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Reinert T, Ramalho S, de Vasconcelos VCA, Silva LR, da Silva AER, de Andrade CA, Kraft MBDPL, Coelho GP, Mandelli J, Binotto M, Cabello C, de Paiva Silva GR, Bines J, Barrios CH, Ellis MJ, Graudenz MS. ESR1 Mutations Are Not a Common Mechanism of Endocrine Resistance in Patients With Estrogen Receptor-Positive Breast Cancer Treated With Neoadjuvant Aromatase Inhibitor Therapy. Front Oncol 2020; 10:342. [PMID: 32309212 PMCID: PMC7145981 DOI: 10.3389/fonc.2020.00342] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/27/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: Mutations in the ESR1 gene (ESR1m) are important mechanisms of resistance to endocrine therapy in estrogen receptor–positive (ER+) metastatic breast cancer and have been studied as a potential therapeutic target, as well as a predictive and prognostic biomarker. Nonetheless, the role of ESR1m as a possible mechanism of primary endocrine resistance, as well as whether it also occurs in tumors that are resistant to ET administered in early-stage disease as (neo)adjuvant, has not been adequately studied. In this study, we evaluated the prevalence of ESR1m in tumor samples from patients with ER+ breast cancer resistant to neoadjuvant aromatase inhibitor therapy. Methods: We followed a prospective cohort of patients with ER+ HER2– stages II and III breast cancer treated with neoadjuvant endocrine therapy (NET). Tumor samples from patients with a pattern of primary endocrine resistance [defined as a Preoperative Endocrine Prognostic Index (PEPI) score of ≥4] were identified and analyzed for the presence of ESR1m. Results: One hundred twenty-seven patients were included in the cohort, of which 100 (79%) had completed NET and underwent surgery. Among these patients, the PEPI score ranged from 0 to 3 in 70% (70/100), whereas 30% (30/100) had a PEPI score of 4 or more. Twenty-three of these patients were included in the analysis. ESR1 mutations were not identified in any of the 23 patients with early-stage ER+ breast cancer resistant to NET. Discussion: Growing evidence supports the notion that there are different mechanisms for primary and secondary endocrine resistance. Our study suggests that ESR1 mutations do not evolve rapidly and do not represent a common mechanism of primary endocrine resistance in the neoadjuvant setting. Therefore, ESR1m should be considered a mechanism of acquired endocrine resistance in the context of advanced disease. Further research should be conducted to identify factors associated with intrinsic resistance to ET.
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Affiliation(s)
- Tomás Reinert
- Postgraduate Program in Medical Sciences, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Centro de Pesquisa da Serra Gaucha (CEPESG), Caxias Do Sul, Brazil.,Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Susana Ramalho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Leonardo Roberto Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana Elisa Ribeiro da Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Camila Annicchino de Andrade
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Jovana Mandelli
- Diagnose Patologia e Biologia Molecular, Caxias Do Sul, Brazil
| | - Monique Binotto
- Centro de Pesquisa da Serra Gaucha (CEPESG), Caxias Do Sul, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Geisilene Russano de Paiva Silva
- Laboratory of Molecular and Investigative Pathology - LAPE, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - José Bines
- Instituto Nacional Do Câncer (INCA - HCIII), Rio de Janeiro, Brazil
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Matthew J Ellis
- Lester and Sue Smith Breast Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Marcia Silveira Graudenz
- Postgraduate Program in Medical Sciences, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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Duarte GM, Almeida NR, Tocchet F, Espinola J, Barreto CTDR, Pinto GA, Soares FA, Marshall P, Russano de Paiva Silva G. Claudin-4 Expression Is Associated With Disease-Free Survival in Breast Carcinoma-in-Situ: Mean Follow-up of 8.2 Years. Clin Breast Cancer 2018; 18:e1111-e1116. [PMID: 30025999 DOI: 10.1016/j.clbc.2018.06.005] [Citation(s) in RCA: 6] [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] [Received: 02/25/2018] [Revised: 05/07/2018] [Accepted: 06/11/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Claudins are tight junctions associated with breast cancer prognosis. The claudin-low intrinsic subtype of invasive carcinoma is associated with high-grade carcinoma, low junction molecule expression, and worse response to chemotherapy. However, it is not known whether the expression of claudins may provide clues as to carcinoma-in-situ (CIS) prognosis. The aim of this study was evaluate claudin-4 expression in CIS and its association with disease-free survival and histologic type of local recurrence (in situ or invasive). METHODS A tissue microarray block, constructed from 137 pure CIS paraffin blocks, was submitted to immunohistochemical staining for claudin-4, β-catenin, E-cadherin, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67. A claudin-4 score categorized samples as claudin-4-low or -high. Clinical and treatment data were obtained from medical records. RESULTS Claudin-4 expression was evaluated in 86 samples; 88.4% were high and 11.6% low. Mean follow-up was 98.4 months, and the local recurrence rate was 10.4%. There was a significant difference in disease-free survival between claudin-4-high and -low (4.9 and 1.9 years, respectively, P = .02); however, there was no difference between them in histologic type of recurrence (invasive or in situ) (P = .44). CONCLUSION In our samples, high claudin-4 expression in CIS was more frequent than low expression. Claudin-4-low expression had a worse prognosis in CIS (inferior disease-free survival), but it was similar to high claudin-4 in histologic type of local recurrence.
