Real-Life Barriers to Diagnosis of Early Mycosis Fungoides: An International Expert Panel Discussion.
Journal
American journal of clinical dermatology
ISSN: 1179-1888
Titre abrégé: Am J Clin Dermatol
Pays: New Zealand
ID NLM: 100895290
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
accepted:
19
09
2022
pubmed:
19
11
2022
medline:
26
1
2023
entrez:
18
11
2022
Statut:
ppublish
Résumé
Mycosis fungoides (MF) is a rare, primary cutaneous T-cell lymphoma that is challenging to diagnose due to its heterogeneous clinical presentation and complex histology. The subtlety of the initial clinical appearance of MF can result in diagnostic delays and hesitancy to refer suspected cases to specialist clinics. An unmet need remains for greater awareness and education. Therefore, an international expert panel of dermatologists, oncologists, hematologists, and dermatopathologists convened to discuss and identify barriers to early and accurate MF diagnosis that could guide clinicians toward making a correct diagnosis. Confirmation of MF requires accurate assessment of symptoms and clinical signs, and subsequent correlation with dermatopathological findings. This review summarizes the expert panel's guidance, based on the literature and real-life experience, for dermatologists to help include MF in their list of differential diagnoses, along with simple clinical and histopathologic checklists that may help clinicians to suspect and identify potential MF lesions and reduce diagnostic delays.
Identifiants
pubmed: 36399227
doi: 10.1007/s40257-022-00732-w
pii: 10.1007/s40257-022-00732-w
pmc: PMC9673193
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5-14Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : Helsinn
ID : Helsinn Healthcare SA
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2022. The Author(s).
Références
Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105(10):3768–85. https://doi.org/10.1182/blood-2004-09-3502 .
doi: 10.1182/blood-2004-09-3502
pubmed: 15692063
Dobos G, Pohrt A, Ram-Wolff C, Lebbé C, Bouaziz JD, Battistella M, et al. Epidemiology of cutaneous T-cell lymphomas: a systematic review and meta-analysis of 16,953 patients. Cancers (Basel). 2020;12(10):2921. https://doi.org/10.3390/cancers12102921 .
doi: 10.3390/cancers12102921
pubmed: 33050643
pmcid: 7600606
Kaufman AE, Patel K, Goyal K, O’Leary D, Rubin N, Pearson D, et al. Mycosis fungoides: developments in incidence, treatment and survival. J Eur Acad Dermatol Venereol. 2020;34(10):2288–94. https://doi.org/10.1111/jdv.16325 .
doi: 10.1111/jdv.16325
pubmed: 32141115
pmcid: 7733543
Maguire A, Puelles J, Raboisson P, Chavda R, Gabriel S, Thornton S. Early-stage mycosis fungoides: epidemiology and prognosis. Acta Derm Venereol. 2020;100(1):adv00013. https://doi.org/10.2340/00015555-3367 .
doi: 10.2340/00015555-3367
pubmed: 31663598
Ottevanger R, de Bruin DT, Willemze R, Jansen PM, Bekkenk MW, de Haas ERM, et al. Incidence of mycosis fungoides and Sezary syndrome in the Netherlands between 2000 and 2020. Br J Dermatol. 2021;185(2):434–5. https://doi.org/10.1111/bjd.20048 .
doi: 10.1111/bjd.20048
pubmed: 33690948
pmcid: 8453738
Larocca C, Kupper T. Mycosis fungoides and Sezary syndrome: an update. Hematol Oncol Clin N Am. 2019;33(1):103–20. https://doi.org/10.1016/j.hoc.2018.09.001 .
doi: 10.1016/j.hoc.2018.09.001
Scarisbrick J. Staging of mycosis fungoides and Sézary syndrome: time for an update? EMJ Allergy Immunol. 2018;6(1):92–100.
