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Vincent A, Ahmed K, Hussein R, Berberovic Z, Tumber A, Zhao X, Minassian BA. Retinal Phenotyping of a Murine Model of Lafora Disease. Genes (Basel) 2023; 14:genes14040854. [PMID: 37107612 PMCID: PMC10137594 DOI: 10.3390/genes14040854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Lafora disease (LD) is a progressive neurologic disorder caused by biallelic pathogenic variants in EPM2A or EPM2B, leading to tissue accumulation of polyglucosan aggregates termed Lafora bodies (LBs). This study aimed to characterize the retinal phenotype in Epm2a−/− mice by examining knockout (KO; Epm2a−/−) and control (WT) littermates at two time points (10 and 14 months, respectively). In vivo exams included electroretinogram (ERG) testing, optical coherence tomography (OCT) and retinal photography. Ex vivo retinal testing included Periodic acid Schiff Diastase (PASD) staining, followed by imaging to assess and quantify LB deposition. There was no significant difference in any dark-adapted or light-adapted ERG parameters between KO and WT mice. The total retinal thickness was cFigure mparable between the groups and the retinal appearance was normal in both groups. On PASD staining, LBs were observed in KO mice within the inner and outer plexiform layers and in the inner nuclear layer. The average number of LBs within the inner plexiform layer in KO mice were 1743 ± 533 and 2615 ± 915 per mm2, at 10 and 14 months, respectively. This is the first study to characterize the retinal phenotype in an Epm2a−/− mouse model, demonstrating significant LB deposition in the bipolar cell nuclear layer and its synapses. This finding may be used to monitor the efficacy of experimental treatments in mouse models.
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Affiliation(s)
- Ajoy Vincent
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5T 3A9, Canada
| | - Kashif Ahmed
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Rowaida Hussein
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | | | - Anupreet Tumber
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Xiaochu Zhao
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Berge A. Minassian
- Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Deniz K. Ground Glass-Like Inclusions: Associated with Liver Toxicity. Turk Patoloji Derg 2021; 37:51-55. [PMID: 33021734 PMCID: PMC10508930 DOI: 10.5146/tjpath.2020.01510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The etiology of ground glass-like inclusions is heterogenous and the pathology has been described in various conditions including HBV infection, Lafora's disease, fibrinogen storage disease, type IV glycogenosis, and alcohol reversion therapy. Similar ground glass-like inclusions are also associated with immunosuppressed conditions and multiple medications, for which the clinical significance is still unclear. Additional cases, some with previously unreported unique etiologies, and their follow-up were described in this study. MATERIALS AND METHODS Eleven cases were examined between 2008 and 2019 for this study. The clinical data and histologic slides were reviewed. All of the cases were negative for Hepatitis B virus. None of the patients declared alcohol intake or a history of epilepsy. RESULTS Liver histology showed mild lobular inflammation in most of the cases (72%). Ground glass-like hepatocytes were distributed in the patchy-panlobular, periportal, and centrizonal pattern at 55%, 27%, and 18%, respectively. Clinical history revealed medication use in nine (82%) patients including NSAIDs, steroids, and chemotherapy. Ground glass-like inclusions were related to herbal toxicity in two of the patients. Liver function tests were elevated in all of the cases. Follow-up data revealed four patients with malignancy who died of their cancer. Seven patients showed resolution of elevated liver enzymes with a median follow-up period of 37 months (range 7-132 months). CONCLUSIONS Medication is the most relevant etiology for the development of these inclusions. Ground glass-like inclusions may also seen in herbal toxicity. Transplantation was not an etiologic factor in our patients. Most of the patients displayed an indolent course with resolution of the elevated transaminases.
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Affiliation(s)
- Kemal Deniz
- Department of Pathology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
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Strnad P, Nuraldeen R, Guldiken N, Hartmann D, Mahajan V, Denk H, Haybaeck J. Broad Spectrum of Hepatocyte Inclusions in Humans, Animals, and Experimental Models. Compr Physiol 2013; 3:1393-436. [DOI: 10.1002/cphy.c120032] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Histologic evaluation of the liver is a major component in the medical management and treatment algorithm of patients with chronic hepatitis B (HBV) and chronic hepatitis C (HCV). Liver biopsy in these patients remains the gold standard, and decisions on treatment are often predicated on the degree of damage and stage of fibrosis. This article outlines the clinical course and serologic diagnosis of HBV and HCV for the clinician and the pathologist, who together have a close working relationship in managing patients with acute and chronic liver disease. The salient histologic features are elucidated in an attempt to provide the clinician with an understanding of the basic histopathology underlying chronic HCV and HBV.
