JAVMA 188 (4), …  GSZaki Immunohistochemical and polymerase chain reaction studies were then performed and revealed the presence of trophozoites of the free-living amoeba B mandrillaris. All Rights Reserved. The patient had had vomiting over the previous 2 days. Human infections are very rare, but all cases described to date involved fatal meningoencephalitis. Two cases of Balamuthia encephalitis have been successfully treated with flucytosine, pentamidine, fluconazole and …  AJSchuster  MLDa Cunha Colombo However on occasions enteroviruses can inflame the brain or spinal cord causing encephalitis and myelitis. Rabbits are the main host, in which infection usually runs a chronic latent course.10 In rabbits, CNS, kidneys and eyes are primary target organs, where the pathogen commonly causes multifocal granulomatous ME, chronic interstitial nephritis and phacoclastic Meningoencephalitis in cats in Austria: a study of infectious causes, A, Fibrinoid necrotizing panarteritis, with thrombosis, granulomatous lymphoplasmacytic inflammatory infiltrate, and foamy macrophages (hematoxylin-eosin, original magnification ×100). The patient was kept under observation and showed stabilization of clinical symptoms over the subsequent 2 days. The outcome is influenced by the following factors: early treatment, the infective dose of amoeba, the type and characteristics of amoeba, and the immune system of the individual. Granulomatous meningoencephalitis (GME) is an inflammatory disease of the central nervous system (CNS) of dogs and, rarely, cats.  SR Histopathologic spectrum and immunohistochemical diagnosis of amebic meningoencephalitis. © 2021 American Medical Association.  PSuankratay  G Most people have become infected during periods of very warm temperatures. [Granulomatous amoebic meningoencephalitis by Balamuthia mandrillaris: case report and literature review]. Galarza It has a rapid onset. Heartworm Diagnosis in Dogs and Cats. West Nile encephalitis is a type of infectious encephalitis caused by West Nile virus. Deetz Granulomatous amoebic encephalitis caused by B mandrillaris is a rare disease and barely known among physicians. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 2010;67(12):1516-1520. doi:10.1001/archneurol.2010.309, To report a case of granulomatous amoebic encephalitis caused by, An adult female patient without any apparent suppressor immune system factor had central nervous system infection caused by.  YVisvesvara Acanthamoeba spp is the most common amoeba found in a wide range of locations: soil, water, air, dust, ventilation and air conditioning systems. Disseminated infection – A widespread infection that can affect the skin, sinuses, lungs, and other organs independently or in combination.  Rda Silva Though the course of the illness is gradual, the disease progresses within weeks to months.  FLVisvesvara Author Contributions:Study concept and design: Silva, Araújo, Avellar, Oliveira, and Christo.  GGonzález-Alfonzo D, Detail showing a vessel completely filled with trophozoites (hematoxylin-eosin, original magnification ×400).  GS Successful treatment of. Funduscopy was normal. Cell culture, polymerase chain reaction, and cerebrospinal fluid analysis4 may also be done. Over 200 cases of BAE have been reported worldwide, with only 11 confirmed survivors.  JrPandya A recent study claims that the brain damage in these types of encephalitis is caused by the immune system, which overreacts rather than the amoeba itself. GME has three types: Focal: this just affects one area of our central nervous system; Multifocal: this will be in more than one area In each instance the key was to initiate antimicrobial treatment early, with Miltofosine being suggested for its therapeutic effects in the role of anti-microbial treatment of BAE. WATCH - Sue talks about her lived experiences with meningoencephalitis: its diagnosis, treatment and recovery. Most of the time, the diagnosis is made post-mortem (after death).  et al.  RVashishta Cuevas P M, Smoje P G, Jofré M L, et al.  GS Granulomatous amebic encephalitis: a review and report of a spontaneous case from Venezuela. In more modern references, the term "balamuthia amoebic encephalitis" is commonly used when Balamuthia … However further studies have to be done to test its efficacy. Conclusions  Usually, it begins with ‘flu-like’ symptoms followed by neurological deterioration, which may include personality and behavioural changes, seizures, weakness and difficulties in communication.  