Olsen E, Whittaker S, Willemze R, Pinter-Brown L, Foss F, Geskin L, et al. Primary cutaneous lymphoma: recommendations for clinical trial design and staging update from ISCL, USCLC, and EORTC. Blood. 2022;140(5):419–37. https://doi.org/10.1182/blood-2007-03-055749 .
doi: 10.1182/blood-2007-03-055749
pubmed: 17540844
Agar NS, Wedgeworth E, Crichton S, Mitchell TJ, Cox M, Ferreira S, et al. Survival outcomes and prognostic factors in mycosis fungoides/Sezary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal. J Clin Oncol. 2010;28(31):4730–9. https://doi.org/10.1200/JCO.2009.27.7665 .
doi: 10.1200/JCO.2009.27.7665
pubmed: 20855822
Demierre MF, Gan S, Jones J, Miller DR. Significant impact of cutaneous T-cell lymphoma on patients’ quality of life: results of a 2005 National Cutaneous Lymphoma Foundation Survey. Cancer. 2006;107(10):2504–11. https://doi.org/10.1002/cncr.22252 .
doi: 10.1002/cncr.22252
pubmed: 17048251
Molloy K, Jonak C, Woei AJF, Guenova E, Busschots AM, Bervoets A, et al. Characteristics associated with significantly worse quality of life in mycosis fungoides/Sezary syndrome from the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study. Br J Dermatol. 2020;182(3):770–9. https://doi.org/10.1111/bjd.18089 .
doi: 10.1111/bjd.18089
pubmed: 31049926
Russomanno K, Carver DeKlotz CM. Acceleration of cutaneous T-cell lymphoma following dupilumab administration. JAAD Case Rep. 2021;8:83–5. https://doi.org/10.1016/j.jdcr.2020.12.010 .
doi: 10.1016/j.jdcr.2020.12.010
pubmed: 33532533
Hollins LC, Wirth P, Fulchiero GJ Jr, Foulke GT. Long-standing dermatitis treated with dupilumab with subsequent progression to cutaneous T-cell lymphoma. Cutis. 2020;106(2):E8–11. https://doi.org/10.12788/cutis.0074 .
doi: 10.12788/cutis.0074
pubmed: 32941565
Martinez-Escala ME, Posligua AL, Wickless H, Rutherford A, Sable KA, Rubio-Gonzalez B, et al. Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor-alpha therapy. J Am Acad Dermatol. 2018;78(6):1068–76. https://doi.org/10.1016/j.jaad.2017.12.068 .
doi: 10.1016/j.jaad.2017.12.068
pubmed: 29307643
pmcid: 5951749
Amitay-Laish I, Guenova E, Ortiz-Romero PL, Vico-Alonso C, Rozati S, Geskin LJ, et al. The course of mycosis fungoides under cytokine pathway blockers: a multicentre analysis of real-life clinical data. Acta Derm Venereol. 2020;100(16):adv00277. https://doi.org/10.2340/00015555-3642 .
doi: 10.2340/00015555-3642
pubmed: 32965506
Hoot JW, Wang L, Kho T, Akilov OE. The effect of phototherapy on progression to tumors in patients with patch and plaque stage of mycosis fungoides. J Dermatol Treat. 2018;29(3):272–6. https://doi.org/10.1080/09546634.2017.1365113 .
doi: 10.1080/09546634.2017.1365113
van Doorn R, Van Haselen CW, van Voorst Vader PC, Geerts ML, Heule F, de Rie M, et al. Mycosis fungoides: disease evolution and prognosis of 309 Dutch patients. Arch Dermatol. 2000;136(4):504–10. https://doi.org/10.1001/archderm.136.4.504 .
doi: 10.1001/archderm.136.4.504
pubmed: 10768649
Pavlotsky F, Hodak E, Dawood M, Barzilai A. Stage IA mycosis fungoides should be treated until proven otherwise. J Am Acad Dermatol. 2020;82(1):e19–20. https://doi.org/10.1016/j.jaad.2019.09.001 .
doi: 10.1016/j.jaad.2019.09.001
pubmed: 31520663
Trautinger F, Eder J, Assaf C, Bagot M, Cozzio A, Dummer R, et al. European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sezary syndrome—update 2017. Eur J Cancer. 2017;77:57–74. https://doi.org/10.1016/j.ejca.2017.02.027 .
doi: 10.1016/j.ejca.2017.02.027
pubmed: 28365528
Willemze R, Hodak E, Zinzani PL, Specht L, Ladetto M, Committee EG. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv30–40. https://doi.org/10.1093/annonc/mdy133 .
doi: 10.1093/annonc/mdy133
pubmed: 29878045
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Primary Cutaneous Lymphomas. Version 2.2021. 2020. https://www.nccn.org/professionals/physician_gls/pdf/primary_cutaneous.pdf . Accessed 28 July, 2021.