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Affiliation(s)
- M Isabel Fiel
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, Mount Sinai School of Medicine, Box 1194, 1468 Madison Avenue, New York, NY 10029, USA.
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Goritsas C, Paissios NP, Trigidou R, Delladetsima J. Hepatic involvement in Wegener's granulomatosis: a case report. J Med Case Rep 2010; 4:9. [PMID: 20157433 PMCID: PMC2821396 DOI: 10.1186/1752-1947-4-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/14/2010] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION We report the case of a 58-year-old Caucasian Greek man who presented with dry cough, fever, bilateral alveolar infiltrates and acute hepatitis. CASE PRESENTATION After a lung biopsy, the patient was diagnosed with Wegener's granulomatosis. The diagnosis was supported by the presence of anti-proteinase-3 anti-neutrophil cytoplasmic antibodies. A liver biopsy demonstrated the presence of mild non-specific lobular hepatitis and periodic acid-Schiff positive Lafora-like inclusions in a large number of his liver cells. The patient was treated with prednisone and cyclophosphamide, which was followed by subsequent remissions of chest X-ray findings and liver function studies. CONCLUSION What makes this case worth reporting is the coexistence of liver inflammation with a biochemical profile of severe anicteric non-viral, non-drug induced hepatitis coinciding with the diagnosis of Wegener's granulomatosis. Our paper may be the first report of hepatic involvement in a patient diagnosed with Wegener's granulomatosis. The aetiological link between the two diseases is supported by the reversion of hepatitis after the immunosuppression of Wegener's granulomatosis. We favor the hypothesis that hepatic vasculitis may be the cause of acute hepatocellular necrosis.
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Affiliation(s)
- Constantin Goritsas
- Department of Internal Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
| | - Nicolas P Paissios
- Department of Internal Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
| | - Rodoula Trigidou
- Department of Pathology, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
| | - Joanna Delladetsima
- Department of Pathology, Laiko University Hospital, Ag Thoma, Athens, 11527, Greece
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O'Shea AM, Wilson GJ, Ling SC, Minassian BA, Turnbull J, Cutz E. Lafora-like ground-glass inclusions in hepatocytes of pediatric patients: a report of two cases. Pediatr Dev Pathol 2007; 10:351-7. [PMID: 17929993 DOI: 10.2350/06-12-01948.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 01/14/2007] [Indexed: 11/20/2022]
Abstract
We report 2 cases of ground-glass hepatocyte inclusions occurring in pediatric patients. Case 1 had alpha-thalassaemia major and was receiving iron chelation therapy, whereas case 2 had trisomy 21 with a history of bone marrow transplantation for acute myeloid leukemia. The liver sections in both cases showed eosinophilic, periodic acid-Schiff diastase-positive intracytoplasmic inclusions that were negative for hepatitis B surface antigen. Immunohistochemically the inclusions showed positive staining with KM279, a monoclonal antibody against polyglucosan derived from Lafora inclusions. On electron microscopy, in case 1, intracytoplasmic inclusions were composed of degenerate organelles, glycogen, and irregular fibrillar structures; in case 2, they were composed of vesicular structures containing granular material. Ultrastructural changes in both cases differed from classical Lafora inclusions and ruled out hepatitis B surface antigen, glycogenosis type IV, and fibrinogen storage disease. Genetic analysis of the Lafora's disease genes performed in case 2 revealed no mutations. The development of hepatocyte cytoplasmic inclusions in both our cases could be related to medication effects, because similar inclusions were reported in patients using cyanamide. Drug-induced inclusions, mimicking Lafora's disease, should be included in the differential diagnosis of hepatocyte ground-glass inclusions.
