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Martínez-Banaclocha N, Martínez-Madueño F, Caballé B, Badia J, Blanes M, Bujanda DA, Calvo V, Gómez Codina J, Blanco CQ, Espinosa P, Lavernia J, Arroyo FRG, Risueño MG, Llorca C, Cumeras R, Pulla MP, Gumà J. A Descriptive Study of 103 Primary Cutaneous B-Cell Lymphomas: Clinical and Pathological Characteristics and Treatment from the Spanish Lymphoma Oncology Group (GOTEL). Cancers (Basel) 2024; 16:1034. [PMID: 38473391 DOI: 10.3390/cancers16051034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Primary cutaneous B-cell lymphomas (PCBCLs) are B-cell lymphomas that can occur in the skin without evidence of extracutaneous involvement. The 2005 WHO/EORTC classification of cutaneous lymphomas and its 2018 update have distinguished three main categories based on clinicopathological, immunohistochemical, and genetic characteristics: primary cutaneous marginal zone lymphoma (PCMZL), primary cutaneous follicle centre lymphoma (PCFCL), and primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT). PCMZL and PCFCL are clinically indolent, while PCDLBCL-LT is an aggressive lymphoma. Due to its low incidence and lack of prospective studies, it is difficult to establish a standard treatment for each subgroup. The objective of our study was to describe the clinical and pathological characteristics of 103 patients with cutaneous B-cell lymphoma from 12 centres belonging to the Spanish Lymphoma Oncology Group. The median age was 53 years (40-65). According to skin extension, 62% had single-site lymphoma, 17% had regional lymphoma, and 20% had multifocal lymphoma. Histology: 66% had PCMZL, 26% had PCFCL, and 8% had PCDLBCL-LT. Twenty-three percent of the patients were treated exclusively with surgery, 26% with radiotherapy only, 21% with surgery plus radiotherapy, 10% with polychemotherapy, and 5% with rituximab monotherapy. Overall, 96% of patients achieved a complete response, and 44% subsequently relapsed, most of them relapsing either locally or regionally. The 10-year OS was 94.5% for the entire cohort, 98% for the PCMZL cohort, 95% for the PCFCL cohort, and 85.7% for the PCDLBCL-LT cohort. Our data are comparable to those of other published series, except for the high frequency of PCMZL. The expected heterogeneity in therapeutic management has been observed.
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Affiliation(s)
- Natividad Martínez-Banaclocha
- Medical Oncology Department, Hospital General Universitario Dr. Balmis, Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Francisca Martínez-Madueño
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Berta Caballé
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Joan Badia
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Mar Blanes
- Dermatology Department, Hospital General Universitario Dr. Balmis, Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - David Aguiar Bujanda
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrin, 35010 Las Palmas de Gran Canaria, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Madrid, Spain
| | - Jose Gómez Codina
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Cristina Quero Blanco
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Pablo Espinosa
- Dermatology Department, Hospital Infanta Cristina, 28981 Parla, Spain
| | - Javier Lavernia
- Medical Oncology Department, Fundación Instituto Valenciano de Oncología (I.V.O.), 46009 Valencia, Spain
| | | | - María Guirado Risueño
- Medical Oncology Department, Hospital General Universitario de Elche, 03203 Alicante, Spain
| | - Cristina Llorca
- Medical Oncology Department, Hospital General Universitario de Elda, 03600 Alicante, Spain
| | - Raquel Cumeras
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Mariano Provencio Pulla
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Madrid, Spain
| | - Josep Gumà
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
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Hu M, Scheffel J, Elieh-Ali-Komi D, Maurer M, Hawro T, Metz M. An update on mechanisms of pruritus and their potential treatment in primary cutaneous T-cell lymphoma. Clin Exp Med 2023; 23:4177-4197. [PMID: 37555911 PMCID: PMC10725374 DOI: 10.1007/s10238-023-01141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 08/10/2023]
Abstract
Primary cutaneous T-cell lymphomas (CTCL), which include mycosis fungoides (MF) and Sézary syndrome (SS), are a group of lymphoproliferative disorders characterized by clonal accumulation of neoplastic T-lymphocytes in the skin. Severe pruritus, one of the most common and distressing symptoms in primary CTCL, can significantly impair emotional well-being, physical functioning, and interpersonal relationships, thus greatly reducing quality of life. Unfortunately, effectively managing pruritus remains challenging in CTCL patients as the underlying mechanisms are, as of yet, not fully understood. Previous studies investigating the mechanisms of itch in CTCL have identified several mediators and their corresponding antagonists used for treatment. However, a comprehensive overview of the mediators and receptors contributing to pruritus in primary CTCL is lacking in the current literature. Here, we summarize and review the mediators and receptors that may contribute to pruritus in primary CTCL to explore the mechanisms of CTCL pruritus and identify effective therapeutic targets using the PubMed and Web of Science databases. Studies were included if they described itch mediators and receptors in MF and SS. Overall, the available data suggest that proteases (mainly tryptase), and neuropeptides (particularly Substance P) may be of greatest interest. At the receptor level, cytokine receptors, MRGPRs, and TRP channels are most likely important. Future drug development efforts should concentrate on targeting these mediators and receptors for the treatment of CTCL pruritus.
