Antonio Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Luigi De Napoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, Pisa, Italy
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, Pisa, Italy
| | - Aleksandr Aghababyan
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, Pisa, Italy
| | - Piermarco Papini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, Pisa, Italy
| | - Carlo Enrico Ambrosini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, Pisa, Italy
| | - Rosa Cervelli
- Division of Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, Pisa, Italy
| | - Eleonora Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, Pisa, Italy
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Podany P, Abi-Raad R, Barbieri A, Garritano J, Prasad ML, Cai G, Adeniran AJ, Gilani SM. Anaplastic Thyroid Carcinoma: Cytomorphologic Features on Fine-Needle Aspiration and Associated Diagnostic Challenges. Am J Clin Pathol 2022; 157:608-619. [PMID: 34661606 PMCID: PMC8973262 DOI: 10.1093/ajcp/aqab159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/20/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Anaplastic thyroid carcinoma (ATC) is an aggressive malignancy, and early diagnosis, often aided by fine-needle aspiration (FNA), is key to improving patient prognosis. While the current literature describes some of the cytologic features (CFs) of this entity, a comprehensive examination of the CFs has not yet been performed. METHODS We retrospectively searched our electronic database for ATC cases with available slides between January 2008 and December 2019. Cases were examined for 22 CFs and compared with a control group of differentiated thyroid carcinoma. RESULTS A total of 18 ATC cases meeting our inclusion criteria were identified. Most cases showed moderate to high cellularity (83%) and epithelioid cytomorphology (83%). Architecture included either predominantly groups/clusters of tumor cells (56%) or single tumor cells (44%). The other CFs were as follows: nuclear enlargement (100%), nuclear crowding (89%), nuclear membrane irregularities (100%), multinucleated tumor cells (33%), and background acute inflammatory cells (50%). Of the CFs examined, statistically significant differences between ATC and the control groups were found in the following: nuclear pleomorphism, coarse/clumped chromatin, macronucleoli, apoptosis, and necrosis. CONCLUSIONS Identification of key CFs in FNA coupled with the clinical history aids in the diagnosis of ATC and helps distinguish it from other mimickers.
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Affiliation(s)
- Peter Podany
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Rita Abi-Raad
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Andrea Barbieri
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - James Garritano
- Medical Scientist Training Program, Yale School of Medicine, New Haven, CT, USA
- Applied Mathematics Program, Yale University, New Haven, CT, USA
| | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Guoping Cai
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | | | - Syed M Gilani
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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Xin S, Li W, Yuan N, Shen C, Zhang D, Chai S. Primary squamous cell carcinoma of the thyroid: a case report. J Int Med Res 2021; 49:3000605211004702. [PMID: 33827322 PMCID: PMC8040576 DOI: 10.1177/03000605211004702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare and rapidly progressive malignancy that carries a poor prognosis. PSCCT is easily misdiagnosed as acute thyroiditis or as another thyroid malignancy. We have reported a 76-year-old woman who presented with progressive neck pain for 1 month. Thyroid function tests revealed subclinical thyrotoxicosis. Ultrasound disclosed a solid nodule with calcification in the right thyroid lobe. Laboratory findings included neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate. The patient's condition was diagnosed as subacute thyroiditis, and she was treated with cefixime and ibuprofen. However, her treatment response was poor. She was then treated with oral prednisone. Her neck pain gradually resolved. The patient subsequently developed dysphagia, choking, dyspnea, and dysphonia with an insidious onset. Further examinations including computed tomography and painless gastroscopy revealed that the volume of the thyroid gland had increased significantly, extending to the anterior superior mediastinum. The trachea and esophagus were stenotic because of external compression. Partial thyroidectomy and tracheotomy were performed under extracorporeal membrane oxygenation. The diagnosis of PSCCT was established via histopathology and immunohistochemistry.
