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Erschienen in: Der Pathologe 6/2012

01.11.2012 | Schwerpunkt

Myeloproliferative Neoplasien

Histopathologische und molekularpathologische Diagnostik

verfasst von: K. Hussein, G. Büsche, J. Schlue, U. Lehmann, Prof. Dr. H. Kreipe

Erschienen in: Die Pathologie | Ausgabe 6/2012

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Zusammenfassung

Zu den myeloproliferativen Neoplasien (chronische myeloproliferative Erkrankungen nach früherer Nomenklatur) zählen die chronische myeloische Leukämie, die Polycythämia vera, die essenzielle Thrombozythämie, die primäre Myelofibrose, die chronische Eosinophilenleukämie, die chronische Neutrophilenleukämie und die systemische Mastozytose. Allen ist gemeinsam, dass eine oder mehrere hämatopoetische Differenzierungslinien exzessiv vermehrt sind und dass sie mit unterschiedlichen Wahrscheinlichkeiten in eine Blastenkrise oder Knochenmarkfibrose übergehen können. Ferner sind bei allen Tyrosinkinasen und assoziierte Signalwege von Mutationen betroffen (BCR-ABL, JAK2V617F, MPLW515L/K, KITD816V und FIP1L1-PDGFRA), welche die gesteigerte Proliferation auslösen. Diese Mutationen sind diagnostisch wie therapeutisch von großer Bedeutung, da sie reaktive Myeloproliferationen ausschließen, mit unterschiedlicher Spezifität zur Subtypisierung beitragen und zumindest z. T. medikamentös gezielt zu hemmen sind. Die molekularen Mechanismen der blastären und fibrotischen Progression sind noch unbekannt.
Literatur
1.
Zurück zum Zitat Beer PA, Delhommeau F, LeCouédic JP et al (2010) Two routes to leukemic transformation after a JAK2 mutation-positive myeloproliferative neoplasm. Blood 115:2891–2900PubMedCrossRef Beer PA, Delhommeau F, LeCouédic JP et al (2010) Two routes to leukemic transformation after a JAK2 mutation-positive myeloproliferative neoplasm. Blood 115:2891–2900PubMedCrossRef
2.
Zurück zum Zitat Bock O, Muth M, Theophile K et al (2009) Identification of new target molecules PTK2, TGFBR2 and CD9 overexpressed during advanced bone marrow remodelling in primary myelofibrosis. Br J Haematol 146:510–520PubMedCrossRef Bock O, Muth M, Theophile K et al (2009) Identification of new target molecules PTK2, TGFBR2 and CD9 overexpressed during advanced bone marrow remodelling in primary myelofibrosis. Br J Haematol 146:510–520PubMedCrossRef
3.
Zurück zum Zitat Brousseau M, Parot-Schinkel E, Moles MP et al (2010) Practical application and clinical impact of the WHO histopathological criteria on bone marrow biopsy for the diagnosis of essential thrombocythemia versus prefibrotic primary myelofibrosis. Histopathology 56:758–767PubMedCrossRef Brousseau M, Parot-Schinkel E, Moles MP et al (2010) Practical application and clinical impact of the WHO histopathological criteria on bone marrow biopsy for the diagnosis of essential thrombocythemia versus prefibrotic primary myelofibrosis. Histopathology 56:758–767PubMedCrossRef
4.
Zurück zum Zitat Buhr T, Hebeda K, Kaloutsi V et al (2012) European Bone Marrow Working Group trial on reproducibility of WHO criteria to discriminate essential thrombocythemia from prefibrotic primary myelofibrosis. Haematologica 97:360–365PubMedCrossRef Buhr T, Hebeda K, Kaloutsi V et al (2012) European Bone Marrow Working Group trial on reproducibility of WHO criteria to discriminate essential thrombocythemia from prefibrotic primary myelofibrosis. Haematologica 97:360–365PubMedCrossRef
5.
Zurück zum Zitat Burkhardt R, Bartl R, Jäger K et al (1986) Working classification of chronic myeloproliferative disorders based on histological, haematological, and clinical findings. J Clin Pathol 39:237–252PubMedCrossRef Burkhardt R, Bartl R, Jäger K et al (1986) Working classification of chronic myeloproliferative disorders based on histological, haematological, and clinical findings. J Clin Pathol 39:237–252PubMedCrossRef
6.
