Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature
Identifieur interne : 004541 ( Istex/Corpus ); précédent : 004540; suivant : 004542Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature
Auteurs : Wonwoo Shon ; Christiane M. Ida ; Jennifer M. Boland-Froemming ; Peter S. Rose ; Andrew FolpeSource :
- Journal of Cutaneous Pathology [ 0303-6987 ] ; 2011-07.
Abstract
A significant proportion of angiosarcoma arises in the setting of chronic lymphedema, often following surgery for breast carcinoma (Stewart–Treves syndrome). Massive localized lymphedema (MLL), a relatively recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm2; range:37.6–68.5 kg/cm2) and had long‐standing soft tissue changes of MLL. The tumors arose in the thigh (two cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size (mean: 15.9 cm). All tumors were conventional high‐grade angiosarcomas and microscopically exhibited an admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases. Clinical follow‐up (four cases; mean: 13.8 months; range: 2–32 months) showed one patient to be dead of disease, one patient to be dead from therapy‐related complications and two patients to be alive without disease. One case was too recent for meaningful clinical follow‐up. We conclude that lymphedema secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma. The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be identical to those of other lymphedema‐associated angiosarcomas. With the continuing epidemic of obesity in Western societies, the incidence of obesity‐related angiosarcoma is probably to increase. Consequently, it is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome. Shon W, Ida CM, Boland‐Froemming JM, Rose PS, Folpe A. Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature.
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DOI: 10.1111/j.1600-0560.2011.01703.x
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Massive localized lymphedema (MLL), a relatively recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm2; range:37.6–68.5 kg/cm2) and had long‐standing soft tissue changes of MLL. The tumors arose in the thigh (two cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size (mean: 15.9 cm). All tumors were conventional high‐grade angiosarcomas and microscopically exhibited an admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases. Clinical follow‐up (four cases; mean: 13.8 months; range: 2–32 months) showed one patient to be dead of disease, one patient to be dead from therapy‐related complications and two patients to be alive without disease. One case was too recent for meaningful clinical follow‐up. We conclude that lymphedema secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma. The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be identical to those of other lymphedema‐associated angiosarcomas. With the continuing epidemic of obesity in Western societies, the incidence of obesity‐related angiosarcoma is probably to increase. Consequently, it is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome. Shon W, Ida CM, Boland‐Froemming JM, Rose PS, Folpe A. 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Rose</name><affiliations><json:string>Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA</json:string></affiliations></json:item><json:item><name>Andrew Folpe</name><affiliations><json:string>Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA</json:string><json:string>E-mail: Folpe.Andrew@Mayo.edu</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>angiosarcoma</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>massive localized lymphedema</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>obesity</value></json:item></subject><articleId><json:string>CUP1703</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>A significant proportion of angiosarcoma arises in the setting of chronic lymphedema, often following surgery for breast carcinoma (Stewart–Treves syndrome). Massive localized lymphedema (MLL), a relatively recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm2; range:37.6–68.5 kg/cm2) and had long‐standing soft tissue changes of MLL. The tumors arose in the thigh (two cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size (mean: 15.9 cm). All tumors were conventional high‐grade angiosarcomas and microscopically exhibited an admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases. Clinical follow‐up (four cases; mean: 13.8 months; range: 2–32 months) showed one patient to be dead of disease, one patient to be dead from therapy‐related complications and two patients to be alive without disease. One case was too recent for meaningful clinical follow‐up. We conclude that lymphedema secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma. The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be identical to those of other lymphedema‐associated angiosarcomas. With the continuing epidemic of obesity in Western societies, the incidence of obesity‐related angiosarcoma is probably to increase. Consequently, it is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome. Shon W, Ida CM, Boland‐Froemming JM, Rose PS, Folpe A. 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Tel: +507‐266‐9229
Fax: +507‐284‐1875
