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Mariotti A, Spatafora P, Sessa F, Saieva C, Galli IC, Roviello G, Doni L, Zaccaro C, Bisegna C, Conte FL, Mariottini R, Marzocco A, Masieri L, Vignolini G, Minervini A, Serni S, Carini M, Nesi G, Villari D. Gender and cystectomy for bladder cancer: A high-volume tertiary urologic care center experience. Eur J Surg Oncol 2023; 49:107034. [PMID: 37639860 DOI: 10.1016/j.ejso.2023.107034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/23/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Differences have often been reported in the outcomes of bladder cancer (BC) patients according to gender. OBJECTIVE This study aims to provide data on patients undergoing radical cystectomy (RC) in a high-volume tertiary urologic center and to assess whether gender discrepancies do exist in terms of surgical options and clinical outcomes. MATERIALS AND METHODS Consecutive BC patients treated between 2016 and 2020 at a single center (Careggi University Hospital, Florence, Italy) were included in the study. The impact of gender on disease stage at diagnosis, overall survival (OS), and type of surgery was analyzed. RESULTS The study series comprised 447 patients (85 females and 362 males). At a median follow-up of 28.3 months (IQR: 33.5), OS was 52.6% and cancer-specific survival was 67.6%. Significant differences in OS emerged for age, acute myocardial infarction (AMI), Charlson Comorbidity Index (CCI), pT, and pN. OS rates were higher in patients undergoing robot-assisted surgery and in those receiving open orthotopic neobladder (ONB) (p = 0.0001). No statistically significant differences were found between male and female patients regarding surgical offer in any age group, surgical time, early postoperative complications, pathologic stage, and OS. CONCLUSIONS After adjustment for pathologic tumor stage and treatment modalities, female and male patients showed similar oncologic outcomes. Further studies should be undertaken to evaluate functional results in women subjected to RC.
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Affiliation(s)
- A Mariotti
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
| | - P Spatafora
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - F Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - C Saieva
- Cancer Risk Factors and LifeStyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - I C Galli
- Histopathology and Molecular Diagnostics, Careggi Hospital, Florence, Italy
| | - G Roviello
- Department of Health Sciences, University of Florence, Florence, Italy
| | - L Doni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - C Zaccaro
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - C Bisegna
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - F L Conte
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - R Mariottini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - A Marzocco
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - L Masieri
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Pediatric Surgery, Pediatric Urology Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - G Vignolini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - A Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - S Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - M Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - G Nesi
- Histopathology and Molecular Diagnostics, Careggi Hospital, Florence, Italy
| | - D Villari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Catalano M, Roviello G, Galli IC, Santi R, Nesi G. Immune checkpoint inhibitor induced nephrotoxicity: An ongoing challenge. Front Med (Lausanne) 2022; 9:1014257. [PMID: 36606052 PMCID: PMC9807763 DOI: 10.3389/fmed.2022.1014257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Although immune checkpoint inhibitors (ICIs) have dramatically revolutionized the field of oncology over the last decade, severe immune-related adverse events (irAEs) are potentially life-threatening. In comparison with toxicities involving the skin, gastrointestinal tract and endocrine system, nephrotoxicity is less common but often underestimated due to difficult diagnosis. Management usually consists of treatment discontinuation and/or corticosteroid use. In this review, we summarize current knowledge of ICI-induced nephrotoxicity, evaluating drawbacks and future perspectives.