Zurück zum Zitat Bellanné-Chantelot C, Chaumarel I, Labopin M et al (2006) Genetic and clinical implications of the Val617Phe JAK2 mutation in 72 families with myeloproliferative disorders. Blood 1081:346–352CrossRef Bellanné-Chantelot C, Chaumarel I, Labopin M et al (2006) Genetic and clinical implications of the Val617Phe JAK2 mutation in 72 families with myeloproliferative disorders. Blood 1081:346–352CrossRef
7.
8.
Zurück zum Zitat Cervantes F, Dupriez B, Pereira A et al (2009) New prognostic scoring system for primary myelofibrosis based on a study of the International Working Group for Myelofibrosis Research and Treatment. Blood 113:2895–2901PubMedCrossRef Cervantes F, Dupriez B, Pereira A et al (2009) New prognostic scoring system for primary myelofibrosis based on a study of the International Working Group for Myelofibrosis Research and Treatment. Blood 113:2895–2901PubMedCrossRef
9.
Zurück zum Zitat Cools J, DeAngelo DJ, Gotlib J et al (2003) A tyrosine kinase created by fusion of the PDGFRA and FIP1L1 genes as a therapeutic target of imatinib in idiopathic hypereosinophilic syndrome. N Engl J Med 348:1201–1214PubMedCrossRef Cools J, DeAngelo DJ, Gotlib J et al (2003) A tyrosine kinase created by fusion of the PDGFRA and FIP1L1 genes as a therapeutic target of imatinib in idiopathic hypereosinophilic syndrome. N Engl J Med 348:1201–1214PubMedCrossRef
10.
Zurück zum Zitat Dameshek W (1951) Some speculations on the myeloproliferative syndromes. Blood 6:372–375PubMed Dameshek W (1951) Some speculations on the myeloproliferative syndromes. Blood 6:372–375PubMed
11.
Zurück zum Zitat Delhommeau F, Dupont S, Della Valle V et al (2009) Mutation in TET2 in myeloid cancers. N Engl J Med 360:2289–2301PubMedCrossRef Delhommeau F, Dupont S, Della Valle V et al (2009) Mutation in TET2 in myeloid cancers. N Engl J Med 360:2289–2301PubMedCrossRef
12.
Zurück zum Zitat Dupriez B, Morel P, Demory JL et al (1996) Prognostic factors in agnogenic myeloid metaplasia: a report on 195 cases with a new scoring system. Blood 88:1013–1018PubMed Dupriez B, Morel P, Demory JL et al (1996) Prognostic factors in agnogenic myeloid metaplasia: a report on 195 cases with a new scoring system. Blood 88:1013–1018PubMed
13.
Zurück zum Zitat Elliott MA, Verstovsek S, Dingli D et al (2007) Monocytosis is an adverse prognostic factor for survival in younger patients with primary myelofibrosis. Leuk Res 31:1503–1509PubMedCrossRef Elliott MA, Verstovsek S, Dingli D et al (2007) Monocytosis is an adverse prognostic factor for survival in younger patients with primary myelofibrosis. Leuk Res 31:1503–1509PubMedCrossRef
14.
Zurück zum Zitat Ernst T, Hochhaus A (2012) Chronic myeloid leukemia: clinical impact of BCR-ABL1 mutations and other lesions associated with disease progression. Semin Oncol 39:58–66PubMedCrossRef Ernst T, Hochhaus A (2012) Chronic myeloid leukemia: clinical impact of BCR-ABL1 mutations and other lesions associated with disease progression. Semin Oncol 39:58–66PubMedCrossRef
15.
Zurück zum Zitat Foa P, Iurlo A, Saglio G et al (1991) Chronic neutrophilic leukaemia associated with polycythemia vera: pathogenetic implications and therapeutic approach. Br J Haematol 78:286–288PubMedCrossRef Foa P, Iurlo A, Saglio G et al (1991) Chronic neutrophilic leukaemia associated with polycythemia vera: pathogenetic implications and therapeutic approach. Br J Haematol 78:286–288PubMedCrossRef
16.