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Affiliation(s)
- Sixu Xin
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Wei Li
- Department of Gastrointestinal Surgery, Peking University International Hospital, Beijing, China
| | - Ning Yuan
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Chao Shen
- Department of Gastrointestinal Surgery, Peking University International Hospital, Beijing, China
| | - Dongdong Zhang
- Department of Gastrointestinal Surgery, Peking University International Hospital, Beijing, China
| | - Sanbao Chai
- Department of Endocrinology, Peking University International Hospital, Beijing, China
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Yang J, Barletta JA. Anaplastic thyroid carcinoma. Semin Diagn Pathol 2020; 37:248-256. [PMID: 32624319 DOI: 10.1053/j.semdp.2020.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
Anaplastic thyroid carcinoma (ATC) is a rare but significant malignancy due to its high mortality rate. Rendering an accurate diagnosis is crucial given the prognostic implications and treatment ramifications. Based on the prognostic significance of the extent of invasion of the primary tumor, T staging for ATC changed in the most recent edition of the American Joint Committee on Cancer (AJCC) staging manual. In the past 5 years there has been a rapid increase in our understanding of the molecular basis of ATC which has provided the basis for targeted therapy for some ATC patients. In this review, ATC prognostic factors, histologic and immunotypic features, staging updates, and molecular alterations, with an emphasis on those that may impact treatment, will be discussed.
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Affiliation(s)
- Jing Yang
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Lai WA, Hang JF, Liu CY, Bai Y, Liu Z, Gu H, Hong S, Pyo JY, Jung CK, Kakudo K, Bychkov A. PAX8 expression in anaplastic thyroid carcinoma is less than those reported in early studies: a multi-institutional study of 182 cases using the monoclonal antibody MRQ-50. Virchows Arch 2019; 476:431-437. [PMID: 31732814 DOI: 10.1007/s00428-019-02708-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/26/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022]
Abstract
Anaplastic thyroid carcinoma (ATC) is an aggressive malignant tumor composed of undifferentiated thyroid follicular cells. Pathological diagnosis of ATC can be challenging as the tumor may show morphological overlap with other neoplasms with anaplastic morphology. Immunohistochemical demonstration of thyroid origin facilitates the diagnosis of ATC. Previous studies using the polyclonal anti-PAX8 antibody 10336-1-AP suggested that PAX8 was the most sensitive marker, expressed in up to 80% of ATC. According to a 2018 NordiQC report, the monoclonal anti-PAX8 antibody MRQ-50 has become the most commonly used anti-PAX8 antibody worldwide. However, validation of this antibody in ATC is lacking. In this study, we recruited 182 ATC cases from seven institutions. Pathology slides were subjected to histology review. PAX8 immunohistochemistry using the MRQ-50 antibody was performed in whole tissue slides (n = 147) or tissue microarray sections (n = 35). We found PAX8 expression in 54.4% of the cases, which was significantly lower than those reported in prior studies with the polyclonal antibody. PAX8 expression was positively correlated with the presence of an epithelial pattern (63.6% vs 37.5%, p = 0.0008) and a coexisting differentiated thyroid carcinoma component (71.6% vs 44.3%, p = 0.0004), but was not associated with age, gender, specimen type, or presence of giant cell and sarcomatoid patterns. In conclusion, we demonstrated PAX8 expression using the monoclonal antibody MRQ-50 in only half of the cases in a large ATC series. Pathologists should be aware that PAX8 expression in ATC is less than those reported in early studies to avoid misdiagnosis.