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Affiliation(s)
- Man Hu
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Jörg Scheffel
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Daniel Elieh-Ali-Komi
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Tomasz Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany.
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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D’Onghia M, Cartocci A, Calabrese L, Maio D, Sirchio A, Erasti M, Tognetti L, Rubegni P, Bocchia M, Cencini E, Fabbri A, Cinotti E. Characteristics of Primary Cutaneous Lymphoma in Italy: A Tertiary Care, Single-Center Study. Curr Oncol 2023; 30:9813-9823. [PMID: 37999132 PMCID: PMC10670225 DOI: 10.3390/curroncol30110712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
Data on primary cutaneous lymphomas (PCLs) patients in the Italian population are limited, and, despite the existence of several treatment options, the management of those patients remains challenging. Our study aimed to investigate the clinical and therapeutic features of PCL patients in a referral center in Italy. We conducted a retrospective study on 100 consecutive PCL patients between January 2017 and December 2022. The mean (SD) age of our cohort was 70.33 (14.14) years. Cutaneous T-cell lymphomas (CTCLs) represented 65% of all cases; the majority were mycosis fungoides (42%), followed by cases of Sezary syndrome (10%) and primary cutaneous anaplastic large cell lymphoma (4%). Cutaneous B-cell lymphomas (CBCLs) accounted for 35 % of PCLs, with 15 cases of primary cutaneous follicle center lymphoma, 10 cases of primary cutaneous diffuse large B-cell lymphoma leg type, and 9 cases of marginal zone B-cell lymphoma. A higher frequency of pruritus (p = 0.008) and higher peripheral blood levels of beta-2 microglobulin (p ≤ 0.001) and lactate dehydrogenase (p = 0.025) were found in CTCLs compared to those of CBCLs. Considering all therapeutic lines performed, treatments were extremely heterogeneous and skin-directed therapies represented the most frequently used approach. Our study confirms the distribution of PCL subtypes formerly reported in the literature and highlights the utility of real-life data in treatments to improve the current management of PCL patients.
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Affiliation(s)
- Martina D’Onghia
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Alessandra Cartocci
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Laura Calabrese
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Daniele Maio
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Azzurra Sirchio
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Maria Erasti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Linda Tognetti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Monica Bocchia
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Emanuele Cencini
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Alberto Fabbri
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
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McDonald EO, Amanullah AA, Park PSU, Song W, Werner TJ, Alavi A, Revheim ME. The role of 18F-FDG PET/CT in primary cutaneous lymphoma: an educational review. Ann Nucl Med 2023; 37:328-348. [PMID: 37095393 DOI: 10.1007/s12149-023-01830-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/05/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Primary cutaneous lymphoma (PCL) is a cutaneous non-Hodgkin's lymphoma that originates in the skin and lacks extracutaneous spread upon initial diagnosis. The clinical management of secondary cutaneous lymphomas is different from that of PCLs, and earlier detection is associated with better prognosis. Accurate staging is necessary to determine the extent of disease and to choose the appropriate treatment. The aim of this review is to investigate the current and potential roles of 18F- fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in the diagnosis, staging, and monitoring of PCLs. METHODS A focused review of the scientific literature was performed using inclusion criteria to filter results pertaining to human clinical studies performed between 2015 and 2021 that analyzed cutaneous PCL lesions on 18F PET/CT imaging. RESULTS & CONCLUSION A review of 9 clinical studies published after 2015 concluded that 18F-FDG PET/CT is highly sensitive and specific for aggressive PCLs and proved valuable for identifying extracutaneous disease. These studies found 18F-FDG PET/CT highly useful for guiding lymph node biopsy and that imaging results influenced therapeutic decision in many cases. These studies also predominantly concluded that 18F-FDG PET/CT is more sensitive than computed tomography (CT) alone for detection of subcutaneous PCL lesions. Routine revision of nonattenuation-corrected (NAC) PET images may improve the sensitivity of 18F-FDG PET/CT for detection of indolent cutaneous lesions and may expand the potential uses of 18F-FDG PET/CT in the clinic. Furthermore, calculating a global disease score from 18F-FDG PET/CT at every follow-up visit may simplify assessment of disease progression in the early clinical stages, as well as predict the prognosis of disease in patients with PCL.