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Affiliation(s)
- Anne-Marie O'Shea
- Department of Pathology and Laboratory Medicine, The Mount Sinai Hospital, Toronto, Ontario, Canada
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Wisell J, Boitnott J, Haas M, Anders RA, Hart J, Lewis JT, Abraham SC, Torbenson M. Glycogen pseudoground glass change in hepatocytes. Am J Surg Pathol 2006; 30:1085-90. [PMID: 16931952 DOI: 10.1097/01.pas.0000208896.92988.fc] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ground glass cytoplasmic change in hepatocytes is typically associated with chronic hepatitis B infection. We report 12 cases of glycogen pseudoground glass change that closely mimics hepatitis B inclusions. Nine individuals were immunosuppressed secondary to liver or kidney transplant (N=3), bone marrow transplant (N=2), HIV infection (N=2), kidney dialysis (N=1), or chronic inflammatory bowel disease (N=1). Medication history was available in 10 individuals and all were on multiple medications (range 2 to 33). Histologically, the pseudoground glass change was identical to the ground glass change seen in chronic hepatitis B infection, with distinct, circumscribed, gray-glassy inclusions surrounded by a rim of cytoplasm. The background livers showed mild or no inflammation and mild or no fibrosis. All cases were negative for chronic hepatitis B infection. The pseudoground glass change was PAS positive and diastase sensitive. Electron microscopy of the inclusions showed glycogen in 3/3 cases. No evidence for viral particles or significant endoplasmic reticulum proliferation was seen. Three cases had follow-up biopsies (1, 1, and 36 mo), and the pseudoground glass was persistent in 2 cases and showed partial resolution in 1 case (1 mo biopsy interval). We conclude that glycogen pseudoground glass change is typically seen in immunosuppressed individuals on numerous medications. The changes are generally seen in the background of mild chronic hepatitis with mild or no fibrosis. Glycogen pseudoground glass change can resolve, but may also persist for years.
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Affiliation(s)
- Joshua Wisell
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA
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Bejarano PA, Garcia MT, Rodriguez MM, Ruiz P, Tzakis AG. Liver glycogen bodies: ground-glass hepatocytes in transplanted patients. Virchows Arch 2006; 449:539-45. [PMID: 17024424 DOI: 10.1007/s00428-006-0286-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 07/31/2006] [Indexed: 01/20/2023]
Abstract
Ground-glass hepatocytes have been described in Lafora's disease, fibrinogen deposition, hepatitis B, type IV glycogenosis, and alcohol aversion (cyanamide) therapy. We encountered ground-glass hepatocytes with intracytoplasmic inclusions in four liver biopsies from three transplanted patients who had none of the above-mentioned underlying diseases. One patient was a 4-year-old boy who had a kidney transplant for severe ureterovesical reflux. Patient 2 was a 52-year-old man who had two liver transplants because of hepatitis C. The third patient was a 7-month-old girl who underwent a multivisceral transplant because of necrotizing enterocolitis and liver failure induced by total parenteral nutrition. The patients developed liver abnormalities from 45 days to 4 years after their transplants. The livers showed conspicuous ground-glass hepatocytes in 90% of the children's samples and 30% of the adult liver cells. The cytoplasmic bodies stained strongly for Gomori methenamine-silver; they were positive for periodic acid-Schiff without diastase, but negative after diastase digestion. They were negative for colloidal iron and hepatitis B core and surface antigens. Electron microscopy revealed non-membrane bound aggregates of glycogen. Idiopathic ground-glass hepatocytes occur in transplanted patients and represent accumulation of altered glycogen. However, their clinical significance and cause are not entirely elucidated.
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Affiliation(s)
- Pablo A Bejarano
- Department of Pathology, University of Miami School of Medicine, Jackson Memorial Hospital, 1611 NW 12th Ave Holtz Bldg, Room 2042, Miami, FL 33136, USA.
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Ikegami H, Okazaki Y, Matsumoto M, Nakatsuji S, Fujihira S, Yoshizawa K, Tsubota K, Murakami Y, Anagawa A, Oishi Y. Hepatocellular Cytoplasmic Inclusions in a Cynomolgus Monkey. J Toxicol Pathol 2006. [DOI: 10.1293/tox.19.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hisashi Ikegami
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
| | - Yoshimasa Okazaki
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
| | | | - Shunji Nakatsuji
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
| | - Shiro Fujihira
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
| | | | - Kenjiro Tsubota
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
| | - Yuichi Murakami
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
| | - Akiko Anagawa
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
| | - Yuji Oishi
- Toxicologic Pathology, Drug Safety Research Labs., Astellas Pharma Inc
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Yamada M, Nakamura K, Nozaki H, Tanaka H. Hepatocellular endoplasmic reticulum storage disease in an African elephant (Loxodonta africana). J Comp Pathol 2003; 128:192-4. [PMID: 12634098 DOI: 10.1053/jcpa.2002.0608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Large intracytoplasmic inclusions were observed in hepatocytes of a 7-year-old African elephant (Loxodonta africana). The inclusions were oval to polyhedral with either a homogeneous glassy or a granular appearance. They were positive for the periodic acid-Schiff (PAS) reaction. Electron microscopical examination revealed that the inclusions consisted of granular material with moderate electron-density and were membrane-bounded. The findings suggested that the inclusions were derived from endoplasmic reticulum. The light and electron microscopical features were similar to those of endoplasmic reticulum storage disease of the liver in man. Such inclusions have not previously been reported in animals.