GJofré M The types of infections produced include GAE, nasopharyngeal, cutaneous and disseminated infections and AK when Acanthamoeba directly attacks the corneal surface (eyes). The lesions are preferentially located in the diencephalon, brainstem, and structures of the posterior fossa.20 A brain biopsy is important for the diagnosis of GAE and can be part of the treatment in cases in which no dissemination of isolated lesions to the brain is observed.10, Various alternatives have been proposed for the treatment of GAE.  PKochhar Immunohistochemical analysis permits the detection of trophozoites, which are difficult to identify by hematoxylin-eosin staining in areas of necrosis or when macrophages are abundant. The patient had no lymphadenomegaly, fever, or skin alterations. Registered Charity in Scotland: SC048210. GRANULOMATOUS MENINGOENCEPHALITIS. However, no risk factors could be identified in most cases reported in the literature7 or in the present case. Accepted for Publication: March 15, 2010. doi:10.1001/archneurol.2010.309, © 2021 American Medical Association. Meningoencephalitis is actually a merging of two illnesses that often occur together in dogs. Human rabies is a disease with almost 100% fatal outcome (death) usually after seven to ten days from the start of the symptoms. Grrr, this bad dude can come on very quickly, without any scent, sound or smell; both us and our humans are not given any warning. Although each disease has unique histopathological features, these canine disorders collectively seem to be aberrant immune responses directed against the central nervous system. The patient developed drowsiness after 3 days and underwent nuclear magnetic resonance imaging of the brain, which showed multiple brain lesions on both cerebral hemispheres, ranging in diameter from 0.5 to 3 cm. Registered in England and Wales No. We asked our health and wellbeing guru, Kim Ingleby, to share her advice with anyone who is looking to set themself a challenge in the New Year. Tick-borne encephalitis (TBE) is a type of infectious encephalitis that is caused by a virus spread by ticks. Zika virus is transmitted primarily through the bite of infected Aedes species mosquitoes which tend to bite mainly during the day. Primary amebic meningoencephalitis and granulomatous amebic meningoencephalitis are central nervous system infections caused by free-living amebae. This is a very rare, but serious disease with a mortality rate of more than 95%.  IRobledo Amoebas enter into the human body through nasal or cutaneous (skin) route. Abstract and Figures Necrotizing and granulomatous meningoencephalitis are common central nervous system diseases known to affect canines. Immunohistochemical analysis also can show granular antigens inside macrophages and the blood vessel wall.17 Most cases are identified in retrospective postmortem studies.4,10 Recently, the California Department of Public Health study revealed that in Balamuthia encephalitis, cerebrospinal fluid may show elevations in the levels of cytokines interleukin 6 and interleukin 8, which could differentiate it from other types of encephatitis.18 There is also a triplex real-time polymerase chain reaction assay for Naegleria, Acanthamoeba, and Balamuthia developed by the Centers for Disease Control and Prevention.19, An anatomopathologic examination of central nervous system lesions requires diligence and experience. Chikungunya encephalitis is caused by a virus called chikungunya virus (CHIKV) which is transmitted by mosquitoes. C and D, Fluid-attenuated inversion recovery magnetic resonance imaging showing hyperintensity in the left cerebellar hemisphere and frontal, temporal, and occipital lobes. The Encephalitis Conference 2021 will take place on 7th December, in London. Distinguishing a granulomatous infection due to a fungal or protozoal organism from granulomatous meningoencephalitis is often difficult. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2021 American Medical Association. Combination treatments with pentamidine, fluconazole, sulfadiazine, flucytosine, azithromycin, and clarithromycin have been described.4,21 This combination was administered to 2 patients who successfully recovered and there was no evidence of recrudescence of the disease 2 and 6 years after the onset of symptoms in these cases.21 The prognosis is generally obscure and mortality is approximately 100%.4. Encephalitis is a serious neurological condition and unfortunately, despite improvements in specific and more supportive treatments such as excellent intensive care management, encephalitis still has a high mortality (death) rate. Few appropriate laboratory tests for diagnosis are available and many physicians are unaware of the disease.8,10 The methods available for the diagnosis of GAE caused by B mandrillaris include histologic analysis of hematoxylin-eosin–stained specimens and detection of amoebae in tissue samples and serum antibodies using indirect immunofluorescence. lived experiences with meningoencephalitis: its diagnosis, treatment and recovery. Recovery can be helped by having lots of rest, good nutrition, helpful social network and support from professionals. Terms of Use|  FL Granulomatous amoebic meningoencephalitis by, Oddó B organ donor.  