Quaglino P, Prince HM, Cowan R, Vermeer M, Papadavid E, Bagot M, et al. Treatment of early-stage mycosis fungoides: results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study. Br J Dermatol. 2021;184(4):722–30. https://doi.org/10.1111/bjd.19252 .
doi: 10.1111/bjd.19252
pubmed: 32479678
pmcid: 7704558
Hodak E, Amitay-Laish I. Mycosis fungoides: a great imitator. Clin Dermatol. 2019;37(3):255–67. https://doi.org/10.1016/j.clindermatol.2019.01.004 .
doi: 10.1016/j.clindermatol.2019.01.004
pubmed: 31178107
Pimpinelli N, Olsen EA, Santucci M, Vonderheid E, Haeffner AC, Stevens S, et al. Defining early mycosis fungoides. J Am Acad Dermatol. 2005;53(6):1053–63. https://doi.org/10.1016/j.jaad.2005.08.057 .
doi: 10.1016/j.jaad.2005.08.057
pubmed: 16310068
Scarisbrick JJ, Quaglino P, Prince HM, Papadavid E, Hodak E, Bagot M, et al. The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients. Br J Dermatol. 2019;181(2):350–7. https://doi.org/10.1111/bjd.17258 .
doi: 10.1111/bjd.17258
pubmed: 30267549
Santucci M, Biggeri A, Feller AC, Burg G, For the European Organization for Research, Treatment of Cancer Cutaneous Lymphoma Project Group. Accuracy, concordance, and reproducibility of histologic diagnosis in cutaneous t-cell lymphoma: An EORTC Cutaneous Lymphoma Project Group study. Arch Dermatol. 2000;136(4):497–502. https://doi.org/10.1001/archderm.136.4.497 .
doi: 10.1001/archderm.136.4.497
pubmed: 10768648
Furlan FC, Sanches JA. Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology. Bras Dermatol. 2013;88(6):954–60. https://doi.org/10.1590/abd1806-4841.20132336 .
doi: 10.1590/abd1806-4841.20132336
Keehn CA, Belongie IP, Shistik G, Fenske NA, Glass LF. The diagnosis, staging, and treatment options for mycosis fungoides. Cancer Control. 2007;14(2):102–11. https://doi.org/10.1177/107327480701400203 .
doi: 10.1177/107327480701400203
pubmed: 17387295
Chairatchaneeboon M, Thanomkitti K, Kim EJ. Parapsoriasis—a diagnosis with an identity crisis: a narrative review. Dermatol Ther. 2022. https://doi.org/10.1007/s13555-022-00716-y .
doi: 10.1007/s13555-022-00716-y
Vakeva L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A. A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides. Acta Dermatovenereol. 2005;85(4):318–23. https://doi.org/10.1080/00015550510030087 .
doi: 10.1080/00015550510030087
Burg G, Dummer R, Nestle FO, Doebbeling U, Haeffner A. Cutaneous lymphomas consist of a spectrum of nosologically different entities including mycosis fungoides and small plaque parapsoriasis. Arch Dermatol. 1996;132(5):567–72.
doi: 10.1001/archderm.1996.03890290101014
pubmed: 8624155
Belousova IE, Vanecek T, Samtsov AV, Michal M, Kazakov DV. A patient with clinicopathologic features of small plaque parapsoriasis presenting later with plaque-stage mycosis fungoides: report of a case and comparative retrospective study of 27 cases of “nonprogressive” small plaque parapsoriasis. J Am Acad Dermatol. 2008;59(3):474–82. https://doi.org/10.1016/j.jaad.2008.05.028 .