Zurück zum Zitat Gangat N, Caramazza D, Vaidya R et al (2011) DIPSS plus: a refined Dynamic International Prognostic Scoring System for primary myelofibrosis that incorporates prognostic information from karyotype, platelet count, and transfusion status. J Clin Oncol 29:392–397PubMedCrossRef Gangat N, Caramazza D, Vaidya R et al (2011) DIPSS plus: a refined Dynamic International Prognostic Scoring System for primary myelofibrosis that incorporates prognostic information from karyotype, platelet count, and transfusion status. J Clin Oncol 29:392–397PubMedCrossRef
17.
Zurück zum Zitat Georgii A, Buhr T, Buesche G et al (1996) Classification and staging of Ph-negative myeloproliferative disorders by histopathology from bone marrow biopsies. Leuk Lymphoma 22(Suppl 1):15–29PubMedCrossRef Georgii A, Buhr T, Buesche G et al (1996) Classification and staging of Ph-negative myeloproliferative disorders by histopathology from bone marrow biopsies. Leuk Lymphoma 22(Suppl 1):15–29PubMedCrossRef
18.
Zurück zum Zitat Hagemeijer A, Plas DC van der, Soekarman D et al (1990) The Philadelphia translocation in CML and ALL: recent investigations, new detection methods. Nouv Rev Fr Hematol 32:83–86PubMed Hagemeijer A, Plas DC van der, Soekarman D et al (1990) The Philadelphia translocation in CML and ALL: recent investigations, new detection methods. Nouv Rev Fr Hematol 32:83–86PubMed
19.
Zurück zum Zitat Haq AU (1990) Transformation of polycythemia vera to Ph-positive chronic myelogenous leukemia. Am J Hematol 35:110–113PubMedCrossRef Haq AU (1990) Transformation of polycythemia vera to Ph-positive chronic myelogenous leukemia. Am J Hematol 35:110–113PubMedCrossRef
20.
Zurück zum Zitat Harrison CN, Bareford D, Butt N et al (2010) Guideline for investigation and management of adults and children presenting with a thrombocytosis. Br J Haematol 149:352–375PubMedCrossRef Harrison CN, Bareford D, Butt N et al (2010) Guideline for investigation and management of adults and children presenting with a thrombocytosis. Br J Haematol 149:352–375PubMedCrossRef
21.
Zurück zum Zitat Harrison CN, Campbell PJ, Buck G et al (2005) Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med 353:33–45PubMedCrossRef Harrison CN, Campbell PJ, Buck G et al (2005) Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med 353:33–45PubMedCrossRef
22.
Zurück zum Zitat Higuchi T, Oba R, Endo M et al (1999) Transition of polycythemia vera to chronic neutrophilic leukemia. Leuk Lymphoma 33:203–206PubMed Higuchi T, Oba R, Endo M et al (1999) Transition of polycythemia vera to chronic neutrophilic leukemia. Leuk Lymphoma 33:203–206PubMed
23.
Zurück zum Zitat Hoppin EC, Lewis JP (1975) Polycythemia rubra vera progressing to Ph-positive chronic myelogenous leukemia. Ann Intern Med 83:820–823PubMed Hoppin EC, Lewis JP (1975) Polycythemia rubra vera progressing to Ph-positive chronic myelogenous leukemia. Ann Intern Med 83:820–823PubMed
24.
Zurück zum Zitat Hussein K, Bock O, Ballmaier M et al (2007) Familial polycythemia vera with non-germline JAK2(V617 F) mutation sparing the abnormal and clonal granulopoiesis. Leukemia 21:2566–2568PubMedCrossRef Hussein K, Bock O, Ballmaier M et al (2007) Familial polycythemia vera with non-germline JAK2(V617 F) mutation sparing the abnormal and clonal granulopoiesis. Leukemia 21:2566–2568PubMedCrossRef
25.
Zurück zum Zitat Hussein K, Bock O, Seegers A et al (2007) Myelofibrosis evolving during imatinib treatment of a chronic myeloproliferative disease with coexisting BCR-ABL translocation and JAK2V617F mutation. Blood 109:4106–4107PubMedCrossRef Hussein K, Bock O, Seegers A et al (2007) Myelofibrosis evolving during imatinib treatment of a chronic myeloproliferative disease with coexisting BCR-ABL translocation and JAK2V617F mutation. Blood 109:4106–4107PubMedCrossRef
26.