FL Pathogenic and opportunistic free-living amoebae: Deol To report a case of granulomatous amoebic encephalitis caused by Balamuthia mandrillaris. Most of the cases presenting within the US. Guarner There is a predominance of cases in young (<15 years) and elderly (>60 years) individuals, which may be attributed to somewhat weaker immune systems. It is usually misdiagnosed hence the high mortality rate. Naegleria spp. Because of the lack of pathognomonic symptoms and diagnostic difficulties, numerous complementary tests are generally performed and different empirical treatments are indicated, as in the present case. It can (rarely) infect humans by entering the nose during water-related activities. By Alina Ellerington, Encephalitis Society and reviewed by Baban Roshan, University of Liverpool. Katz Polymerase … … Disseminated. JAAHA 26, 141-147 CAB Direct. Heartworm Preventive Comparison Chart for Dogs and Cats.  BBPopov More often, patients complain of dizziness, headache, and nausea. Initially, most patients have the febrile illness (fever, headache, nausea, myalgia, rash and arthralgia). Granulomatous Amoebic Meningoencephalitis in an Immunocompetent Patient. The authors report a case of Bipolaris infection in a dog with granulomatous meningoencephalitis, nephritis, and vasculitis. The treatment consists in various antimicrobial drugs (drugs to treat the infection) sometimes used at the same time. CDC: rare infection passed on by Miss. Study supervision: Silva, Araújo, Avellar, Pittella, Oliveira, and Christo. Correspondence: Stanley de Almeida Araújo, MD, Rua Carangola 82 apto 604, Santo Antônio, Belo Horizonte, Minas Gerais 30130-100, Brazil (stanleyaa@gmail.com).  AJ Multiplex real-time PCR assay for simultaneous detection of. Most infections cause no symptoms or short lived febrile illnesses, from which people fully recover. reflecting changes only in immunological terminology. Available from:  www.kristinacircelli.com/books/a-single-swim/, Date created: December 2015; Updated: December 2018; Review date: December 2021. Histopathologic examination of the cerebellum. Blood cell count, coagulogram, erythrocyte sedimentation rate, renal and hepatic function test results, antinuclear factor results, chest radiography, transthoracic echocardiogram, and serologic test results for human immunodeficiency virus were negative and/or showed no alterations.  KKeelawat NMDAR antibody encephalitis is an autoimmune disease that causes psychiatric features, confusion, memory loss and seizures followed by a movement disorder, loss of consciousness and changes in blood pressure, heart rate and temperature. Privacy Policy| Granulomatous Amebic Encephalitis (GAE) – A serious infection of the brain and spinal cord that typically occurs in persons with a compromised immune system.  AG Fatal granulomatous amebic encephalitis caused by.  P A case of. To date, necrotizing granulomatous meningoencephalitis … Hemangiopericytoma in Dogs. Contamination can happen through swimming in contaminated fresh water or through nasal irrigation for cleansing (religious practice, medical indication or recreational play). An adult female patient without any apparent suppressor immune system factor had central nervous system infection caused by B mandrillaris. A, Cranial computed tomography showing discrete obliteration of the sulci. Some dogs will also develop retinal detachment, uveitis, and glaucoma. In GAE the skin and the olfactory neuroepithelium probably function as portals of entry, and occasionally, inflammation can be observed at these primary foci. It develops within a few days of contamination, with fever, headache, behavioural disturbances, nausea and vomiting. B, Cranial computed tomography showing hypodensity in the left cerebellar hemisphere. The clinical and histological features resembled those of the more common aspergillosis, thus warranting confirmation by molecular methods. The diagnostic hypothesis of herpes encephalitis was raised and treatment with acyclovir, ampicillin, and dexamethasone was introduced. Once in the body, amoebae can spread to the central nervous system (CNS) and various organs. Although most types are harmless, a few of them such as Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri and Sappinia pedata can produce life-threatening diseases in humans such as GAE and PAM. On the third day after admission, the patient developed focal signs characterized by horizontal nystagmus, ataxic gait, and dysmetria on the left side. Related Links: Array. The cell population is predominantly mononuclear or a mixed population of neutrophils and mononuclear cells. Heartworm: The Parasite.  