e‐mail: Folpe.Andrew@Mayo.edu</affiliation></author><idno type="istex">9320E1C06A0B7ADBEAEE322F98D59C250A7F8DA2</idno><idno type="DOI">10.1111/j.1600-0560.2011.01703.x</idno><idno type="unit">CUP1703</idno><idno type="toTypesetVersion">file:CUP.CUP1703.pdf</idno></analytic><monogr><title level="j" type="main">Journal of Cutaneous Pathology</title><title level="j" type="alt">JOURNAL OF CUTANEOUS PATHOLOGY</title><idno type="pISSN">0303-6987</idno><idno type="eISSN">1600-0560</idno><idno type="book-DOI">10.1111/(ISSN)1600-0560</idno><idno type="book-part-DOI">10.1111/cup.2011.38.issue-7</idno><idno type="product">CUP</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">38</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="560">560</biblScope><biblScope unit="page" to="564">564</biblScope><biblScope unit="page-count">5</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2011-07"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p>A significant proportion of angiosarcoma arises in the setting of chronic lymphedema, often following surgery for breast carcinoma (Stewart–Treves syndrome). Massive localized lymphedema (MLL), a relatively recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm<hi rend="superscript">2</hi>; range:37.6–68.5 kg/cm<hi rend="superscript">2</hi>) and had long‐standing soft tissue changes of MLL. The tumors arose in the thigh (two cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size (mean: 15.9 cm). All tumors were conventional high‐grade angiosarcomas and microscopically exhibited an admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases. Clinical follow‐up (four cases; mean: 13.8 months; range: 2–32 months) showed one patient to be dead of disease, one patient to be dead from therapy‐related complications and two patients to be alive without disease. One case was too recent for meaningful clinical follow‐up. We conclude that lymphedema secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma. The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be identical to those of other lymphedema‐associated angiosarcomas. With the continuing epidemic of obesity in Western societies, the incidence of obesity‐related angiosarcoma is probably to increase. Consequently, it is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome.</p><p>Shon W, Ida CM, Boland‐Froemming JM, Rose PS, Folpe A. Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">angiosarcoma</term><term xml:id="k2">massive localized lymphedema</term><term xml:id="k3">obesity</term></keywords><classCode scheme="tocHeading1">Original Articles</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/9320E1C06A0B7ADBEAEE322F98D59C250A7F8DA2/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1600-0560</doi><issn type="print">0303-6987</issn><issn type="electronic">1600-0560</issn><idGroup><id type="product" value="CUP"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF CUTANEOUS PATHOLOGY">Journal of Cutaneous Pathology</title></titleGroup></publicationMeta><publicationMeta level="part" position="07107"><doi origin="wiley">10.1111/cup.2011.38.issue-7</doi><numberingGroup><numbering type="journalVolume" number="38">38</numbering><numbering type="journalIssue" number="7">7</numbering></numberingGroup><coverDate startDate="2011-07">July 2011</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="6" status="forIssue"><doi origin="wiley">10.1111/j.1600-0560.2011.01703.x</doi><idGroup><id type="unit" value="CUP1703"></id></idGroup><countGroup><count type="pageTotal" number="5"></count></countGroup><titleGroup><title type="tocHeading1">Original Articles</title></titleGroup><copyright>Copyright © 2011 John Wiley & Sons A/S</copyright><eventGroup><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.5 mode:FullText" date="2011-06-06"></event><event type="publishedOnlineEarlyUnpaginated" date="2011-04-26"></event><event type="publishedOnlineFinalForm" date="2011-05-27"></event><event type="firstOnline" date="2011-04-26"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-16"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-30"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="560">560</numbering><numbering type="pageLast" number="564">564</numbering></numberingGroup><correspondenceTo>Dr Andrew Folpe Mayo Clinic, Rochester, MN 55905, USA
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e‐mail: <email>Folpe.Andrew@Mayo.edu</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:CUP.CUP1703.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Accepted for publication March 11, 2011</unparsedEditorialHistory><countGroup><count type="figureTotal" number="5"></count><count type="tableTotal" number="1"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="16"></count></countGroup><titleGroup><title type="main">Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature</title><title type="shortAuthors">Shon et al.</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Wonwoo</givenNames><familyName>Shon</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>Christiane M.</givenNames><familyName>Ida</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>Jennifer M.</givenNames><familyName>Boland‐Froemming</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a2"><personName><givenNames>Peter S.