Zurück zum Zitat Hussein K, Bock O, Theophile K et al (2008) Chronic myeloproliferative diseases with concurrent BCR-ABL junction and JAK2V617F mutation. Leukemia 22:1059–1062PubMedCrossRef Hussein K, Bock O, Theophile K et al (2008) Chronic myeloproliferative diseases with concurrent BCR-ABL junction and JAK2V617F mutation. Leukemia 22:1059–1062PubMedCrossRef
27.
Zurück zum Zitat Hussein K, Bock O, Theophile K et al (2009) JAK2(V617F) allele burden discriminates essential thrombocythemia from a subset of prefibrotic-stage primary myelofibrosis. Exp Hematol 37:1186–1193PubMedCrossRef Hussein K, Bock O, Theophile K et al (2009) JAK2(V617F) allele burden discriminates essential thrombocythemia from a subset of prefibrotic-stage primary myelofibrosis. Exp Hematol 37:1186–1193PubMedCrossRef
28.
Zurück zum Zitat Hussein K, Theophile K, Buhr T et al (2009) Different lineage involvement in myelodysplastic/myeloproliferative disease with combined MPLW515L and JAK2V617F mutation. Br J Haematol 145:673–675PubMedCrossRef Hussein K, Theophile K, Buhr T et al (2009) Different lineage involvement in myelodysplastic/myeloproliferative disease with combined MPLW515L and JAK2V617F mutation. Br J Haematol 145:673–675PubMedCrossRef
29.
Zurück zum Zitat Iurlo A, Foa P, Maiolo AT et al (1990) Polycythemia vera terminating in chronic neutrophilic leukemia: report of a case. Am J Hematol 35:139–140PubMedCrossRef Iurlo A, Foa P, Maiolo AT et al (1990) Polycythemia vera terminating in chronic neutrophilic leukemia: report of a case. Am J Hematol 35:139–140PubMedCrossRef
30.
Zurück zum Zitat James C, Ugo V, Le Couédic JP et al (2005) A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Nature 434:1144–1148PubMedCrossRef James C, Ugo V, Le Couédic JP et al (2005) A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Nature 434:1144–1148PubMedCrossRef
31.
Zurück zum Zitat Jantunen E, Nousiainen T (1991) Ph-positive chronic myelogenous leukemia evolving after polycythemia vera. Am J Hematol 37:212PubMedCrossRef Jantunen E, Nousiainen T (1991) Ph-positive chronic myelogenous leukemia evolving after polycythemia vera. Am J Hematol 37:212PubMedCrossRef
32.
Zurück zum Zitat Kreipe H, Hussein K, Göhring G, Schlegelberger B (2011) Progression of myeloproliferative neoplasms to myelofibrosis and acute leukaemia. J Hematopathol 4:61–68CrossRef Kreipe H, Hussein K, Göhring G, Schlegelberger B (2011) Progression of myeloproliferative neoplasms to myelofibrosis and acute leukaemia. J Hematopathol 4:61–68CrossRef
33.
Zurück zum Zitat Kreipe H, Jaquet K, Felgner J et al (1991) Clonal granulocytes and bone marrow cells in the cellular phase of agnogenic myeloid metaplasia. Blood 78:1814–1817PubMed Kreipe H, Jaquet K, Felgner J et al (1991) Clonal granulocytes and bone marrow cells in the cellular phase of agnogenic myeloid metaplasia. Blood 78:1814–1817PubMed
34.
Zurück zum Zitat Kreipe HH, Beham-Schmid C, Dirnhofer S et al (2011) Essential thrombocythemia versus early primary myelofibrosis: a multicenter study to validate the WHO classification. [e-Letter], Blood http://bloodjournal.hematologylibrary.org/content/117/21/5710.long/reply#bloodjournal_el_3427). Zugegriffen: 23. Dez. 2011 Kreipe HH, Beham-Schmid C, Dirnhofer S et al (2011) Essential thrombocythemia versus early primary myelofibrosis: a multicenter study to validate the WHO classification. [e-Letter], Blood http://​bloodjournal.​hematologylibrar​y.​org/​content/​117/​21/​5710.​long/​reply#bloodjournal_el_3427). Zugegriffen: 23. Dez. 2011
35.
