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Lee J, Benavides J, Manwar R, Puyana C, May J, Tsoukas M, Avanaki K. Noninvasive imaging exploration of phacomatosis pigmentokeratotica using high-frequency ultrasound and optical coherence tomography: Can biopsy of PPK patients be avoided? Skin Res Technol 2023; 29:e13279. [PMID: 37113090 PMCID: PMC10234170 DOI: 10.1111/srt.13279] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/16/2022] [Accepted: 01/03/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Phacomatosis pigmentokeratotica (PPK) is a distinct and rare type of epidermal nevus syndrome characterized by coexisting nonepidermolytic organoid sebaceous nevus (SN) with one or more speckled lentiginous nevi (SLN). Atypical nevi including compound Spitz and compound dysplastic may manifest within regions of SLN. Patients with PPK, or similar atypical nevus syndromes, may be subject to a significant lifetime number of biopsies, leading to pain, scarring, anxiety, financial burden, and decreased quality of life. The current literature includes case reports, genetics, and associated extracutaneous symptoms of PPK, but use of noninvasive imaging techniques have not been explored. We aim to investigate the value of high-frequency ultrasound (HFUS) and optical coherence tomography (OCT) in discriminating morphological features of pigmented lesions and nevus sebaceous within one patient with PPK. MATERIALS AND METHODS Two modalities, (1) HFUS imaging, based on acoustic properties and (2) OCT imaging, based on optical properties, were used to image a patient with PPK. Benign pigmented lesions, which may raise clinical suspicion for significant atypia, and nevus sebaceous, were selected on different areas of the body to be studied. RESULTS Five pigmented lesions and one area of nevus sebaceous were imaged and analyzed for noninvasive features. Distinct patterns of hypoechoic features were seen on HFUS and OCT. CONCLUSION HFUS provides a deep view of the tissue, with ability to differentiate gross structures beneath the skin. OCT provides a smaller penetration depth and a higher resolution. We have described noninvasive features of atypical nevi and nevus sebaceous on HFUS and OCT, which indicate benign etiology.
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Affiliation(s)
- Jenna Lee
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Juliana Benavides
- Richard and Loan Hill Biomedical Engineering DepartmentCollege of Engineering and MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Rayyan Manwar
- Richard and Loan Hill Biomedical Engineering DepartmentCollege of Engineering and MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Carolina Puyana
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Julia May
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Maria Tsoukas
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Kamran Avanaki
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
- Richard and Loan Hill Biomedical Engineering DepartmentCollege of Engineering and MedicineUniversity of Illinois—ChicagoChicagoIllinois
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Beyens A, Lietaer C, Claes K, De Baere E, Goeteyn M, Lerut B, Syryn H, Vanakker O, Van der Meulen J, Vanwalleghem L, Callewaert B. HRAS-related epidermal nevus syndromes: Expansion of the spectrum with first branchial arch defects. Clin Genet 2023; 103:709-713. [PMID: 36896710 DOI: 10.1111/cge.14323] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
Epidermal nevus syndrome (ENS) comprises a heterogeneous group of neurocutaneous syndromes associated with the presence of epidermal nevi and variable extracutaneous manifestations. Postzygotic activating HRAS pathogenic variants were previously identified in nevus sebaceous (NS), keratinocytic epidermal nevus (KEN), and different ENS, including Schimmelpenning-Feuerstein-Mims and cutaneous-skeletal-hypophosphatasia syndrome (CSHS). Skeletal involvement in HRAS-related ENS ranges from localized bone dysplasia in association with KEN to fractures and limb deformities in CSHS. We describe the first association of HRAS-related ENS and auricular atresia, thereby expanding the disease spectrum with first branchial arch defects if affected by the mosaic variant. In addition, this report illustrates the first concurrent presence of verrucous EN, NS, and nevus comedonicus (NC), indicating the possibility of mosaic HRAS variation as an underlying cause of NC. Overall, this report extends the pleiotropy of conditions associated with mosaic pathogenic variants in HRAS affecting ectodermal and mesodermal progenitor cells.