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Affiliation(s)
- Giuliano M Duarte
- Woman's Hospital Prof Dr José Aristodemo Pinotti, CAISM, UNICAMP (State University of Campinas), Campinas, Brazil.
| | - Natalie Rios Almeida
- Woman's Hospital Prof Dr José Aristodemo Pinotti, CAISM, UNICAMP (State University of Campinas), Campinas, Brazil
| | - Fernando Tocchet
- Woman's Hospital Prof Dr José Aristodemo Pinotti, CAISM, UNICAMP (State University of Campinas), Campinas, Brazil
| | - Juliana Espinola
- Woman's Hospital Prof Dr José Aristodemo Pinotti, CAISM, UNICAMP (State University of Campinas), Campinas, Brazil
| | | | - Glauce Aparecida Pinto
- Woman's Hospital Prof Dr José Aristodemo Pinotti, CAISM, UNICAMP (State University of Campinas), Campinas, Brazil
| | | | - Priscila Marshall
- Woman's Hospital Prof Dr José Aristodemo Pinotti, CAISM, UNICAMP (State University of Campinas), Campinas, Brazil
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Russano de Paiva Silva G, Tournier E, Sarian LO, Bulai-Livideanu C, Delsol G, Lamant L, Vassallo J, Brousset P, Laurent C. Prevalence of CD30 immunostaining in neoplastic mast cells: A retrospective immunohistochemical study. Medicine (Baltimore) 2018; 97:e10642. [PMID: 29794740 PMCID: PMC6392733 DOI: 10.1097/md.0000000000010642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 01/04/2023] Open
Abstract
Mastocytosis is a rare disease characterized by clonal neoplastic proliferation of mast cells (MCs). It ranges from skin lesions as cutaneous mastocytosis (CM) which may spontaneously regress to highly aggressive neoplasms with multiorgan involvement corresponding to some aggressive systemic mastocytosis (ASM), mast cell leukemia (MCL), and/or mast cell sarcoma (MCS).There is increasing evidence of CD30 expression in neoplastic MCs of the bone marrow. This expression has been described almost exclusively in aggressive forms of systemic mastocytosis (SM).The aim of the present study is to evaluate CD30 expression both in cutaneous and systemic forms of mastocytosis. Forty-two mastocytosis cases were reviewed, including cutaneous (n = 29) and systemic (n = 13) forms to assess the prevalence of CD30 expression. Thirty-nine out of 42 (92.8%) cases were CD30 positive. In cases of CM, 28/29 (96.5%) cases were CD30 positive, 11/13 cases of SM (84.6%) were positive for CD30. MCs in normal skin biopsies and in urticaria lesions were CD30-negative. This study found that CD30 is also frequently expressed in CM as well as in systemic forms. This finding is a major departure from the prevailing concept that CD30 expression is often related to aggressive systemic forms of mastocytosis.