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Affiliation(s)
| | - Amir A Amanullah
- Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Peter Sang Uk Park
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William Song
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway.
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Treatment of Indolent Cutaneous B-Cell Lymphoma with Intralesional or Intravenous Rituximab. Cancers (Basel) 2022; 14:cancers14194787. [PMID: 36230709 PMCID: PMC9564090 DOI: 10.3390/cancers14194787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cutaneous B-cell lymphomas (CBCL) are a heterogeneous group of mature B-cells neoplasms that present in the skin without evidence of nodal or systemic involvement. Despite being indolent in nature, they tend to recur in a third of patients after treatment. As repetitive treatments may be necessary for patients with CBCL, there is a need for gentle non-invasive therapy. Rituximab is a medication that targets CD20, a receptor regularly expressed on CBCL, and thereby destroys the cancerous cells. This medication can be given as an infusion into the vein or as an injection directly into the skin tumors. In this study, we found that rituximab injections have a similar efficacy compared to infusions for patients with limited CBCL lesions. Abstract Indolent cutaneous B-cell lymphomas (CBCL) are a rare disease for which the therapeutic recommendations are based on clinical reports. Recommendations for solitary lesions include surgery or irradiation. However, the high relapse rates may require less invasive repeatable therapy. This study seeks to retrospectively assess the efficacy of intralesional rituximab (ILR) for indolent CBCL when compared with intravenous rituximab (IVR). Patients treated for indolent CBCL with ILR or IVR at the Division of DermatoOncology of the University Hospital Heidelberg were eligible for this study. Characteristics of lymphoma, treatment response, and adverse events were assessed. Twenty-one patients, 67% male at a median age of 52 (range 17–80), were included. Nineteen (90%) had only localized lymphoma (stage T1 and T2). Complete response was achieved in 92% (11/12) of ILR after a median of one cycle (three injections) and 78% (7/8) of IVR patients after a median of six cycles. Half of ILR patients and 78% of IVR patients showed relapse after a median of 15 and 23 months, respectively. Adverse reactions were usually mild and were limited to the first injection of ILR. One patient with IVR contracted a pulmonary infection. ILR may be an alternative to the intravenous administration of rituximab for localized indolent CBCL.