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Affiliation(s)
- Martina Catalano
- School of Human Health Sciences, University of Florence, Florence, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, University of Florence, Florence, Italy,*Correspondence: Giandomenico Roviello ✉
| | - Ilaria Camilla Galli
- Histopathology and Molecular Diagnostics, Careggi Teaching Hospital, Florence, Italy
| | - Raffaella Santi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriella Nesi
- Histopathology and Molecular Diagnostics, Careggi Teaching Hospital, Florence, Italy
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Roviello G, Catalano M, Santi R, Santoni M, Galli IC, Amorosi A, Polom W, De Giorgi U, Nesi G. Neoadjuvant Treatment in Muscle-Invasive Bladder Cancer: From the Beginning to the Latest Developments. Front Oncol 2022; 12:912699. [PMID: 35936721 PMCID: PMC9353067 DOI: 10.3389/fonc.2022.912699] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Urothelial carcinoma of the bladder is one of the most prevalent cancers worldwide, diagnosed as muscle invasive in 25% of cases. Although several studies have demonstrated an overall 5% absolute survival benefit at 5 years with cisplatin-based combination neoadjuvant treatment, administration of chemotherapy prior to radical cystectomy (RC) in muscle-invasive bladder cancer (MIBC) patients is still a matter of debate. This may be due to the perceived modest survival benefit, cisplatin-based chemotherapy ineligibility, or fear of delaying potentially curative surgery in non-responders. However, immunotherapy and novel targeted therapies have shown to prolong survival in advanced disease and are under investigation in the neoadjuvant and adjuvant settings to reduce systemic relapse and improve cure rates. Genomic characterization of MIBC could help select the most effective chemotherapeutic regimen for the individual patient. Large cohort studies on neoadjuvant treatments with immune checkpoint inhibitors (ICIs) and molecular therapies, alone or combined with chemotherapy, are ongoing. In this review, we trace the development of neoadjuvant therapy in MIBC and explore recent advances that may soon change clinical practice.
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Affiliation(s)
| | - Martina Catalano
- School of Human Health Sciences, University of Florence, Florence, Italy
| | - Raffaella Santi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Ilaria Camilla Galli
- Histopathology and Molecular Diagnostics, Careggi Teaching Hospital, Florence, Italy
| | - Andrea Amorosi
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Wojciech Polom
- Department of Urology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Gabriella Nesi
- Department of Health Sciences, University of Florence, Florence, Italy
- *Correspondence: Gabriella Nesi,
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Sobhani N, Neeli PK, D’Angelo A, Pittacolo M, Sirico M, Galli IC, Roviello G, Nesi G. AR-V7 in Metastatic Prostate Cancer: A Strategy beyond Redemption. Int J Mol Sci 2021; 22:5515. [PMID: 34073713 PMCID: PMC8197232 DOI: 10.3390/ijms22115515] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 01/03/2023] Open
Abstract
Metastatic prostate cancer is the most common cancer in males and the fifth cause of cancer mortality worldwide. Despite the major progress in this field, leading to the approval of novel anti-androgens, the prognosis is still poor. A significant number of patients acquire an androgen receptor splice variant 7 (AR-V7), which is constitutively activated and lacks the ligand-binding domain (LBD) while maintaining the nuclear localization signal and DNA-binding domain (DBD). This conformational change, even in the absence of the ligand, allows its retention within the nucleus, where it acts as a transcription factor repressing crucial tumor suppressor genes. AR-V7 is an important oncogenic driver and plays a role as an early diagnostic and prognostic marker, as well as a therapeutic target for antagonists such as niclosamide and TAS3681. Anti-AR-V7 drugs have shown promise in recent clinical investigations on this subset of patients. This mini-review focuses on the relevance of AR-V7 in the clinical manifestations of castration-resistant prostate cancer (CRPC) and summarizes redemptive therapeutic strategies.
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Affiliation(s)
- Navid Sobhani
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (N.S.); (P.K.N.); (M.P.)
| | - Praveen Kumar Neeli
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (N.S.); (P.K.N.); (M.P.)
| | - Alberto D’Angelo
- Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, UK;
| | - Matteo Pittacolo
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (N.S.); (P.K.N.); (M.P.)