doi: 10.1016/j.jaad.2008.05.028
pubmed: 18694680
Guitart J, Kennedy J, Ronan S, Chmiel JS, Hsiegh YC, Variakojis D. Histologic criteria for the diagnosis of mycosis fungoides: proposal for a grading system to standardize pathology reporting. J Cutan Pathol. 2001;28(4):174–83. https://doi.org/10.1034/j.1600-0560.2001.028004174.x .
doi: 10.1034/j.1600-0560.2001.028004174.x
pubmed: 11426824
Zackheim HS, McCalmont TH. Mycosis fungoides: the great imitator. J Am Acad Dermatol. 2002;47(6):914–8. https://doi.org/10.1067/mjd.2002.124696 .
doi: 10.1067/mjd.2002.124696
pubmed: 12451378
Song SX, Willemze R, Swerdlow SH, Kinney MC, Said JW. Mycosis fungoides: report of the 2011 Society for Hematopathology/European Association for Haematopathology workshop. Am J Clin Pathol. 2013;139(4):466–90. https://doi.org/10.1309/AJCPOBDP2OQAJ5BR .
doi: 10.1309/AJCPOBDP2OQAJ5BR
pubmed: 23525617
Alsayyah A. Is it mycosis fungoides? A comprehensive guide to reaching the diagnosis and avoiding common pitfalls. Ann Diagn Pathol. 2020;47: 151546. https://doi.org/10.1016/j.anndiagpath.2020.151546 .
doi: 10.1016/j.anndiagpath.2020.151546
pubmed: 32554312
Virmani P, Myskowski PL, Pulitzer M. Unusual variants of mycosis fungoides. Diagn Histopathol (Oxf). 2016;22(4):142–51. https://doi.org/10.1016/j.mpdhp.2016.04.004 .
doi: 10.1016/j.mpdhp.2016.04.004
pubmed: 29225700
pmcid: 5720164
Willemze R, Cerroni L, Kempf W, Berti E, Facchetti F, Swerdlow SH, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood. 2019;133(16):1703–14. https://doi.org/10.1182/blood-2018-11-881268 .
doi: 10.1182/blood-2018-11-881268
pubmed: 30635287
pmcid: 6473500
Hodak E, David M, Maron L, Aviram A, Kaganovsky E, Feinmesser M. CD4/CD8 double-negative epidermotropic cutaneous T-cell lymphoma: an immunohistochemical variant of mycosis fungoides. J Am Acad Dermatol. 2006;55(2):276–84. https://doi.org/10.1016/j.jaad.2006.01.020 .
doi: 10.1016/j.jaad.2006.01.020
pubmed: 16844512
Nikolaou VA, Papadavid E, Katsambas A, Stratigos AJ, Marinos L, Anagnostou D, et al. Clinical characteristics and course of CD8+ cytotoxic variant of mycosis fungoides: a case series of seven patients. Br J Dermatol. 2009;161(4):826–30. https://doi.org/10.1111/j.1365-2133.2009.09301.x .
doi: 10.1111/j.1365-2133.2009.09301.x
pubmed: 19558552
Miyagaki T. Diagnosis of early mycosis fungoides. Diagnostics (Basel). 2021;11(9):1721. https://doi.org/10.3390/diagnostics11091721 .
doi: 10.3390/diagnostics11091721
pubmed: 34574062
pmcid: 8465146
Vandergriff T, Nezafati KA, Susa J, Karai L, Sanguinetti A, Hynan LS, et al. Defining early mycosis fungoides: validation of a diagnostic algorithm proposed by the International Society for Cutaneous Lymphomas. J Cutan Pathol. 2015;42(5):318–28. https://doi.org/10.1111/cup.12470 .
doi: 10.1111/cup.12470
pubmed: 25721994
Thurber SE, Zhang B, Kim YH, Schrijver I, Zehnder J, Kohler S. T-cell clonality analysis in biopsy specimens from two different skin sites shows high specificity in the diagnosis of patients with suggested mycosis fungoides. J Am Acad Dermatol. 2007;57(5):782–90. https://doi.org/10.1016/j.jaad.2007.06.004 .