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Krenitsky A, Klager S, Hatch L, Sarriera-Lazaro C, Chen PL, Seminario-Vidal L. Update in Diagnosis and Management of Primary Cutaneous B-Cell Lymphomas. Am J Clin Dermatol 2022; 23:689-706. [PMID: 35854102 DOI: 10.1007/s40257-022-00704-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 02/05/2023]
Abstract
Primary cutaneous lymphomas are a rare group of diseases, with an estimated incidence of 0.5-1 case per 100,000 people per year. Primary cutaneous B-cell lymphomas (pCBCLs) represent 25-30% of all primary cutaneous lymphomas. There are three main subtypes of pCBCL: primary cutaneous marginal zone lymphoma, primary cutaneous follicle center lymphoma, and primary cutaneous diffuse large B-cell lymphoma, leg type. Cutaneous B-cell lymphomas have a broad spectrum of clinical presentations, which makes diagnostic and therapeutic strategies challenging. To date, treatment recommendations for cutaneous B-cell lymphomas have been largely based on small retrospective studies and institutional experience. Recently, the pharmacotherapeutic landscape has expanded to include drugs that may modify the underlying disease pathology of pCBCLs, representing new therapeutic modalities for this rare group of diseases. Novel therapies used for other systemic B-cell lymphomas show promise for the treatment of pCBCLs and are being increasingly considered. These new therapies are divided into five main groups: monoclonal antibodies, immune checkpoint inhibitors, small-molecule inhibitors, bispecific T-cell engaging, and chimeric antigen receptor T cell. In this review, we discuss the clinical, histopathological, molecular, and cytogenetic features of the most common pCBCL subtypes with a focus on current and innovative therapeutic developments in their management. These emerging treatment strategies for B-cell lymphomas and cutaneous B-cell lymphomas may represent novel first-line options for the management of these rare diseases.
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Affiliation(s)
- Amanda Krenitsky
- Department of Dermatology and Cutaneous Surgery, University of South Florida, 13320 USF Laurel Drive, Tampa, FL, 33612, USA.
| | - Skylar Klager
- Department of Dermatology and Cutaneous Surgery, University of South Florida, 13320 USF Laurel Drive, Tampa, FL, 33612, USA
| | - Leigh Hatch
- Department of Dermatology and Cutaneous Surgery, University of South Florida, 13320 USF Laurel Drive, Tampa, FL, 33612, USA
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Pei Ling Chen
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
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Antognoni MT, Misia AL, Brachelente C, Mechelli L, Paolini A, Miglio A. Non Epitheliotropic B-Cell Lymphoma with Plasmablastic Differentiation vs. Cutaneous Plasmacytosis in a 12-Years-Old Beagle: Case Presentation and Clinical Review. Vet Sci 2021; 8:vetsci8120317. [PMID: 34941844 PMCID: PMC8707514 DOI: 10.3390/vetsci8120317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022] Open
Abstract
Cutaneous lymphoid neoplasms and cutaneous plasmacytosis are rare in the dog; in human and in veterinary medicine, these have many clinical, cytological, histological, and phenotypic similarities, and a diagnosis of certainty is not easy. The aim of this study is to describe a case of cutaneous non epitheliotropic B-cell lymphoma (CNEBL) with plasmablastic differentiation vs. multiple cutaneous plasmacytosis (CP) in a dog, since the scarce bibliographic data on these topics. A 12-year-old male Beagle dog was presented for multiple, nodular, cutaneous, and subcutaneous, indolent masses disseminated on the whole body. Cytological, histological, flow cytometric, and immunohistochemical examinations, as well as complete radiographic evaluation, echocardiography, and abdominal ultrasound were performed. Cytology, histopathology, flow cytometric, and immunohistochemical examination, performed on the skin lesions, revealed a B-cell phenotype with plasmablastic differentiation. Nevertheless, a final diagnosis could not be achieved and it was categorized as a case of borderline CNEBL with plasmablastic differentiation versus CP. The dog was treated with a COP chemotherapeutic protocol. Total remission was obtained and relapse occurred 120 days later. To our knowledge, specific markers are actually unavailable to certainly differentiate CNEBL and CP in the dog and future studies are needed to improve knowledge on these pathologies in veterinary medicine, since prognosis and therapy are different.
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Affiliation(s)
- Maria Teresa Antognoni
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06124 Perugia, Italy; (M.T.A.); (C.B.); (L.M.)
| | - Ambra Lisa Misia
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06124 Perugia, Italy; (M.T.A.); (C.B.); (L.M.)
- Correspondence: (A.L.M.); (A.M.)
| | - Chiara Brachelente
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06124 Perugia, Italy; (M.T.A.); (C.B.); (L.M.)
| | - Luca Mechelli
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06124 Perugia, Italy; (M.T.A.); (C.B.); (L.M.)
| | - Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, Via Renato Balzarini 1, 64100 Teramo, Italy;
| | - Arianna Miglio
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06124 Perugia, Italy; (M.T.A.); (C.B.); (L.M.)
- Correspondence: (A.L.M.); (A.M.)
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