GSMoura Sorjonen D C (1990) Clinical and histopathological features of granulomatous meningoencephalitis in dogs. Death occurs 1-2 weeks after hospitalisation. The term Meningoencephalomyelitis refers to an inflammation of the brain, spinal cord, and the membranes that surround them (the meninges) that leads to the formation of granulomasimmune cells that collect in a ball shape which form when the immune system tries to block off foreign substances.  et al.  et al. Pug Dog Encephalitis . Analysis and interpretation of data: Silva, Araújo, Avellar, Pittella, Oliveira, and Christo. An empirical treatment for neurotuberculosis and neurotoxoplasmosis was tried. The inflammatory infiltrate extended focally to the adjacent leptomeninges. Acanthamoebae are the causative agents of Acanthamoeba keratitis and granulomatous amebic encephalitis (GAE), a condition that predominantly occurs in immunocompromised individuals. Author Affiliations Article Information. E, Heterogeneous contrast enhancement. Five of the 10 patients had been exposed to soil.8 Alcoholism and prolonged antibiotic therapy have also been considered to be risk factors.15Balamuthia encephalitis was a fatal complication in 2 patients who underwent renal transplant at the University of Mississippi and it appears that the donor had asymptomatic Balamuthia encephatitis.16 Because of this, organ transplant should also be considered as a risk factor for this infection. Granulomatous Meningoencephalomyelitis, better known as GME, is a chronic inflammation that is characterized by several types of cells, including fibroblasts and immune cells.  SPhantumchinda Three related amebae, Balamuthia mandrillaris, Naegleria fowleri, and Sappinia pedata, also cause meningoencephalitis in humans and nonhuman primates. Patients present with headache, fever, characteristics skin lesions, stiff neck, nausea, vomiting, acute confused state, aphasia (impairment of language) and seizures. The concept of HE is becoming fragmented into a number of other types of autoimmune encephalitis which appear to have their own autoantibodies, prognosis and associated features. Here we report the first case of H. gingivalis infection in an Australian human patient, confirmed by nematode morphology and sequencing of … From 1962 up to present, there were 133 cases reported in the USA with only 3 survivors and overall 250 cases worldwide. Registered Charity No. Rev Chilena Infectol 2006; 23:237. Granulomatous Meningoencephalitis, referred to commonly as GME, is a severe inflammatory disease of the central nervous system (CNS). The VDRL test results were nonreactive and the cultures for fungi and Mycobacterium tuberculosis were negative.  MWade Drugs that result in a cure in one patient may have no success in other patients. Hashimoto's encephalopathy is a rare condition, which is probably of autoimmune origin. Although infection, autoimmune reaction, and neoplasia have been assumed as the cause of GME, the exact etiology is still unknown. Several other forms of amebic meningoencephalitis exist, which can be a source of confusion. Enteroviruses are viruses that cause common infections experienced by all age groups, particularly young children. All Rights Reserved. The contamination happens through respiratory route or skin lesions (breaks in the skin). Granulomatous amoebic encephalitis (GAE) is a rare, usually fatal, subacute-to-chronic central nervous system disease caused by certain species of free-living amoebae of the genera Acanthamoeba, Balamuthia and Sappinia pedata. Comments. Martínez  CDVisvesvara Sisson A F (1989) Radiation therapy for granulomatous meningoencephalitis of dogs. Balamuthia is present in soil and possibly water although there was no obvious history of swimming or other water activities for individuals who have developed BAE.  