</givenNames><familyName>Rose</familyName></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a1" corresponding="yes"><personName><givenNames>Andrew</givenNames><familyName>Folpe</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="US"><unparsedAffiliation>Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="US"><unparsedAffiliation>Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">angiosarcoma</keyword><keyword xml:id="k2">massive localized lymphedema</keyword><keyword xml:id="k3">obesity</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p>A significant proportion of angiosarcoma arises in the setting of chronic lymphedema, often following surgery for breast carcinoma (Stewart–Treves syndrome). Massive localized lymphedema (MLL), a relatively recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm<sup>2</sup>; range:37.6–68.5 kg/cm<sup>2</sup>) and had long‐standing soft tissue changes of MLL. The tumors arose in the thigh (two cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size (mean: 15.9 cm). All tumors were conventional high‐grade angiosarcomas and microscopically exhibited an admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases. Clinical follow‐up (four cases; mean: 13.8 months; range: 2–32 months) showed one patient to be dead of disease, one patient to be dead from therapy‐related complications and two patients to be alive without disease. One case was too recent for meaningful clinical follow‐up. We conclude that lymphedema secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma. The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be identical to those of other lymphedema‐associated angiosarcomas. With the continuing epidemic of obesity in Western societies, the incidence of obesity‐related angiosarcoma is probably to increase. Consequently, it is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome.</p><p>Shon W, Ida CM, Boland‐Froemming JM, Rose PS, Folpe A. Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature</title></titleInfo><name type="personal"><namePart type="given">Wonwoo</namePart><namePart type="family">Shon</namePart><affiliation>Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Christiane M.</namePart><namePart type="family">Ida</namePart><affiliation>Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jennifer M.</namePart><namePart type="family">Boland‐Froemming</namePart><affiliation>Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Peter S.</namePart><namePart type="family">Rose</namePart><affiliation>Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Andrew</namePart><namePart type="family">Folpe</namePart><affiliation>Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA</affiliation><affiliation>E-mail: Folpe.Andrew@Mayo.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2011-07</dateIssued><edition>Accepted for publication March 11, 2011</edition><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">5</extent><extent unit="tables">1</extent><extent unit="references">16</extent></physicalDescription><abstract lang="en">A significant proportion of angiosarcoma arises in the setting of chronic lymphedema, often following surgery for breast carcinoma (Stewart–Treves syndrome). Massive localized lymphedema (MLL), a relatively recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm2; range:37.6–68.5 kg/cm2) and had long‐standing soft tissue changes of MLL. The tumors arose in the thigh (two cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size (mean: 15.9 cm). All tumors were conventional high‐grade angiosarcomas and microscopically exhibited an admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases. Clinical follow‐up (four cases; mean: 13.8 months; range: 2–32 months) showed one patient to be dead of disease, one patient to be dead from therapy‐related complications and two patients to be alive without disease. One case was too recent for meaningful clinical follow‐up. We conclude that lymphedema secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma. The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be identical to those of other lymphedema‐associated angiosarcomas. With the continuing epidemic of obesity in Western societies, the incidence of obesity‐related angiosarcoma is probably to increase. Consequently, it is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome. Shon W, Ida CM, Boland‐Froemming JM, Rose PS, Folpe A. Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature.</abstract><subject lang="en"><genre>keywords</genre><topic>angiosarcoma</topic><topic>massive localized lymphedema</topic><topic>obesity</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Cutaneous Pathology</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0303-6987</identifier><identifier type="eISSN">1600-0560</identifier><identifier type="DOI">10.1111/(ISSN)1600-0560</identifier><identifier type="PublisherID">CUP</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>38</number></detail><detail type="issue"><caption>no.</caption><number>7</number></detail><extent unit="pages"><start>560</start><end>564</end><total>5</total></extent></part></relatedItem><identifier type="istex">9320E1C06A0B7ADBEAEE322F98D59C250A7F8DA2</identifier><identifier type="DOI">10.1111/j.1600-0560.2011.01703.x</identifier><identifier type="ArticleID">CUP1703</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2011 John Wiley & Sons A/S</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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