| | - Marianna Sirico
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK;
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Ilaria Camilla Galli
- Histopathology and Molecular Diagnostics, Careggi Teaching Hospital, 50139 Florence, Italy;
| | | | - Gabriella Nesi
- Department of Health Sciences, University of Florence, 50139 Florence, Italy;
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D'Angelo A, Bagby S, Galli IC, Bortoletti C, Roviello G. Overview of the clinical use of erdafitinib as a treatment option for the metastatic urothelial carcinoma: where do we stand. Expert Rev Clin Pharmacol 2020; 13:1139-1146. [PMID: 32935605 DOI: 10.1080/17512433.2020.1823830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Erdafitinib is the first orally administered pan-fibroblast growth factor receptor (FGFR) kinase inhibitor approved by the Food and Drug Administration (FDA). AREAS COVERED Specifically binding to FGFR family (FGFR-1 to FGFR-4), erdafitinib leads to reduced cell signaling and cellular apoptosis. Coupled with the ability to bind to vascular endothelial growth factor 2 (VEGFR-2), KIT, Fms-related tyrosine kinase 4 (FLT4), platelet-derived growth factor receptor α and β (PDGFR-α and PDGFR-β), RET and colony-stimulating factor 1 receptor (CSF-1 R), erdafitinib has further reported antitumor features causing cell killing. EXPERT OPINION In this review, we provide a comprehensive overview of erdafitinib chemical structure, pharmacologic properties, and current knowledge of clinical efficacy in the treatment of locally advanced or metastatic urothelial carcinoma. This treatment, recently approved in the U.S., is available for adult patients harboring FGFR2/FGFR3 genetic alterations who progressed within 12 months of an adjuvant or neoadjuvant chemotherapy regimen including platinum or progressed during or after prior a chemotherapy regimen including platinum.
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Affiliation(s)
- Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath , Bath, UK
| | - Stefan Bagby
- Department of Biology and Biochemistry, University of Bath , Bath, UK
| | - Ilaria Camilla Galli
- Department of Health Sciences, University of Florence, Section of Pathological Anatomy, University Hospital of Florence , Florence, Italy
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Cito G, Santi R, Gemma L, Galli IC, Cocci A, Carini M, Minervini A, Nesi G. Myointimoma of the penis. Int J Impot Res 2020; 33:583-586. [PMID: 32488208 DOI: 10.1038/s41443-020-0316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Abstract
Myointimoma is an uncommon, benign soft-tissue tumor derived from the intimal cells of blood vessels. Since little is known about this rare tumor entity, our aim is to describe an additional case and to perform the first literature review on this topic. A 49-year-old Caucasian man presented with a 12-month history of a palpable, firm, solitary lesion involving the glans penis. On physical examination, there was a 1 cm palpable, endophytic well-circumscribed nodule located to the left side of glans penis, close to the coronal sulcus, with disease-free external urethral orifice. The patient was submitted to complete excisional biopsy. A skin rhombus measuring 1.1 × 0.8 × 0.3 cm was removed and the biopsy sample, fixed in 10% formaldehyde, sent to Pathology. At the 18-month follow-up visit, the patient was clinically disease free. Histopathology revealed a multinodular intravascular proliferation of the corpus spongiosum. This myointimal proliferation comprised bland predominantly spindle cells in an abundant fibromyxoid stroma. Immunostains for smooth muscle actin (1A4), cytokeratins (AE1/AE3, CAM5.2), and CD34 were carried out using the avidin-biotin complex (ABC) immunoperoxidase method. Lesional cells displayed positivity for smooth muscle actin and negativity for cytokeratins and CD34. Myointimoma is confirmed to be a penile benign lesion that may be adequately treated with excisional biopsy. Even after incomplete or marginal removal, the penile lesion has been shown to remain stable overtime or regress. Differential diagnosis is essential to exclude similar histologic entities that could be more aggressive or have possible systemic implications.
