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Zanelli M, Sanguedolce F, Zizzo M, Fragliasso V, Broggi G, Palicelli A, Loscocco GG, Cresta C, Caprera C, Corsi M, Martino G, Bisagni A, Marchetti M, Koufopoulos N, Parente P, Caltabiano R, Ascani S. Skin Involvement by Hematological Neoplasms with Blastic Morphology: Lymphoblastic Lymphoma, Blastoid Variant of Mantle Cell Lymphoma and Differential Diagnoses. Cancers (Basel) 2023; 15:3928. [PMID: 37568745 PMCID: PMC10416851 DOI: 10.3390/cancers15153928] [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: 07/09/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Hematological neoplasms sharing a blastic morphology may involve the skin. The skin may be either the primary site of occurrence of hematological malignancies with blastic features or cutaneous lesions are the first manifestation of an underlying systemic malignancy. The assessment of skin biopsies of hematological neoplasms with blastic features poses diagnostic problems and requires expert hematopathologists considering a wide range of differential diagnoses. The precise diagnosis of diseases sharing blastic features but with different outcomes and requiring distinct therapies is essential for patient management. The present paper mainly focuses on cutaneous involvement of the blastoid variant of mantle cell lymphoma and lymphoblastic lymphoma of B-cell or T-cell origin. The relevant literature has been reviewed and the clinical aspects, pathological features, prognosis, and therapy of both blastoid mantle cell lymphoma and lymphoblastic lymphoma involving the skin are discussed. A focus on other hematological entities with blastic features, which may involve the skin, to be taken into consideration in differential diagnosis is also given.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | | | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Valentina Fragliasso
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (R.C.)
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | - Giuseppe Gaetano Loscocco
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera-Universitaria Careggi, University of Florence, 50134 Florence, Italy;
- Doctorate School GenOMec, University of Siena, 53100 Siena, Italy
| | - Camilla Cresta
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
| | - Matteo Corsi
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
- Hematology, Centro di Ricerca Emato-Oncologica—C.R.E.O., University of Perugia, 06129 Perugia, Italy
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | - Marialisa Marchetti
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | - Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece;
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Foggia, Italy;
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (R.C.)
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
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Hoster E, Rosenwald A, Berger F, Bernd HW, Hartmann S, Loddenkemper C, Barth TF, Brousse N, Pileri S, Rymkiewicz G, Kodet R, Stilgenbauer S, Forstpointner R, Thieblemont C, Hallek M, Coiffier B, Vehling-Kaiser U, Bouabdallah R, Kanz L, Pfreundschuh M, Schmidt C, Ribrag V, Hiddemann W, Unterhalt M, Kluin-Nelemans JC, Hermine O, Dreyling MH, Klapper W. Prognostic Value of Ki-67 Index, Cytology, and Growth Pattern in Mantle-Cell Lymphoma: Results From Randomized Trials of the European Mantle Cell Lymphoma Network. J Clin Oncol 2016; 34:1386-94. [DOI: 10.1200/jco.2015.63.8387] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Mantle-cell lymphoma (MCL) is a rather aggressive B-cell malignancy whose considerable variability of individual outcome is associated with clinical characteristics (Mantle Cell Lymphoma International Prognostic Index [MIPI]). The Ki-67 index is a strong independent prognostic factor; however, the biologic MIPI (MIPI-b) distinguishes only two groups, which does not appropriately depict the clinical heterogeneity. By using the cohort from the European MCL Younger and MCL Elderly trials, we aimed to evaluate the additional prognostic impact of cytology and growth pattern and to improve risk stratification with the Ki-67 index and MIPI. Patients and Methods Diagnostic tumor biopsies were reviewed by the European Mantle Cell Lymphoma Pathology Panel to determine Ki-67 index by using published guidelines, cytology, and growth pattern. We evaluated prognostic effects for overall survival (OS) by Cox regression. For the cohort used for MIPI-b development (German Low-Grade Lymphoma Study Group [GLSG] 1996 and GLSG2000), we checked whether the equally weighted combination of Ki-67 index (dichotomized at the validated 30% cutoff) and MIPI risk groups was adequate and compared the prognostic power of this modified combination to MIPI and MIPI-b for the MCL Younger/MCL Elderly cohort. Results The Ki-67 index was assessed in 508 of 832 patients (median age, 62 years). Blastoid cytology was associated with inferior OS independently of MIPI but not independently of the Ki-67 index. Growth pattern was not independently prognostic. The modified combination of the Ki-67 index and MIPI separated four groups with 5-year OS: 85%, 72%, 43%, and 17% (P < .001) and was more discriminative than MIPI and MIPI-b. Conclusion Using the Ki-67 index is superior to using cytology and growth pattern as prognostic factors in MCL. The modified combination of the Ki-67 index and MIPI showed a refined risk stratification, reflecting their strong complementary prognostic effects while integrating the most relevant prognostic factors available in clinical routine.
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Affiliation(s)
- Eva Hoster
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Andreas Rosenwald
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Françoise Berger
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Heinz-Wolfram Bernd
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Sylvia Hartmann
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Christoph Loddenkemper
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Thomas F.E. Barth
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Nicole Brousse
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Stefano Pileri
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Grzegorz Rymkiewicz
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Roman Kodet
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Stephan Stilgenbauer
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Roswitha Forstpointner
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Catherine Thieblemont
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Michael Hallek
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Bertrand Coiffier
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Ursula Vehling-Kaiser
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Réda Bouabdallah
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Lothar Kanz
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Michael Pfreundschuh
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Christian Schmidt
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Vincent Ribrag
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Wolfgang Hiddemann
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Michael Unterhalt
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Johanna C. Kluin-Nelemans
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Olivier Hermine
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Martin H. Dreyling
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
| | - Wolfram Klapper
- Eva Hoster, Roswitha Forstpointner, Christian Schmidt, Wolfgang Hiddemann, Michael Unterhalt, and Martin H. Dreyling, University Hospital Munich; Eva Hoster, University of Munich, Munich; Andreas Rosenwald, University of Würzburg, Würzburg; Heinz-Wolfram Bernd, University Hospital Schleswig-Holstein, Lübeck; Sylvia Hartmann, University Hospital of Frankfurt, Frankfurt am Main; Christoph Loddenkemper, University Hospital Berlin Charité; Christoph Loddenkemper, Pathologie PathoTres, Berlin; Thomas F.E
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