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Affiliation(s)
- Aude Beyens
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Charlotte Lietaer
- Department of Otorhinolaryngology, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Kathleen Claes
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marleen Goeteyn
- Department of Dermatology, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Bob Lerut
- Department of Otorhinolaryngology, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Hannes Syryn
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium
| | - Olivier Vanakker
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium
| | - Joni Van der Meulen
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium.,Molecular Diagnostics Ghent University Hospital (MDG), Ghent University Hospital, Ghent, Belgium
| | | | - Bert Callewaert
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium
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Merz LM, Buerger F, Ziegelasch N, Zenker M, Wieland I, Lipek T, Wallborn T, Terliesner N, Prenzel F, Siekmeyer M, Dittrich K. A Case Report: First Long-Term Treatment With Burosumab in a Patient With Cutaneous-Skeletal Hypophosphatemia Syndrome. Front Endocrinol (Lausanne) 2022; 13:866831. [PMID: 35600592 PMCID: PMC9120998 DOI: 10.3389/fendo.2022.866831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
Epidermal nevus syndromes encompass a highly heterogeneous group of systemic disorders, characterized by epidermal nevi, and a spectrum of neuromuscular, ocular, and bone abnormalities. Cutaneous-skeletal hypophosphatemia syndrome (CSHS) constitutes a specific sub-entity in which elevated levels of fibroblast growth factor-23 cause hypophosphatemic rickets that are, to date, not amenable to causal therapy. Here, we report the first long-term follow-up of causal treatment with burosumab in a 3-year-old female patient with CSHS. 4 weeks after initiation of burosumab treatment, serum phosphate normalized to age-appropriate levels. Furthermore, long-term follow-up of 42 months revealed significant improvement of linear growth and gross physical functions, including respiratory insufficiency. Radiographic rickets severity as well as subjective bone pain were strongly reduced, and no side effects were observed over the course of treatment. In summary, we, here, report about a successful treatment of hypophosphatemic rickets in CSHS with burosumab over the time course of 42 months. In our patient, burosumab showed convincing efficacy and safety profile, without any loss of effect or increase of dose.
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Affiliation(s)
- Lea Maria Merz
- Department of Pediatric Nephrology and Pulmonology, University Hospital Leipzig, Leipzig, Germany
- *Correspondence: Lea Maria Merz,
| | - Florian Buerger
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Niels Ziegelasch
- Department of Pediatric Nephrology and Pulmonology, University Hospital Leipzig, Leipzig, Germany
| | - Martin Zenker
- Faculty of Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Ilse Wieland
- Faculty of Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Tobias Lipek
- Department of Pediatric Nephrology and Pulmonology, University Hospital Leipzig, Leipzig, Germany
| | - Tillmann Wallborn
- Department of Pediatric Nephrology, St. Georg Hospital, Leipzig, Germany
| | - Nicolas Terliesner
- Department of Pediatric Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Freerk Prenzel
- Department of Pediatric Nephrology and Pulmonology, University Hospital Leipzig, Leipzig, Germany
| | - Manuela Siekmeyer
- Department of Pediatric Nephrology and Pulmonology, University Hospital Leipzig, Leipzig, Germany
| | - Katalin Dittrich
- Department of Pediatric Nephrology and Pulmonology, University Hospital Leipzig, Leipzig, Germany
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Biçer Ö, Boyvat A, Hoşal MB, Cansız Ersöz C, Okçu Heper A. Systematized Epidermal Nevus Syndrome Involving the Upper and Lower Eyelids Bilaterally. Turk J Ophthalmol 2021; 51:243-245. [PMID: 34461711 PMCID: PMC8411292 DOI: 10.4274/tjo.galenos.2021.72662] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/03/2021] [Indexed: 12/01/2022] Open
Abstract
A 29-year-old woman presented with dark-colored raised lesions on both eyelids since early childhood. Ophthalmological examination revealed pigmented verrucous lesions on her upper and lower eyelids bilaterally. The patient had a history of generalized tonic-clonic seizures. Dermatological examination revealed hyperpigmented verrucous plaques arranged along lines of Blaschko on the neck, trunk, and arms. On the basis of these findings, the diagnosis of epidermal nevus syndrome (ENS) was made. She had surgery for debulking of the lesions. Histological analysis revealed hyperkeratosis with foci of parakeratosis, acanthosis, and papillomatosis, consistent with linear verrucous epidermal nevus. Postoperative residual lesions did not respond to oral acitretin therapy (10 mg/kg/day for 2 months). Systematized ENS can rarely cause linear verrucous nevi on the upper and lower eyelids on both sides. These patients should be investigated for accompanying systemic anomalies and followed for potential malignant transformation of the skin lesions.