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Affiliation(s)
- Geisilene Russano de Paiva Silva
- UMR U.1037, Centre de recherche sur cancer de Toulouse, Université Paul-Sabatier
- Laboratory of Molecular and Investigative Pathology—LAPE, Faculty of Medical Sciences, State University of Campinas Medical School, Campinas, Brazil
| | - Emilie Tournier
- UMR U.1037, Centre de recherche sur cancer de Toulouse, Université Paul-Sabatier
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole
| | - Luis Otávio Sarian
- Laboratory of Molecular and Investigative Pathology—LAPE, Faculty of Medical Sciences, State University of Campinas Medical School, Campinas, Brazil
| | - Cristina Bulai-Livideanu
- Department of Dermatology, Paul Sabatier University, Mastocytosis National Reference Center (CEREMAST), Toulouse University and CHU, Toulouse, France
| | - Georges Delsol
- UMR U.1037, Centre de recherche sur cancer de Toulouse, Université Paul-Sabatier
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole
| | - Laurence Lamant
- UMR U.1037, Centre de recherche sur cancer de Toulouse, Université Paul-Sabatier
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole
| | - José Vassallo
- Laboratory of Molecular and Investigative Pathology—LAPE, Faculty of Medical Sciences, State University of Campinas Medical School, Campinas, Brazil
| | - Pierre Brousset
- UMR U.1037, Centre de recherche sur cancer de Toulouse, Université Paul-Sabatier
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole
- Laboratoire d’excellence Labex TOUCAN, Toulouse, France
| | - Camille Laurent
- UMR U.1037, Centre de recherche sur cancer de Toulouse, Université Paul-Sabatier
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole
- Laboratoire d’excellence Labex TOUCAN, Toulouse, France
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Serra KP, Ramalho S, Torresan R, Vassallo J, Sarian LOZ, Silva GRDP, Derchain S. [The new classification of breast cancers: finding the luminal A]. Rev Bras Ginecol Obstet 2016; 36:575-80. [PMID: 25466817 DOI: 10.1590/so100-720320140005158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/03/2014] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To compare the distributions of patients with clinical-pathological subtypes of luminal B-like breast cancer according to the 2011 and 2013 St. Gallen International Breast Cancer Conference Expert Panel. METHODS We studied 142 women with breast cancer who were positive to estrogen receptor and had been treated in São Paulo state, southeast Brazil. The expression of the following receptors was assessed by immunohistochemistry: estrogen, progesterone (PR) and Ki-67. The expression of HER-2 was measured by fluorescent in situ hybridization analysis in tissue microarray. RESULTS There were 29 cases of luminal A breast cancers according to the 2011 St. Gallen International Breast Cancer Conference Expert Panel that were classified as luminal B-like in the 2013 version. Among the 65 luminal B-like breast cancer cases, 29 (45%) were previous luminal A tumors, 15 cases (20%) had a Ki-67 >14% and were at least 20% PR positive and 21 cases (35%) had Ki-67 >14% and more than 20% were PR positive. CONCLUSIONS The 2013 St. Gallen consensus updated the definition of intrinsic molecular subtypes and increased the number of patients classified as having luminal B-like breast cancer in our series, for whom the use of cytotoxic drugs will probably be proposed with additional treatment cost.
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Affiliation(s)
- Katia Piton Serra
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Susana Ramalho
- Departmento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Renato Torresan
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Jose Vassallo
- Departmento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Luis Otávio Zanatta Sarian
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Geisilene Russano de Paiva Silva
- Departmento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Sophie Derchain
- Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
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Serra KP, Peres RMR, Sarian LO, Vassallo J, Pinto GA, Silva GRDP, Soares FA, da Cunha IW, Espinola J, Bento AM, Del Corso LM, Derchain S. Cyclooxygenase-2 (COX2) and p53 protein expression are interdependent in breast cancer but not associated with clinico-pathological surrogate subtypes, tumor aggressiveness and patient survival. Acta Histochem 2016; 118:176-82. [PMID: 26791786 DOI: 10.1016/j.acthis.2015.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/06/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED In the last decade, different molecular subtypes of breast cancer have been proposed. Although displaying appreciable association with disease prognosis and the prognostic value of cytotoxic and endocrine therapeutic modalities, the subtypes seem to fail at completely explaining disease behavior and response to treatment. Molecules such as those of the cyclocooxigenase (COX) family, currently composed of three entities (COX 1, 2 and 3) have been shown to be associated with breast carcinogenesis, and the analysis of p53 expression in breast tumors may also offer some additional prognostic clues. Our study is aimed at assessing COX2 and p53 expression in these clinico-pathological surrogate subtypes, and to evaluate whether the expression of these molecules can help further explain the variability in prognosis still found within the clinico-pathological subtypes groups of breast cancer. METHODS A total of 183 breast cancer samples were obtained from women treated at the Womeńs Hospital of Campinas State University, Campinas, Brazil, between June 2008 and January 2011. Immunohistochemistry was performed to detect the expression of ER, PR, ki67, COX2, and p53 and the HER2 status of the 183 specimens was assessed using FISH. Two COX2 staining thresholds were used to define COX2 positivity: low threshold (LT): moderate and intense staining were considered positive; high-threshold (HT): only intense staining was considered positive. RESULTS There was no trend in COX2 overexpression from Luminal A-like to Triple-negative subtypes. By contrast, p53 was expressed in roughly 67% of the Luminal A-like tumors, 50% of the Luminal B-like HER2 positive tumors, 60.9% of the Luminal B-like HER2 negative, approximately 82% of the HER2 positive (non-luminal) and 87% of the Triple-negative tumors (p for trends=0.06). There was a significantly higher proportion of COX2 positive (LT) tumors (66.9%) when p53 was also positive compared to when the tumor was negative for p53 (in which case only18.0% of the tumors were positive for COX2; p<0.001). Neither marker was found to be associated with patients' survival. CONCLUSIONS There seems to be a positive association between the expressions of COX2 and p53. Otherwise, neither the expression of COX nor that of p53 was associated with clinico-pathological subtypes, tumor features and prognosis. It seems to be too early to elect the detection of COX2 using IHC as prognostic or predictive tool, but incipient evidence points toward a possible role for the marker.