Zurück zum Zitat Lugassy G, Farhi R(1989) Chronic neutrophilic leukemia associated with polycythemia vera. Am J Hematol 31:300–301PubMedCrossRef Lugassy G, Farhi R(1989) Chronic neutrophilic leukemia associated with polycythemia vera. Am J Hematol 31:300–301PubMedCrossRef
36.
Zurück zum Zitat Mirza I, Frantz C, Clarke G et al (2007) Transformation of polycythemia vera to chronic myelogenous leukemia. Arch Pathol Lab Med 131:1719–1724PubMed Mirza I, Frantz C, Clarke G et al (2007) Transformation of polycythemia vera to chronic myelogenous leukemia. Arch Pathol Lab Med 131:1719–1724PubMed
37.
Zurück zum Zitat Muth M, Engelhardt BM, Kröger N et al (2011) Thrombospondin-1 (TSP-1) in primary myelofibrosis (PMF)—a megakaryocyte-derived biomarker which largely discriminates PMF from essential thrombocythemia. Ann Hematol 90:33–40PubMedCrossRef Muth M, Engelhardt BM, Kröger N et al (2011) Thrombospondin-1 (TSP-1) in primary myelofibrosis (PMF)—a megakaryocyte-derived biomarker which largely discriminates PMF from essential thrombocythemia. Ann Hematol 90:33–40PubMedCrossRef
38.
Zurück zum Zitat Pardanani A, Lasho TL, Finke CM et al (2010) IDH1 and IDH2 mutation analysis in chronic- and blast-phase myeloproliferative neoplasms. Leukemia 24:1146–1151PubMedCrossRef Pardanani A, Lasho TL, Finke CM et al (2010) IDH1 and IDH2 mutation analysis in chronic- and blast-phase myeloproliferative neoplasms. Leukemia 24:1146–1151PubMedCrossRef
39.
Zurück zum Zitat Pardanani A, Lasho TL, Finke CM, Tefferi A (2011) Infrequent occurrence of MPL exon 10 mutations in polycythemia vera and post-polycythemia vera myelofibrosis. Am J Hematol 86:701–702PubMedCrossRef Pardanani A, Lasho TL, Finke CM, Tefferi A (2011) Infrequent occurrence of MPL exon 10 mutations in polycythemia vera and post-polycythemia vera myelofibrosis. Am J Hematol 86:701–702PubMedCrossRef
40.
Zurück zum Zitat Pietra D, Li S, Brisci A et al (2008) Somatic mutations of JAK2 exon 12 in patients with JAK2 (V617 F)-negative myeloproliferative disorders. Blood 111:1686–1689PubMedCrossRef Pietra D, Li S, Brisci A et al (2008) Somatic mutations of JAK2 exon 12 in patients with JAK2 (V617 F)-negative myeloproliferative disorders. Blood 111:1686–1689PubMedCrossRef
41.
Zurück zum Zitat Primo D, Sanchez ML, Espinosa AB et al (2006) Lineage involvement in chronic myeloid leukaemia: comparison between MBCR/ABL and mBCR/ABL cases. Br J Haematol 132:736–739PubMedCrossRef Primo D, Sanchez ML, Espinosa AB et al (2006) Lineage involvement in chronic myeloid leukaemia: comparison between MBCR/ABL and mBCR/ABL cases. Br J Haematol 132:736–739PubMedCrossRef
43.
Zurück zum Zitat Spivak JL, Silver RT (2008) The revised World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia and primary myelofibrosis: an alternative proposal. Blood 112:231–239PubMedCrossRef Spivak JL, Silver RT (2008) The revised World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia and primary myelofibrosis: an alternative proposal. Blood 112:231–239PubMedCrossRef
44.
Zurück zum Zitat Swerdlow SH, Campo E, Harris NL et al (2008) WHO classification of tumours of haemtopoietic and lymphoid tissues. Lyon, IARC, Lyon Swerdlow SH, Campo E, Harris NL et al (2008) WHO classification of tumours of haemtopoietic and lymphoid tissues. Lyon, IARC, Lyon
45.