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Affiliation(s)
- Özlem Biçer
- Boğazlıyan State Hospital, Clinic of Ophthalmology, Yozgat, Turkey
| | - Ayşe Boyvat
- Ankara University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
| | - Melek Banu Hoşal
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | | | - Aylin Okçu Heper
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey
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Mizutani Y, Nagai M, Iwata H, Matsunami K, Seishima M. Epidermal Nevus Syndrome Associated with Dwarfism and Atopic Dermatitis. Children (Basel) 2021; 8:children8080697. [PMID: 34438587 PMCID: PMC8394286 DOI: 10.3390/children8080697] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
Epidermal nevus syndrome (ENS) is a congenital disorder characterized by widespread linear epidermal lesions consisting of epidermal nevus and extracutaneous involvements, especially of the central nervous system and skeletal system. Garcia-Hafner-Happle syndrome, also known as fibroblast growth factor receptor 3 (FGFR3)-ENS, is characterized by a systematized keratinocytic EN of soft and velvety type with neurological abnormalities such as seizures, intellectual impairment, and cortical atrophy. We present a case of a 9-year-old Japanese boy afflicted with Garcia-Hafner-Happle syndrome associated with dwarfism and atopic dermatitis. We show the results of physical examination, DNA analysis, and imaging studies and discuss the mutation underlying the child's disorder.
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Affiliation(s)
- Yuki Mizutani
- Department of Dermatology, Gifu Prefectural General Medical Center, Gifu 500-8717, Japan;
- Correspondence: ; Tel.:+81-246-1111
| | - Miki Nagai
- Department of Dermatology, Gifu Prefectural General Medical Center, Gifu 500-8717, Japan;
| | - Hitoshi Iwata
- Department of Pathology, Gifu Prefectural General Medical Center, Gifu 500-8717, Japan;
| | - Kunihiro Matsunami
- Department of Pediatrics, Gifu Prefectural General Medical Center, Gifu 500-8717, Japan;
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan;
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Kuok C, Chan K. Renal Involvement in Linear Nevus Sebaceous Syndrome-An Underrecognized Feature. Pediatr Rep 2021; 13:203-9. [PMID: 34062947 DOI: 10.3390/pediatric13020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/29/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022] Open
Abstract
Linear nevus sebaceous syndrome (LNSS) is a rare neurocutaneous disorder. It is characterized by the presence of nevus sebaceous, ocular anomalies, neurological deficits, and convulsion. Renal involvement was not commonly reported. We report a 10-year-old girl with LNSS who had concomitant cystic kidney disease and diffuse aortopathy with bilateral renal artery stenosis, leading to hypertension requiring oral anti-hypertensive medications. The girl presented with chorioretinal coloboma and multiple nevus sebaceous at birth. She had aortic coarctation and received surgical repair at one week of life. She had persistent hypertension during her follow-up. Further investigations were performed to look for causes of hypertension apart from possible re-coarctation. Her magnetic resonance angiogram revealed diffuse aortopathy, which extended from the aortic arch to the abdominal aorta. Branches of the aorta, including the celiac trunk, superior mesenteric arteries, and renal arteries, were also narrowed. Multiple renal cysts were also identified in her right kidney. Interventional angioplasty over the renal arteries was not feasible due to diffuse narrowing of the aorta, especially at the origins of renal arteries. The blood pressure was controlled with oral anti-hypertensive medications. Our case illustrated that pediatricians should be aware of the possible renal involvements in LNSS, which impose a significant impact on the management and long-term prognosis of these patients.