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Affiliation(s)
- Katia Piton Serra
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences PO Box 6111, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
| | - Raquel Mary Rodrigues Peres
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences PO Box 6111, State University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Luis Otávio Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences PO Box 6111, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
| | - José Vassallo
- Department of Pathology, Street Tessalia Vieira de Camargo, 126, State University of Campinas-UNICAMP, Postal Code 13083-887, Campinas, São Paulo, Brazil; Department of Pathology, A.C. Camargo Cancer Hospital, Antônio Prudente Foundation, Street Professor Antônio Prudente,109, Liberdade, 01509-900 São Paulo, São Paulo, Brazil.
| | - Glauce Aparecida Pinto
- Department of Pathology, Street Tessalia Vieira de Camargo, 126, State University of Campinas-UNICAMP, Postal Code 13083-887, Campinas, São Paulo, Brazil.
| | - Geisilene Russano de Paiva Silva
- Department of Pathology, Street Tessalia Vieira de Camargo, 126, State University of Campinas-UNICAMP, Postal Code 13083-887, Campinas, São Paulo, Brazil.
| | - Fernando Augusto Soares
- Department of Pathology, A.C. Camargo Cancer Hospital, Antônio Prudente Foundation, Street Professor Antônio Prudente,109, Liberdade, 01509-900 São Paulo, São Paulo, Brazil.
| | - Isabela Werneck da Cunha
- Department of Pathology, A.C. Camargo Cancer Hospital, Antônio Prudente Foundation, Street Professor Antônio Prudente,109, Liberdade, 01509-900 São Paulo, São Paulo, Brazil.
| | - Juliana Espinola
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences PO Box 6111, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
| | - Adriano Mesquita Bento
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences PO Box 6111, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
| | - Leticia Marinho Del Corso
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences PO Box 6111, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences PO Box 6111, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
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de Toledo MCS, Sarian LO, Sallum LF, Andrade LLA, Vassallo J, de Paiva Silva GR, Pinto GA, Soares FA, Fonseca CDPP, Derchain SFM. Analysis of the contribution of immunologically-detectable HER2, steroid receptors and of the "triple-negative" tumor status to disease-free and overall survival of women with epithelial ovarian cancer. Acta Histochem 2014; 116:440-7. [PMID: 24238473 DOI: 10.1016/j.acthis.2013.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 03/14/2013] [Revised: 09/16/2013] [Accepted: 09/30/2013] [Indexed: 12/15/2022]
Abstract
We assessed associations between steroid receptors including: estrogen-alpha, estrogen-beta, androgen receptor, progesterone receptor, the HER2 status and triple-negative epithelial ovarian cancer (ERα-/PR-/HER2-; TNEOC) status and survival in women with epithelial ovarian cancer. The study included 152 women with primary epithelial ovarian cancer. The status of steroid receptor and HER2 was determined by immunohistochemistry. Disease-free and overall survival were calculated and compared with steroid receptor and HER2 status as well as clinicopathological features using the Cox Proportional Hazards model. A mean follow-up period of 43.6 months (interquartile range=41.4 months) was achieved where 44% of patients had serous tumor, followed by mucinous (23%), endometrioid (9%), mixed (9%), undifferentiated (8.5%) and clear cell tumors (5.3%). ER-alpha staining was associated with grade II-III tumors. Progesterone receptor staining was positively associated with a Body Mass Index≥25. Androgen receptor positivity was higher in serous tumors. In stand-alone analysis of receptor contribution to survival, estrogen-alpha positivity was associated with greater disease-free survival. However, there was no significant association between steroid receptor expression, HER2 status, or TNEOC status, and overall survival. Although estrogen-alpha, androgen receptor, progesterone receptor and the HER2 status were associated with key clinical features of the women and pathological characteristics of the tumors, these associations were not implicated in survival. Interestingly, women with TNEOC seem to fare the same way as their counterparts with non-TNEOC.
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Affiliation(s)
- Maria Carolina Szymanski de Toledo
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil
| | - Luis Otavio Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil.
| | - Luis Felipe Sallum
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil
| | - Liliana Lucci Angelo Andrade
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil
| | - José Vassallo
- Laboratory of Experimental Pathology, CAISM - Unicamp, Campinas, São Paulo, Brazil
| | - Geisilene Russano de Paiva Silva
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil; Laboratory of Experimental Pathology, CAISM - Unicamp, Campinas, São Paulo, Brazil
| | | | - Fernando Augusto Soares
- Department of Pathology, Hospital do Câncer A C Camargo, Fundação Antonio Prudente de São Paulo, Brazil
| | | | - Sophie F M Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil
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