Zurück zum Zitat Tan PT, Wei AH (2011) The epigenomics revolution in myelodysplasia: a clinico-pathological perspective. Pathology 43:536–546PubMedCrossRef Tan PT, Wei AH (2011) The epigenomics revolution in myelodysplasia: a clinico-pathological perspective. Pathology 43:536–546PubMedCrossRef
46.
Zurück zum Zitat Tefferi A, Vainchenker W (2011) Myeloproliferative neoplasms: molecular pathophysiology, essential clinical understanding, and treatment strategies. J Clin Oncol 29:573–582PubMedCrossRef Tefferi A, Vainchenker W (2011) Myeloproliferative neoplasms: molecular pathophysiology, essential clinical understanding, and treatment strategies. J Clin Oncol 29:573–582PubMedCrossRef
47.
Zurück zum Zitat Theocharides A, Boissinot M, Girodon F et al (2007) Leukemic blasts in transformed JAK2-V617F-positive myeloproliferative disorders are frequently negative for the JAK2-V617F mutation. Blood 110:375–379PubMedCrossRef Theocharides A, Boissinot M, Girodon F et al (2007) Leukemic blasts in transformed JAK2-V617F-positive myeloproliferative disorders are frequently negative for the JAK2-V617F mutation. Blood 110:375–379PubMedCrossRef
48.
Zurück zum Zitat Thiele J, Kvasnicka HM, Facchetti F et al (2005) European consensus on grading bone marrow fibrosis and assessment of cellularity. Haematologica 90:1128–1132PubMed Thiele J, Kvasnicka HM, Facchetti F et al (2005) European consensus on grading bone marrow fibrosis and assessment of cellularity. Haematologica 90:1128–1132PubMed
49.
Zurück zum Zitat Thiele J, Kvasnicka HM, Müllauer L et al (2011) Essential thromobcythemia versus early primary myelofibrosis—a multicenter study to validate WHO classification. Blood 117:5710–5718PubMedCrossRef Thiele J, Kvasnicka HM, Müllauer L et al (2011) Essential thromobcythemia versus early primary myelofibrosis—a multicenter study to validate WHO classification. Blood 117:5710–5718PubMedCrossRef
50.
Zurück zum Zitat Thoennissen NH, Krug UO, Lee DH et al (2010) Prevalence and prognostic impact of allelic imbalances associated with leukemic transformation of Philadelphia chromosome-negative myeloproliferative neoplasms. Blood 115:2882–2890PubMedCrossRef Thoennissen NH, Krug UO, Lee DH et al (2010) Prevalence and prognostic impact of allelic imbalances associated with leukemic transformation of Philadelphia chromosome-negative myeloproliferative neoplasms. Blood 115:2882–2890PubMedCrossRef
51.
Zurück zum Zitat Verstovsek S, Kantarjian HM, Estrov Z et al (2012) Long term outcomes of 107 patients with myelofibrosis receiving JAK1/JAK2 inhibitor ruxolitinib: survival advantage in comparison to matched historical controls. Blood Verstovsek S, Kantarjian HM, Estrov Z et al (2012) Long term outcomes of 107 patients with myelofibrosis receiving JAK1/JAK2 inhibitor ruxolitinib: survival advantage in comparison to matched historical controls. Blood
52.
Zurück zum Zitat Wilkins BS, Erber WN, Bareford D et al (2008) Bone marrow pathology in essential thrombocythemia: interobserver reliability and utility for identifying disease subtypes. Blood 111:60–70PubMedCrossRef Wilkins BS, Erber WN, Bareford D et al (2008) Bone marrow pathology in essential thrombocythemia: interobserver reliability and utility for identifying disease subtypes. Blood 111:60–70PubMedCrossRef
Metadaten
Titel
Myeloproliferative Neoplasien
Histopathologische und molekularpathologische Diagnostik
verfasst von
K. Hussein
G. Büsche
J. Schlue
U. Lehmann
Prof. Dr. H. Kreipe
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Die Pathologie / Ausgabe 6/2012
Print ISSN: 2731-7188
Elektronische ISSN: 2731-7196
DOI
https://doi.org/10.1007/s00292-012-1651-3

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