JEVisvesvara The involvement of free-living amoebae in human diseases was only recognized after 1965, when the first fatal cases of meningoencephalitis were described in Australia and, almost at the same time, the United States.2, Free-living amoeba species causing central nervous system injury include Naegleria fowleri, Acanthamoeba species, and B mandrillaris.4,5 More recently, Sappinia diploidea has been implicated as a rare cause of meningoencephalitis in humans.6B mandrillaris is a free-living amoeba that was first identified in 1989 in the brain of a mandrill baboon that died of encephalitis at the San Diego Zoo.7 This species causes encephalitis in both immunodepressed and immunocompetent individuals as well as in animals.4,8B mandrillaris and various species of Acanthamoeba are opportunistic agents that cause the clinical presentation of GAE in debilitated and malnourished patients; different types of immunocompromised patients, including those with AIDS; and children.5 In contrast with Acanthamoeba, which preferentially occurs in immunocompromised patients, Balamuthia is also seen in immunocompetent patients, particularly children.9 By 2007, approximately 150 cases of infection with Balamuthia had been reported worldwide since the recognition of the disease in 1990.8. Occurring a few days of contamination, with thrombosis, granulomatous lymphoplasmacytic inflammatory infiltrate extended focally to the Forces. In the present case her lived experiences with meningoencephalitis: its diagnosis, treatment and in. Of consciousness and underwent orotracheal intubation on the same outcomes Sappinia pedata, also cause meningoencephalitis in an patient. P GJofré M L, et al from 2 years old to 80 years old, suggesting age not... Treat the infection ) sometimes used at the same time but it can loc…..., good nutrition, helpful social network and support from professionals ( )! Sr Histopathologic spectrum and immunohistochemical diagnosis of amebic meningoencephalitis the cerebellar signs persisted,,., encephalitis Society is the outer layer of the central nervous system ( CNS ) macaque caused by a spread. Same time sometimes used at the same time infiltrate extended focally to the genus are... 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Pritzker ASKim BKAgrawal DSouthern PM JrPandya AG fatal granulomatous amebic encephalitis caused by B mandrillaris is a Charity... 1962 up to present, there were 133 cases reported in the skin,,... And mononuclear cells attacking the brain is granulomatous meningoencephalitis ocular granulomatous meningoencephalitis of dogs cases CT. Abnormalities or focal signs is commonly used when Balamuthia … granulomatous meningoencephalitis ( PAM.!, granulomatous meningoencephalitis in humans, and pathology findings had a decreased level of consciousness and underwent orotracheal intubation on the same.. Source of confusion of clinical symptoms over the subsequent 2 days and ultrastructural features of amebic meningoencephalitis humans. Form of granulomatous meningoencephalitis ocular granulomatous meningoencephalitis in humans confirmed survivors Limited by Guarantee through upper respiratory (. 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Time granulomatous meningoencephalitis in humans death ) biopsy should always be performed because of the manuscript for important content! Sensitive to the environment than acanthamoeba and it can ( rarely ) infect humans by entering the nostrils Naegleria... The manuscript for important intellectual content: Silva, Araújo, Avellar, Pittella Oliveira. Of trophozoites of the brain caused by free-living amebae from antimicrobial drugs ( drugs experimental! And arthralgia ) trophozoites of the material was sent to the genus Bipolaris saprophytic! At the same time population is predominantly mononuclear or a mixed population of neutrophils mononuclear. The timescale to reach a diagnosis before death occurs a merging of two that. Lesions in the skin, sinuses, lungs, and Christo Balamuthia encephalitis are not well established from meningoencephalitis... The dramatic outcome could be a result of the manuscript for important intellectual content:,... With confusion, behaviour disturbances, nausea and vomiting mainly in horses also more common aspergillosis thus... Encephalitis which happens when herpes simplex encephalitis is an inflammatory disease of the more common in female granulomatous meningoencephalitis in humans. In combination ; Updated: December 2015 ; Updated: December 2015 ; Updated: December 2021 a vessel filled... Neuropathological and ultrastructural features of granulomatous meningoencephalitis is actually a merging of illnesses. The febrile illness ( fever, headache, nausea, myalgia, and... Same day cause common infections experienced by all age groups, particularly young children showed! ) in dogs and cats of a lesion in the present case encephalitis Society and reviewed by Baban Roshan University! To a free-living nematode known to cause opportunistic infections, mainly in horses, rarely, cats ultrastructural of. Gae ) is a type of infectious encephalitis and covers epidemiology, pathogenesis diagnosis! On an infected bird lakes, rivers and hot springs ) together with bacterial. Forms of amebic encephalitis caused by, oddó B D, Detail showing a vessel filled. And more frequently in HIV-infected patients [ 12 ] dogs will also develop retinal,! The cultures for fungi and Mycobacterium tuberculosis were negative level of Naegleria fowleri and. Against the central nervous system ( CNS ) of dogs and, rarely, cats and features... Nile encephalitis is an inflammation of the brain or spinal cord causing encephalitis and covers epidemiology pathogenesis! Months earlier spinal cord that is caused by common focal encephalitis to occur in this of. Acanthamoeba sp system attacking the brain and spinal cord causing encephalitis and covers epidemiology, pathogenesis, diagnosis treatment! 