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Affiliation(s)
- M Yamada
- National Institute of Animal Health, Kannondai, Tsukuba, Ibaraki, 305-0856, Japan
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Abstract
Many inherited metabolic diseases affect the liver in neonates, children, or adults. The histopathologic changes are diverse and may be acute or chronic. They can be considered primary (when the injury is from the cytopathic effect of an accumulated metabolite) or secondary (e.g., an infection caused by an immune deficiency). All forms of liver disease are described: for example, intrahepatic cholestasis, neonatal hepatitis with giant-cell transformation, paucity of bile ducts, steatosis, steatohepatitis, necroinflammatory diseases (acute or chronic), fibrosis, cirrhosis, and neoplasms (benign or malignant). Familiarity with the morphologic changes is important in clinicopathologic correlation, diagnosis, and understanding of pathogenetic mechanisms.
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Affiliation(s)
- Kamal G Ishak
- Department of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
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12
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Yamada M, Nakamura K, Nakajima Y, Yamamoto M, Komae H, Okuda K, Tsuji M, Arai M. Ground-glass hepatocytes in fibrinogen storage disease in Japanese Black calves. J Comp Pathol 2002; 126:95-9. [PMID: 11944997 DOI: 10.1053/jcpa.2001.0525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper reports the occurrence of large intracytoplasmic inclusions observed in the hepatocytes of six Japanese Black calves showing clinical illness. These inclusions were round to elongated polyhedral in shape, with a consistently homogeneous glassy appearance. Hepatocytes with the inclusions had a ground-glass appearance. The inclusions were negative for the periodic acid-Schiff reaction and methenamine silver stain. Immunohistochemically, they were strongly positive for fibrinogen. Electron microscopy revealed that the inclusions consisted of granular material, showing moderate electron density and bounded by a unit membrane. On the external surface of the unit membrane, there were direct connections to cellular organelles, including the ribosomes and rough-surfaced endoplasmic reticulum. The results showed these inclusions to be entirely consistent with fibrinogen inclusions described in man. Hepatocellular fibrinogen storage disease, as identified in this study, has not previously been described in animals.
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Affiliation(s)
- M Yamada
- National Institute of Animal Health, Kannondai, Tsukuba, Ibaraki 305-0856, Japan
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Boyd KL, Latimer KS. Hepatic hyaline globules in an Eclectus parrot (Eclectus roratus). J Vet Diagn Invest 2001; 13:270-2. [PMID: 11482611 DOI: 10.1177/104063870101300318] [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: 11/16/2022] Open
Abstract
Hepatic hyaline globules, similar to those reported in some human livers, were observed in liver tissue from an Eclectus parrot (Eclectus roratus). The cytoplasmic inclusions were periodic acid-Schiff positive and diastase resistant and failed to stain by acid-fast or Congo red techniques. Ultrastructurally, the hepatic globules were composed of granular amorphous material with small peripheral striations that extended into the cytoplasm.
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Affiliation(s)
- K L Boyd
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens 30602-7388, USA
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Wills EJ. Ground glasslike hepatocytes produced by glycogen-membrane complexes ("glycogen bodies"). Ultrastruct Pathol 1992; 16:491-503. [PMID: 1323894 DOI: 10.3109/01913129209057834] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 54-year-old man developed liver disease 11 months after renal transplantation. Liver biopsy demonstrated hepatitis with numerous periodic acid-Schiff-positive, diastase-sensitive ground glass inclusions in parenchymal cells. Electron microscopy revealed that the inclusions consisted of parallel arrays of smooth surfaced cisternae separated by glycogen rosettes ("glycogen bodies"). The differential diagnosis of ground glass hepatocytes, the occurrence of glycogen bodies, and the possible etiological factors in the patient's liver disease are discussed.
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Affiliation(s)
- E J Wills
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, NSW, Australia
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