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Affiliation(s)
- Wei-An Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Room 5046, Medical Science & Technology Building 5F, No. 201, Sec. 2, Shipai Rd, Taipei, 11217, Taiwan
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Room 5046, Medical Science & Technology Building 5F, No. 201, Sec. 2, Shipai Rd, Taipei, 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhiyan Liu
- Department of Pathology, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Haiyan Gu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - SoonWon Hong
- Department of Pathology, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Ju Yeon Pyo
- Department of Pathology, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Faculty of Medicine, Kindai University, Nara, Japan
| | - Andrey Bychkov
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Prediction of Immunohistochemistry of Suspected Thyroid Nodules by Use of Machine Learning-Based Radiomics. AJR Am J Roentgenol 2019; 213:1348-1357. [PMID: 31461321 DOI: 10.2214/ajr.19.21626] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE. The purpose of this study was to develop and validate a radiomics model for evaluating immunohistochemical characteristics in patients with suspected thyroid nodules. MATERIALS AND METHODS. A total of 103 patients (training cohort-to-validation cohort ratio, ≈ 3:1) with suspected thyroid nodules who had undergone thyroidectomy and immunohistochemical analysis were enrolled. The immunohistochemical markers were cytokeratin 19, galectin 3, thyroperoxidase, and high-molecular-weight cytokeratin. All patients underwent CT before surgery, and a 3D slicer was used to analyze images of the surgical specimen. Test-retest and Spearman correlation coefficient (ρ) were used to select reproducible and nonredundant features. The Kruskal-Wallis test (p < 0.05) was used for feature selection, and a feature-based model was built by support vector machine methods. The performance of the radiomic models was assessed with respect to accuracy, sensitivity, specificity, corresponding AUC, and independent validation. RESULTS. Eighty-six reproducible and nonredundant features selected from the 828 features were used to build the model. The best performance of the cytokeratin 19 model yielded accuracy of 84.4% in the training cohort and 80.0% in the validation cohort. The thyroperoxidase and galectin 3 predictive models yielded accuracies of 81.4% and 82.5% in the training cohort and 84.2% and 85.0% in the validation cohort. The performance of the high-molecular-weight cytokeratin predictive model was not good (accuracy, 65.7%) and could not be validated. CONCLUSION. A radiomics model with excellent performance was developed for individualized noninvasive prediction of the presence of cytokeratin 19, galectin 3, and thyroperoxidase based on CT images. This model may be used to identify benign and malignant thyroid nodules.
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Cameselle-Teijeiro JM, Bella Cueto MR, Eloy C, Abdulkader I, Amendoeira I, Matías-Guiu X, Sobrinho-Simões M. [Tumors of the thyroid gland. Proposal for the management and study of samples from patients with thyroid neoplasms]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 53:27-36. [PMID: 31932006 DOI: 10.1016/j.patol.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 11/18/2022]
Abstract
The recent changes in the classification and staging of thyroid tumors have arisen from the need to provide an adequate response to the exponential increase of thyroid cancer, which, however, has not been accompanied by an increase in mortality. These changes pretend to reduce overdiagnoses of malignancy, unnecessary treatment, side effects as well as cost for the health system. To this end, this article reviews recommendations for the management of thyroid surgical pathology samples with emphasis on the new terminology of the WHO classification. The basic criteria for the diagnosis of malignancy in well-differentiated thyroid carcinomas are reviewed and the criteria for NIFTP (non-invasive follicular tumor with papillary-like nuclear features) diagnosis are updated. Recommendations for the elaboration of the pathological report are also included.
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Affiliation(s)
- José Manuel Cameselle-Teijeiro
- Servicio de Anatomía Patológica, Hospital Clínico Universitario, SERGAS, Departamento de Anatomía Patológica, Universidad de Santiago de Compostela, Santiago de Compostela, España.
| | - María Rosa Bella Cueto
- Servicio de Anatomía Patológica, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Catarina Eloy
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Ihab Abdulkader
- Servicio de Anatomía Patológica, Hospital Clínico Universitario, SERGAS, Departamento de Anatomía Patológica, Universidad de Santiago de Compostela, Santiago de Compostela, España
| | - Isabel Amendoeira
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal; Department of Pathology, Hospital de S. João, Porto, Portugal
| | - Xavier Matías-Guiu
- Servicio de Anatomía Patológica, Hospital Universitari Arnau de Vilanova, Lleida, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Manuel Sobrinho-Simões
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal; Department of Pathology, Hospital de S. João, Porto, Portugal
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