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G Rindi
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C Klersy Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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F Inzani
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G Fellegara Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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L Ampollini Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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A Ardizzoni Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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N Campanini Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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P Carbognani Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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T M De Pas Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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D Galetta Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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P L Granone Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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L Righi Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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M Rusca Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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L Spaggiari Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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M Tiseo Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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G Viale Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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M Volante Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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M Papotti Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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G Pelosi Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy
Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy

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. 1998 , Marchevsky et al . 2001 , Iyoda et al . 2007 , den Bakker et al . 2010 , Righi et al . 2010 , Ha et al . 2012 ). The clinical significance of distinguishing between high-grade LCNEC and SCLC is not clear due to the overlapping survival

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Guido Rindi Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Università Cattolica del Sacro Cuore, Rome, Italy
ENETS Center of Excellence, Neuroendocrine Tumour (NET) Center, Rome, Italy

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Frediano Inzani Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
ENETS Center of Excellence, Neuroendocrine Tumour (NET) Center, Rome, Italy

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-invasion-metastasis deposition. At the same time, prognosis depends on NEN cancer biology and displays a range of clinical behaviors from low to high grade malignancy. Indeed, a large fraction of well-differentiated NEN behave as low-grade malignant if not indolent. In fact, the

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Dermot O'Toole Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland
Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Anne Couvelard Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland
Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Vinciane Rebours Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Magali Zappa Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Olivia Hentic Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Pascal Hammel Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Philippe Levy Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Pierre Bedossa Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland
Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Eric Raymond Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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Philippe Ruszniewski Department of Clinical Medicine and Gastroenterology, Service de Gastroentérologie, Service d'Anatomie Pathologique, INSERM U773, Service de Radiologie, Service d'Oncologie Bichat-Beaujon, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland

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. Microvessel MVD ranged from 0 to 350 vessels/mm 2 (median: 100; mean: 126; Fig. 1 b); 42% had high expression. MVD was higher in tumors of grade G 2 /G 3 compared with G 1 tumors ( P =0.02). p53 The nuclear score ranged from 0 to 200 (median: 0; mean: 18

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Marijn A Vermeulen Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

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Shusma C Doebar Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands

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Carolien H M van Deurzen Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands

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John W M Martens BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands
Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands

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Paul J van Diest Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

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Cathy B Moelans Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

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which low-grade DCIS progresses to low-grade IDC and high-grade DCIS to high-grade IDC. These parallel pathways have been postulated to have distinct genomic aberrations ( Hwang et al . 2004 , Moelans et al . 2010 a , Burger et al . 2013

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M Lacroix Laboratoire Jean-Claude Heuson de Cancérologie Mammaire, Institut Jules Bordet, Université Libre de Bruxelles, 127 boulevard de Waterloo, B-1000 Bruxelles, Brussels, Belgium

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R-A Toillon Laboratoire Jean-Claude Heuson de Cancérologie Mammaire, Institut Jules Bordet, Université Libre de Bruxelles, 127 boulevard de Waterloo, B-1000 Bruxelles, Brussels, Belgium

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G Leclercq Laboratoire Jean-Claude Heuson de Cancérologie Mammaire, Institut Jules Bordet, Université Libre de Bruxelles, 127 boulevard de Waterloo, B-1000 Bruxelles, Brussels, Belgium

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expression or proliferation. A classification based on an ER-positive/ ER-negative or a low-grade/high-grade dichotomy hardly suffices to describe the complex spectrum of breast tumors; however, its simplicity will facilitate our main purpose: evaluating the

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Michail Kaklamanos
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Ioannis Karoumpalis Department of Pathophysiology, Gastroenterology, Cytology, Pathology, Endocrinology Section, National and Kapodistrian University of Athens, 75 Mikras Asias St., PC: 11527 Athens, Greece Departments of

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Charitini Salla Department of Pathophysiology, Gastroenterology, Cytology, Pathology, Endocrinology Section, National and Kapodistrian University of Athens, 75 Mikras Asias St., PC: 11527 Athens, Greece Departments of

