1
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Schoelinck J, Pissaloux D, Mouthon M, Vergara R, de la Fouchardière A. [Clinical, histological and genetic correlations in melanocytic tumours with chromosomal rearrangements]. Ann Pathol 2024:S0242-6498(24)00031-2. [PMID: 38320889 DOI: 10.1016/j.annpat.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
In some tumoral subtypes chromosomal translocations lead to an oncogenic chimeric protein acting as a tumorigenesis driver event. The main fusion model combines the promoter swapping of an inactivated tumor suppressor gene and a functional kinase that evades its regulatory system. The range of described fusions keeps growing in the 2023 WHO classification of melanocytic tumours. It is not limited to the group of Spitz tumours as previously but now extends to blue tumours and dermal tumours with a melanocytic phenotype. Molecular pathology helps detect these anomalies using clinical and morphological features. This analysis is essential as this strongly conditions the adapted local treatment of such tumours who are often overtreated.
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Affiliation(s)
- Jeremy Schoelinck
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France.
| | - Daniel Pissaloux
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Maxime Mouthon
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Rémi Vergara
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Arnaud de la Fouchardière
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France; Équipe labellisée Ligue contre le cancer, Inserm 1052, CNRS 5286, centre Léon-Bérard, Cancer Research Center of Lyon, université de Lyon, université Claude-Bernard Lyon 1, Lyon, France
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2
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Donati M, Grossmann P, Mansour B, Kazakov DV. Melanocytic Neoplasm With KIT and APC Mutations: A New Subtype of Melanocytoma? Am J Dermatopathol 2024; 46:107-110. [PMID: 37982490 DOI: 10.1097/dad.0000000000002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ABSTRACT We report a very unusual case of melanocytic neoplasm appearing clinically as a 0.5-cm dome-shaped pigmented papule on the chest of a 63-year-old man. Microscopically, it was an asymmetric, entirely dermally based neoplasm characterized by a multinodular, vaguely plexiform architecture composed of moderately pleomorphic spindled melanocytes with ample, dusty pigmented cytoplasm and scattered multinucleated cells. The tumor cells were strongly positive for Melan-A, HMB45, S100, and PRAME, whereas p16 showed diffuse nuclear loss. β-catenin presented a strong and diffuse cytoplasmic staining, while nuclei were negative. Despite an increased cellularity, mitotic count was low (1/mm 2 ). Fluorescence in situ hybridization revealed no copy number alteration in melanoma-related genes ( CDKN2A, MYB, MYC, CCND1 and RREB1 ). DNA and RNA sequencing identified KIT c.2458G>T and APC c.6709C>T mutations. No further genetic alteration was detected including TERT-promoter (TERT-p ) hot-spot mutation. A re-excision was performed. A sentinel lymph node biopsy was negative. Clinical investigations revealed no extracutaneous involvement. The patient is disease-free after a follow-up period of 8 months. Given the peculiar morphologic and molecular findings, we hypothesize the lesion may represent a novel subtype of an intermediate grade melanocytic tumor (melanocytoma).
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Affiliation(s)
- Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Petr Grossmann
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | | | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Switzerland
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3
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Urso C. Spitz Tumors and Melanoma in the Genomic Age: A Retrospective Look at Ackerman's Conundrum. Cancers (Basel) 2023; 15:5834. [PMID: 38136379 PMCID: PMC10741987 DOI: 10.3390/cancers15245834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
After 25 years, "Ackerman's conundrum", namely, the distinction of benign from malignant Spitz neoplasms, remains challenging. Genomic studies have shown that most Spitz tumors harbor tyrosine and serine/threonine kinase fusions, including ALK, ROS1, NTRK1, NTRK2, NTRK3, BRAF and MAP3K8, or some mutations, such as HRAS and MAP3K8. These chromosomal abnormalities act as drivers, initiating the oncogenetic process and conferring basic bio-morphological features. Most Spitz tumors show no additional genomic alterations or few ones; others harbor a variable number of mutations, capable of conferring characteristics related to clinical behavior, including CDKN2A deletion and TERT-p mutation. Since the accumulation of mutations is gradual and progressive, tumors appear to form a bio-morphologic spectrum, in which they show a progressive increase of clinical risk and histological atypia. In this context, a binary classification Spitz nevus-melanoma appears as no longer adequate, not corresponding to the real genomic substrate of lesions. A ternary classification Spitz nevus-Spitz melanocytoma-Spitz melanoma is more adherent to the real neoplastic pathway, but some cases with intermediate ambiguous features remain difficult to diagnose. A prognostic stratification of Spitz tumors, based on the morphologic and genomic characteristics, as a complement to the diagnosis, may contribute to better treatment plans for patients.