doi: 10.1016/j.jaad.2007.06.004
pubmed: 17646032
de Masson A, O’Malley JT, Elco CP, Garcia SS, Divito SJ, Lowry EL, et al. High-throughput sequencing of the T cell receptor β gene identifies aggressive early-stage mycosis fungoides. Sci Transl Med. 2018;10(440):eaar5894. https://doi.org/10.1126/scitranslmed.aar5894 .
doi: 10.1126/scitranslmed.aar5894
pubmed: 29743350
pmcid: 6366329
Gibbs JD, Ma S, Kim A, Seminario-Vidal L, Sokol L, Zhang H, et al. Utility of flow cytometry and gene rearrangement analysis in tissue and blood of patients with suspected cutaneous Tcell lymphoma. Oncol Rep. 2021;45(1):349–58. https://doi.org/10.3892/or.2020.7865 .
doi: 10.3892/or.2020.7865
pubmed: 33416132
Rea B, Haun P, Emerson R, Vignali M, Farooqi M, Samimi S, et al. Role of high-throughput sequencing in the diagnosis of cutaneous T-cell lymphoma. J Clin Pathol. 2018;71(9):814–20. https://doi.org/10.1136/jclinpath-2018-205004 .
doi: 10.1136/jclinpath-2018-205004
pubmed: 29636372
Alberti VS, Alaibac M, Ardigo M, Baldo A, Dim N, Massone C, et al. An expert consensus report on mycosis fungoides in Italy: epidemiological impact and diagnostic-therapeutic pathway. Ital J Dermatol Venereol. 2021;156(4):413–21. https://doi.org/10.23736/S2784-8671.20.06668-7 .
doi: 10.23736/S2784-8671.20.06668-7
Dulmage BO, Geskin LJ. Lessons learned from gene expression profiling of cutaneous T-cell lymphoma. Br J Dermatol. 2013;169(6):1188–97. https://doi.org/10.1111/bjd.12578 .
doi: 10.1111/bjd.12578
pubmed: 23937674
pmcid: 3954533
Litvinov IV, Tetzlaff MT, Thibault P, Gangar P, Moreau L, Watters AK, et al. Gene expression analysis in cutaneous t-cell lymphomas (CTCL) highlights disease heterogeneity and potential diagnostic and prognostic indicators. Oncoimmunology. 2017;6(5): e1306618. https://doi.org/10.1080/2162402X.2017.1306618 .
doi: 10.1080/2162402X.2017.1306618
pubmed: 28638728
pmcid: 5468001
Morimura S, Sugaya M, Suga H, Miyagaki T, Ohmatsu H, Fujita H, et al. TOX expression in different subtypes of cutaneous lymphoma. Arch Dermatol Res. 2014;306(9):843–9. https://doi.org/10.1007/s00403-014-1501-7 .
doi: 10.1007/s00403-014-1501-7
pubmed: 25216799
Zhang Y, Wang Y, Yu R, Huang Y, Su M, Xiao C, et al. Molecular markers of early-stage mycosis fungoides. J Investig Dermatol. 2012;132(6):1698–706. https://doi.org/10.1038/jid.2012.13 .
doi: 10.1038/jid.2012.13
pubmed: 22377759
Yuki A, Shinkuma S, Hayashi R, Fujikawa H, Kato T, Homma E, et al. CADM1 is a diagnostic marker in early-stage mycosis fungoides: multicenter study of 58 cases. J Am Acad Dermatol. 2018;79(6):1039–46. https://doi.org/10.1016/j.jaad.2018.06.025 .
doi: 10.1016/j.jaad.2018.06.025
pubmed: 29928911
Rittig AH, Lindahl LM, Johansen C, Celis P, Odum N, Iversen L, et al. The microRNA expression profile differs between erythrodermic mycosis fungoides and Sezary syndrome. Acta Derm Venereol. 2019;99(12):1148–53. https://doi.org/10.2340/00015555-3306 .