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Dimitrios Thomas
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George Kanakis
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Krystallenia Alexandraki
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Stavros Sougioultzis
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Evanthia Diakatou Department of Pathophysiology, Gastroenterology, Cytology, Pathology, Endocrinology Section, National and Kapodistrian University of Athens, 75 Mikras Asias St., PC: 11527 Athens, Greece Departments of

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George Kontogeorgos Department of Pathophysiology, Gastroenterology, Cytology, Pathology, Endocrinology Section, National and Kapodistrian University of Athens, 75 Mikras Asias St., PC: 11527 Athens, Greece Departments of

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Gregory Kaltsas
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Dear Editor Although pancreatic neuroendocrine tumours (PETs) are rare, autopsy series have revealed a high incidence ranging from 0.8 to 10%, reflecting their relative lack of progression and low malignant potential ( Kaltsas et al . 2004

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O Hentic Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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P Hammel Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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A Couvelard Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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V Rebours Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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M Zappa Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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M Palazzo Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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F Maire Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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G Goujon Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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A Gillet Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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P Lévy Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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P Ruszniewski Pôle des Maladies de L'appareil Digestif, Service de Pathologie, Service de Radiologie, Service de Gastroentérologie–Pancréatologie

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condition due to aggressive and diffuse disease. These tumors are characterized by aggressive histological features (high Ki-67 index, extensive necrosis, and nuclear atypia) and are classified as neuroendocrine carcinomas (NECs) grade 3 according to the new

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Louis W C Chow State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau SAR, Macao
Organisation for Oncology and Translational Research, Hong Kong SAR, China
UNIMED Medical Institute, Hong Kong SAR, China

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Satoshi Morita Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan

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Christopher Y C Chow UNIMED Medical Institute, Hong Kong SAR, China

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Wai-Kuen Ng Department of Pathology, Precious Blood Hospital, Hong Kong SAR, China

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Masakazu Toi Organisation for Oncology and Translational Research, Hong Kong SAR, China
Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

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Introduction The usefulness of endocrine therapy has been well demonstrated in the management of hormone-sensitive breast cancer ( Ellis et al. 2011 ). The neoadjuvant ACOSOG Z1031 trial showed a high clinical response rate of 63–75% in

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Mabel Ryder Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine
Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine

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Ronald A Ghossein Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine

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Julio C M Ricarte-Filho Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine

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Jeffrey A Knauf Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine
Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine

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James A Fagin Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine
Endocrinology Service, Human Oncology and Pathogenesis Program, Department of Pathology, Department of Medicine

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each histological grade at low and high power magnifications. Figure 1 Immunostain for tumor-associated macrophages (TAM) markers in tissue microarrays. The signal is golden brown. (A) Very low density of CD68 + TAM per tissue core (0.28 mm 2 ) in well

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Pushpa Patel
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Rowan Hardy
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Vaiyapuri Sumathi School of Clinical and Experimental Medicine, Department of Musculoskeletal Pathology, Oncology Department, Institute of Biomedical Research, The University of Birmingham, Birmingham B15 2TT, UK

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Gillian Bartle School of Clinical and Experimental Medicine, Department of Musculoskeletal Pathology, Oncology Department, Institute of Biomedical Research, The University of Birmingham, Birmingham B15 2TT, UK

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Lars-Gunnar Kindblom School of Clinical and Experimental Medicine, Department of Musculoskeletal Pathology, Oncology Department, Institute of Biomedical Research, The University of Birmingham, Birmingham B15 2TT, UK

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Robert Grimer School of Clinical and Experimental Medicine, Department of Musculoskeletal Pathology, Oncology Department, Institute of Biomedical Research, The University of Birmingham, Birmingham B15 2TT, UK

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Iwona Bujalska
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Paul M Stewart
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Elizabeth Rabbitt
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Neil J L Gittoes
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Mark S Cooper
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). Most OSs are high grade and there are few morphological markers relating to long-term survival. Patients with metastases at presentation have a very poor outlook. For patients without clinically evident metastasis, the most important prognostic factor

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