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Affiliation(s)
- Carmelo Urso
- Dermatopathology Study Center of Florence, I-50129 Florence, Italy
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4
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Hagstrom M, Fumero-Velázquez M, Dhillon S, Olivares S, Gerami P. An update on genomic aberrations in Spitz naevi and tumours. Pathology 2023; 55:196-205. [PMID: 36631338 DOI: 10.1016/j.pathol.2022.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Spitz neoplasms continue to be a diagnostic challenge for dermatopathologists and are defined by distinctive morphological and genetic features. With the recent advancements in genomic sequencing, the classification, diagnosis, and prognostication of these tumours have greatly improved. Several subtypes of Spitz neoplasms have been identified based on their specific genomic aberrations, which often correlate with distinctive morphologies and biological behaviour. These genetic driver events can be classified into four major groups, including: (1) mutations [HRAS mutations (with or without 11p amplification) and 6q23 deletions]; (2) tyrosine kinase fusions (ROS1, ALK, NTRK1-3, MET and RET); (3) serine/threonine kinase fusions and mutations (BRAF, MAP3K8, and MAP2K1); and (4) other rare genomic aberrations. These driver genomic events are hypothesised to enable the initial proliferation of melanocytes and are often accompanied by additional genomic aberrations that affect biological behaviour. The discovery of theses genomic fusions has allowed for a more objective definition of a Spitz neoplasm. Further studies have shown that the majority of morphologically Spitzoid appearing melanocytic neoplasms with aggressive behaviour are in fact BRAF or NRAS mutated tumours mimicking Spitz. Truly malignant fusion driven Spitz neoplasms may occur but are relatively uncommon, and biomarkers such as homozygous 9p21 (CDKN2A) deletions or TERT-p mutations can have some prognostic value in such cases. In this review, we discuss the importance and various methods of identifying Spitz associated genomic fusions to help provide more definitive classification. We also discuss characteristic features of the various fusion subtypes as well as prognostic biomarkers.
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Affiliation(s)
- Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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5
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Moorthi S, Berger AH. All About That Ras: Novel Fusion Drives Ras Pathway Activation in Lung Cancer. Clin Cancer Res 2022; 28:2983-2985. [PMID: 35512219 PMCID: PMC9451010 DOI: 10.1158/1078-0432.ccr-22-0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 01/17/2023]
Abstract
Lung cancers in never- and light-smokers often harbor targetable oncogenic mutations in Ras pathway genes. Here, a novel OCLN-RASGRF1 fusion is identified in an otherwise Ras wild-type lung tumor. Studying this and other RASGRF1 fusions, the authors show that these fusions lead to malignant phenotypes that can be reversed by MEK inhibition. See related article by Hunihan et al., p. 3091.
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Affiliation(s)
- Sitapriya Moorthi
- Human Biology Division, Fred Hutchinson Cancer Research
Center, Seattle, WA
| | - Alice H. Berger
- Human Biology Division, Fred Hutchinson Cancer Research
Center, Seattle, WA,Herbold Computational Biology Program, Public Health
Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Genome Sciences, University of Washington,
Seattle, WA
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6
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Hunihan L, Zhao D, Lazowski H, Li M, Qian Y, Abriola L, Surovtseva YV, Muthusamy V, Tanoue LT, Gould Rothberg BE, Schalper KA, Herbst RS, Wilson FH. RASGRF1 Fusions Activate Oncogenic RAS Signaling and Confer Sensitivity to MEK Inhibition. Clin Cancer Res 2022; 28:3091-3103. [PMID: 35247929 PMCID: PMC9288503 DOI: 10.1158/1078-0432.ccr-21-4291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE The identification of actionable oncogenic alterations has enabled targeted therapeutic strategies for subsets of patients with advanced malignancies, including lung adenocarcinoma (LUAD). We sought to assess the frequency of known drivers and identify new candidate drivers in a cohort of LUAD from patients with minimal smoking history. EXPERIMENTAL DESIGN We performed genomic characterization of 103 LUADs from patients with ≤10 pack-year smoking history. Tumors were subjected to targeted molecular profiling and/or whole-exome sequencing and RNA sequencing in search of established and previously uncharacterized candidate drivers. RESULTS We identified an established oncogenic driver in 98 of 103 tumors (95%). From one tumor lacking a known driver, we identified a novel gene rearrangement between OCLN and RASGRF1. The encoded OCLN-RASGRF1 chimera fuses the membrane-spanning portion of the tight junction protein occludin with the catalytic RAS-GEF domain of the RAS activator RASGRF1. We identified a similar SLC4A4-RASGRF1 fusion in a pancreatic ductal adenocarcinoma cell line lacking an activating KRAS mutation and an IQGAP1-RASGRF1 fusion from a sarcoma in The Cancer Genome Atlas. We demonstrate these fusions increase cellular levels of active GTP-RAS, induce cellular transformation, and promote in vivo tumorigenesis. Cells driven by RASGRF1 fusions are sensitive to targeting of the RAF-MEK-ERK pathway in vitro and in vivo. CONCLUSIONS Our findings credential RASGRF1 fusions as a therapeutic target in multiple malignancies and implicate RAF-MEK-ERK inhibition as a potential treatment strategy for advanced tumors harboring these alterations. See related commentary by Moorthi and Berger, p. 2983.