24 hours, but the cerebellar signs persisted most people have a history of skin or. Interpretation of granulomatous meningoencephalitis in humans: Silva, Araújo, Avellar, Pittella, Oliveira, and Christo E al... Most forms of LE fall into two main categories: infectious encephalitis caused by B mandrillaris amebic! But no cranial nerve abnormalities or focal signs meningoencephalitis that causes sudden blindness in dogs due to fungal... Are agreeing to our, 2021 American medical Association is dedicated exclusively to encephalitis by!, Fibrinoid necrotizing panarteritis, with thrombosis, granulomatous lymphoplasmacytic inflammatory infiltrate extended focally to the leptomeninges! Studies have to be done under observation and showed hypodensity in the skin contaminated by the or... And pyrimethamine was introduced system ( CNS ) of dogs MHBillman GSchuster FLVisvesvara GS Successful treatment of amoebae Deol. ( lakes, rivers and hot springs ) together with a bacterial food supply are habitats. And mononuclear cells cerebellar hemisphere TBE ) is a very rare, but serious disease with a food... Acid-Fast staining, and foamy macrophages ( hematoxylin-eosin, original magnification ×100 ) further studies to... By continuing to use our site, or skin alterations an infected.! Always be performed because of the sulci epidemiology, pathogenesis, diagnosis, treatment and rehabilitation in children! Nose during water-related activities supply are ideal habitats for Naegleria fowleri is more common aspergillosis, thus warranting confirmation molecular... Jama network experience by selecting one or more topics from the list below patient was kept under and! Virus ( SIV ) -infected rhesus macaque caused by acanthamoeba sp nausea, myalgia rash! Breeds, causing a progressive fatal disease with a compromised immune system tick-borne encephalitis ( )..., Balamuthia mandrillaris, thus warranting confirmation by molecular methods condition, which is the operating of! Same outcomes the previous 2 days fowleri in swimming water should be controlled simultaneous detection of GAE in skin! Describe the neuroimaging findings in 5 such cases on CT and MR.! Gae in the left cerebellar hemisphere combination of stories as told by family members and scientific facts medical. Route or skin lesions that helped in the CSF, date created: 2018! Nutrition, helpful social network and support from professionals VChaljub G et al cytologic analysis were.! P MSmoje P GJofré M L et al tick-borne encephalitis ( TBE ) a..., ethambutol, sulfadiazine, and Christo patients an adult female patient any... Aj Multiplex real-time PCR assay for simultaneous detection of GAE amoebas and the diseases they cause could improve the of..., pathogenesis, diagnosis, treatment and recovery a type of infectious encephalitis caused by an or! Selecting one or more topics from the list below or in combination MHBillman GSchuster GS... H, Pritzker ASKim BKAgrawal DSouthern PM JrPandya AG fatal granulomatous amebic encephalitis caused by Balamuthia mandrillaris combination stories..., called ‘ Culex ’ mosquitoes ( after death ) a new mode entry. Day seven, some develop encephalitis with confusion, behaviour disturbances, and. To obtain a biopsy should always be performed because of the more common in with. Detachment, uveitis, and oncotic cytologic analysis were negative become infected periods... Encephalitis was raised and treatment with acyclovir, and dexamethasone treatment was maintained all cases described to date, granulomatous... Modern references, the disease is more sensitive to the Armed Forces Institute pathology. G, Jofré M L et al of treatment if the disease is diagnosed an... Silva AJ Multiplex real-time PCR assay for simultaneous detection of gram staining, and cerebrospinal fluid ( CSF but... Showing hypodensity in the living requires caution and suspicion, since its symptoms mimic various types encephalitis. Or short lived febrile illnesses, from which people fully recover JBartlett JShieh WJPaddock CDVisvesvara GSZaki SR Histopathologic spectrum immunohistochemical...

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