doi: 10.2340/00015555-3306
pubmed: 31453630
Ralfkiaer U, Lindal L, Litman T, Gjerdrum L-M, Ahler CB, Gniadecki R, et al. MicroRNA expression in early mycosis fungoides is distinctly different from atopic dermatitis and advanced cutaneous T-cell lymphoma. Anticancer Res. 2014;34(12):7207–17.
pubmed: 25503151
Marstrand T, Ahler CB, Ralfkiaer U, Clemmensen A, Kopp KL, Sibbesen NA, et al. Validation of a diagnostic microRNA classifier in cutaneous T-cell lymphomas. Leuk Lymphoma. 2014;55(4):957–8. https://doi.org/10.3109/10428194.2013.815352 .
doi: 10.3109/10428194.2013.815352
pubmed: 23772646
Dusilkova N, Basova P, Polivka J, Kodet O, Kulvait V, Pesta M, et al. Plasma miR-155, miR-203, and miR-205 are biomarkers for monitoring of primary cutaneous T-cell lymphomas. Int J Mol Sci. 2017;18(10):2136. https://doi.org/10.3390/ijms18102136 .
doi: 10.3390/ijms18102136
pubmed: 29036928
pmcid: 5666818
Motamedi M, Xiao MZX, Iyer A, Gniadecki R. Patterns of gene expression in cutaneous T-cell lymphoma: systematic review of transcriptomic studies in mycosis fungoides. Cells. 2021. https://doi.org/10.3390/cells10061409 .
doi: 10.3390/cells10061409
pubmed: 34204115
pmcid: 8229125
Lindahl LM, Gluud M, Emmanuel T, Thomsen EA, Hu T, Rittig AH, et al. MicroRNA-106b regulates expression of the tumour suppressors p21 and TXNIP and promotes tumour cell proliferation in mycosis fungoides. Acta Derm Venereol. 2020;100(16):adv00270. https://doi.org/10.2340/00015555-3574 .
doi: 10.2340/00015555-3574
pubmed: 32556351
Moyal L, Arkin C, Gorovitz-Haris B, Querfeld C, Rosen S, Knaneh J, et al. Mycosis fungoides-derived exosomes promote cell motility and are enriched with microRNA-155 and microRNA-1246, and their plasma-cell-free expression may serve as a potential biomarker for disease burden. Br J Dermatol. 2021;185(5):999–1012. https://doi.org/10.1111/bjd.20519 .
doi: 10.1111/bjd.20519
pubmed: 34053079
pmcid: 8864770
Zhu M, Yu W, Wang P, Liu J, Li Z, Dai H, et al. Reflectance confocal microscopy may be included as part of the diagnostic algorithm of early-stage mycosis fungoides. Skin Res Technol. 2020;26(4):591–8. https://doi.org/10.1111/srt.12840 .
doi: 10.1111/srt.12840
pubmed: 31950528
Melhoranse Gouveia B, Wells J, Kim J, Collgros H, Guitera P, Longo C, et al. Reflectance confocal microscopy role in mycosis fungoides follow-up. Skin Res Technol. 2021;27(3):414–21. https://doi.org/10.1111/srt.12967 .
doi: 10.1111/srt.12967
pubmed: 33098224
Hsiao YP, Chiu CW, Lu CW, Nguyen HT, Tseng YS, Hsieh SC, et al. Identification of skin lesions by using single-step multiframe detector. J Clin Med. 2021;10(1):144. https://doi.org/10.3390/jcm10010144 .
doi: 10.3390/jcm10010144
pubmed: 33406761
pmcid: 7796252
Chong Y, Lee JY, Kim Y, Choi J, Yu H, Park G, et al. A machine-learning expert-supporting system for diagnosis prediction of lymphoid neoplasms using a probabilistic decision-tree algorithm and immunohistochemistry profile database. J Pathol Transl Med. 2020;54(6):462–70. https://doi.org/10.4132/jptm.2020.07.11 .
doi: 10.4132/jptm.2020.07.11
pubmed: 32854491
pmcid: 7674765