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Hannah CE, Keller JR, Noe MH, Gordon JR, Fridlington EK, Ceilley RI, Liu V. Phacomatosis pigmentokeratotica without extracutaneous abnormalities: 12-year follow-up. JAAD Case Rep 2019; 5:1055-1057. [PMID: 31788526 PMCID: PMC6880094 DOI: 10.1016/j.jdcr.2019.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Claire E. Hannah
- Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jaclyn R. Keller
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Megan H. Noe
- Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | | | | | | | - Vincent Liu
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Correspondence to: Vincent Liu, MD, 200 Hawkins Dr, 40030 PFP, Iowa City, IA 52242
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Ullah W, Abdullah HMA, Shahzad MA, Sadiq MA, Ahmad E, Khan S. First Reported Case of ' Epidermal Nevus Syndrome' with a Triad of Central Nervous System Deformities. Cureus 2016; 8:e916. [PMID: 28083460 PMCID: PMC5218882 DOI: 10.7759/cureus.916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/29/2022] Open
Abstract
Epidermal nevus syndrome (ENS) is a term used to describe the occurrence of an epidermal nevus in association with other extra-cutaneous developmental anomalies, most commonly involving the nervous and musculoskeletal systems. The nevus is classified on the basis of the main component which may be keratinocytic, sebaceous, follicular, apocrine, or eccrine. Most patients who present with ENS is at the time of birth, though some become apparent later in life. This case describes a young female who presented with seizures and cognitive impairment along with a linear epidermal nevus on the midline of her face. The presence of the nevus prompted brain imaging which showed cortical dysplasia, multiple hamartomas in the temporal lobe, thalamus, and periventricular regions along with cerebellar atrophy and Dandy-Walker variant. To our knowledge, this is the first case in which three different types of brain lesions were found in the same patient.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, University of Arizona, Tucson, AZ
| | | | | | | | - Ejaz Ahmad
- Internal Medicine, Nishtar Hospital, Multan, Pakistan
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Alsohim F, Abou-Jaoude P, Ninet J, Pracros JP, Phan A, Cochat P. Bilateral renal artery stenosis and epidermal nevus syndrome in a child. Pediatr Nephrol 2011; 26:2081-4. [PMID: 21720804 PMCID: PMC3178020 DOI: 10.1007/s00467-011-1949-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 11/29/2022]
Abstract
Epidermal nevus syndrome is a rare congenital sporadic neuro-ectodermic disorder, characterized by the presence of epidermal nevi in association with various developmental abnormalities of the skin, eyes, nervous, skeletal, cardiovascular and urogenital systems. We describe a 5-year-old boy with conjunctival lipodermoid, cervical and facial sebaceous nevi who presented at 3 years of age with hypertension due to bilateral renal artery stenosis together with multiple vascular anomalies (aorta, celiac trunk, superior mesenteric artery) as shown by magnetic resonance angiography. Systemic arterial hypertension was difficult to control despite combined anti-hypertensive drugs and the surgical repair of the aortic coarctation.
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Affiliation(s)
- Fahad Alsohim
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme Mère Enfant, centre de référence des maladies rénales rares, Hospices Civils de Lyon, 59 boulevard Pinel, 69500 Bron, France.
| | - Pauline Abou-Jaoude
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme Mère Enfant, centre de référence des maladies rénales rares, Hospices Civils de Lyon, 59 boulevard Pinel, 69500 Bron, France
| | - Jean Ninet
- Service de chirurgie cardio-vasculaire, Hôpital Louis Pradel, groupement hospitalier Est, Bron, France
| | | | - Alice Phan
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, Hôpital Femme Mère Enfant, centre de référence des maladies rénales rares, Hospices Civils de Lyon, 59 boulevard Pinel, 69500 Bron, France
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Abstract
Linear epidermal nevus (LEN) is a sporadic hamartomatous lesion of the skin due to the proliferation of clones of embryonic ectodermal cells, which are arranged according to a typical linear configuration known as Blaschko's lines. Oral involvement of LEN is very rare and few cases have been reported in the medical literature. We report two new cases of LEN with exclusive oral involvement, which presented with the typical unilateral or midline distribution. Oral LEN presents as an exophytic lesion with well defined borders and a verrucous or papillary surface which correspond, histologically, to epithelial papillomatosis with a moderate degree of hyperkeratosis and acanthosis. Oral LEN appears mainly at birth, grows slowly during childhood and stabilize by adolescence. Localized lesions do not show any recurrence after surgical removal but widespread lesions seem to have more risk of recurrence and are more difficult to manage. Functional problems and malignant transformation have not been reported.
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Affiliation(s)
- Domenico Tesi
- Reference Center for the study of Oral Diseases, University of Florence, Florence, Italy ,Azienda Ospedaliero-Universitaria, Florence, Italy ,Department of Odonto-Stomatology, University of Florence, Viale Morgagni 85, Florence, Italy
| | - Giuseppe Ficarra
- Reference Center for the study of Oral Diseases, University of Florence, Florence, Italy ,Azienda Ospedaliero-Universitaria, Florence, Italy ,Department of Odonto-Stomatology, University of Florence, Viale Morgagni 85, Florence, Italy
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