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Affiliation(s)
- Lisa Hunihan
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT,Department of Genetics, Yale School of Medicine, New Haven, CT,Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Dejian Zhao
- Department of Genetics, Yale School of Medicine, New Haven, CT,Yale Center for Genome Analysis, Yale School of Medicine, New Haven, CT
| | - Heather Lazowski
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT
| | - Man Li
- Center for Precision Cancer Modeling, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Yuping Qian
- Center for Precision Cancer Modeling, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Laura Abriola
- Center for Molecular Discovery, Yale University, West Haven, CT
| | | | - Viswanathan Muthusamy
- Center for Precision Cancer Modeling, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Lynn T. Tanoue
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Bonnie E. Gould Rothberg
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT
| | | | - Roy S. Herbst
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT
| | - Frederick H. Wilson
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT,Department of Genetics, Yale School of Medicine, New Haven, CT,Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT
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7
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Cheng TW, Ahern MC, Giubellino A. The Spectrum of Spitz Melanocytic Lesions: From Morphologic Diagnosis to Molecular Classification. Front Oncol 2022; 12:889223. [PMID: 35747831 PMCID: PMC9209745 DOI: 10.3389/fonc.2022.889223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Spitz tumors represent a distinct subtype of melanocytic lesions with characteristic histopathologic features, some of which are overlapping with melanoma. More common in the pediatric and younger population, they can be clinically suspected by recognizing specific patterns on dermatoscopic examination, and several subtypes have been described. We now classify these lesions into benign Spitz nevi, intermediate lesions identified as “atypical Spitz tumors” (or Spitz melanocytoma) and malignant Spitz melanoma. More recently a large body of work has uncovered the molecular underpinning of Spitz tumors, including mutations in the HRAS gene and several gene fusions involving several protein kinases. Here we present an overarching view of our current knowledge and understanding of Spitz tumors, detailing clinical, histopathological and molecular features characteristic of these lesions.
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Affiliation(s)
- Tiffany W. Cheng
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Madeline C. Ahern
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Alessio Giubellino,
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8
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Macagno N, Pissaloux D, de la Fouchardière A, Karanian M, Lantuejoul S, Galateau Salle F, Meurgey A, Chassagne-Clement C, Treilleux I, Renard C, Roussel J, Gervasoni J, Cockenpot V, Crozes C, Baltres A, Houlier A, Paindavoine S, Alberti L, Duc A, Loarer FL, Dufresne A, Brahmi M, Corradini N, Blay JY, Tirode F. Wholistic approach - transcriptomic analysis and beyond using archival material for molecular diagnosis. Genes Chromosomes Cancer 2022; 61:382-393. [PMID: 35080790 DOI: 10.1002/gcc.23026] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 11/07/2022] Open
Abstract
Many neoplasms remain unclassified after histopathological examination, which requires further molecular analysis. To this regard, mesenchymal neoplasms are particularly challenging due to the combination of their rarity and the large number of subtypes, and many entities still lack robust diagnostic hallmarks. RNA transcriptomic profiles have proven to be a reliable basis for the classification of previously unclassified tumors and notably for mesenchymal neoplasms. Using exome-based RNA capture sequencing on more than 5000 samples of archival material (FFPE), the combination of expression profiles analyzes (including several clustering methods), fusion genes, and small nucleotide variations has been developed at the Centre Léon Bérard (CLB) in Lyon for the molecular diagnosis of challenging neoplasms and the discovery of new entities. The molecular basis of the technique, the protocol, and the bioinformatics algorithms used are described herein, as well as its advantages and limitations.
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Affiliation(s)
- Nicolas Macagno
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,Aix-Marseille University, Marmara institute, INSERM, U1251, MMG, DOD-CET, Marseille, France.,NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,CARADERM, French network of rare skin cancers, France
| | - Daniel Pissaloux
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Arnaud de la Fouchardière
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Marie Karanian
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Biopathology, UNICANCER, Bergonié Institute, Bordeaux, France
| | - Sylvie Lantuejoul
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Grenoble Alpes University, Grenoble, France.,MESOPATH, MESOBANK, French network of mesothelioma, France
| | - Françoise Galateau Salle
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,MESOPATH, MESOBANK, French network of mesothelioma, France
| | - Alexandra Meurgey
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France.,NETSARC+, French Sarcoma Group (GSF-GETO) network, France
| | | | | | - Caroline Renard
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Juliette Roussel
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Julie Gervasoni
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Vincent Cockenpot
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Carole Crozes
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Aline Baltres
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Aurélie Houlier
- Department of Biopathology, UNICANCER, Centre Léon Bérard, Lyon, France
| | | | - Laurent Alberti
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Adeline Duc
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Francois Le Loarer
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,Department of Biopathology, UNICANCER, Bergonié Institute, Bordeaux, France
| | - Armelle Dufresne
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Oncology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Mehdi Brahmi
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Oncology, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Nadège Corradini
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Institute of pediatric oncology, IHOPe, UNICANCER, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- NETSARC+, French Sarcoma Group (GSF-GETO) network, France.,Department of Oncology, UNICANCER, Centre Léon Bérard, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon I, Lyon, France.,Headquarters, UNICANCER, Paris, France
| | - Franck Tirode
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Lyon, France.,Department of Biopathology, UNICANCER, Bergonié Institute, Bordeaux, France.,Univ Lyon, Université Claude Bernard Lyon I, Lyon, France
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