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Affiliation(s)
- Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Raffaella Santi
- Pathology Section, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Luca Gemma
- Department of Urology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Ilaria Camilla Galli
- Pathology Section, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Gabriella Nesi
- Pathology Section, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
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Santi R, Galli IC, Canzonieri V, Lopez JI, Nesi G. Inverted urothelial papilloma of the upper urinary tract: description of two cases with systematic literature review. Diagn Pathol 2020; 15:40. [PMID: 32321559 PMCID: PMC7175583 DOI: 10.1186/s13000-020-00961-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inverted urothelial papilloma (IUP) of the upper urinary tract is an uncommon benign tumour that occasionally presents as a polypoid mass causing urinary obstruction. Histologically, IUP is characterised by a proliferating urothelium arranged in cords and trabeculae, in continuity with overlying intact epithelium, and extending into the lamina propria in a non-invasive, endophytic manner. Cytological atypia is minimal or absent. Top differential diagnoses include urothelial carcinoma with inverted growth pattern and florid ureteritis cystica. Although urothelial carcinomas of the upper urinary tract with prominent inverted growth pattern commonly harbour microsatellite instability, the role of the mutator phenotype pathway in IUP development is still unclear. The aim of this study was to describe two additional cases of IUP of the upper urinary tract, along with an extensive literature review. CASE PRESENTATION We observed two polypoid tumours originating in the renal pelvis and the distal ureter, respectively. Both patients, a 76-year-old woman and a 56-year-old man, underwent surgery because of the increased likelihood of malignancy. Histology was consistent with IUP and patients are alive and asymptomatic after long-term follow-up (6 years for the renal pelvis lesion and 5 years for the ureter lesion). The tumours retained the expression of the mismatch-repair protein MLH1, MSH2, and PMS2 whereas loss of MSH6 was found in both cases. CONCLUSIONS When completely resected, IUP does not require rigorous surveillance protocols, such as those for urothelial carcinoma and exophytic urothelial papilloma. It is therefore important for the surgical pathologist to be aware of this rare entity in order to ensure correct patient management.
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Affiliation(s)
- R Santi
- Pathology Unit, Careggi University Hospital, Florence, Italy
| | - I C Galli
- Pathology Section, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - V Canzonieri
- Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste Medical School, Trieste, Italy
| | - J I Lopez
- University of the Basque Country, Barakaldo, Spain
| | - G Nesi
- Pathology Section, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Cai T, Santi R, Tamanini I, Galli IC, Perletti G, Bjerklund Johansen TE, Nesi G. Current Knowledge of the Potential Links between Inflammation and Prostate Cancer. Int J Mol Sci 2019; 20:ijms20153833. [PMID: 31390729 PMCID: PMC6696519 DOI: 10.3390/ijms20153833] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023] Open
Abstract
Inflammation is inherent in prostatic diseases and it is now accepted that it may facilitate cellular proliferation in both benign and malignant conditions. The strong relationship between prostatic inflammation and pathogenesis of benign prostatic hyperplasia (BPH) is supported by epidemiologic, histopathologic and molecular evidence. Contrariwise, the role of inflammation in prostate carcinogenesis is still controversial, although current data indicate that the inflammatory microenvironment can regulate prostate cancer (PCa) growth and progression. Knowledge of the complex molecular landscape associated with chronic inflammation in the context of PCa may lead to the introduction and optimization of novel targeted therapies. In this perspective, evaluation of the inflammatory component in prostate specimens could be included in routine pathology reports.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, 38122 Trento, Italy
| | | | - Irene Tamanini
- Department of Urology, Santa Chiara Regional Hospital, 38122 Trento, Italy
| | | | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, 21100 Busto Arsizio, Italy
| | | | - Gabriella Nesi
- Department of Health Sciences, University of Florence, 50139 Florence, Italy.
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Santi R, Cai T, Nobili S, Galli IC, Amorosi A, Comperat E, Nesi G. Snail immunohistochemical overexpression correlates to recurrence risk in non-muscle invasive bladder cancer: results from a longitudinal cohort study. Virchows Arch 2018. [PMID: 29525824 DOI: 10.1007/s00428-018-2310-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Raffaella Santi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Stefania Nobili
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Andrea Amorosi
- Institute of Pathology, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Eva Comperat
- Academic Department of Pathology, Hôpital Tenon, AP-HP, UPMC University Paris 06, Paris, France
| | - Gabriella Nesi
- Division of Pathological Anatomy, University of Florence, Florence, Italy.
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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