Cutaneous Epithelioid Clear Cells Angiosarcoma in a Young Woman with Congenital Lymphedema
Identifieur interne : 002407 ( Pmc/Checkpoint ); précédent : 002406; suivant : 002408Cutaneous Epithelioid Clear Cells Angiosarcoma in a Young Woman with Congenital Lymphedema
Auteurs : Flore Tabareau-Delalande [France] ; Anne De Muret [France] ; Elodie Miquelestorena-Standley [France] ; Anne-Valérie Decouvelaere [France] ; Gonzague De Pinieux [France]Source :
- Case Reports in Pathology [ 2090-6781 ] ; 2013.
Abstract
Angiosarcomas are rare aggressive neoplasms that can occur secondary to chronic lymphedema (Stewart-Treves syndrome). Although secondary angiosarcomas are commonly described after-mastectomy and/or after-radiotherapy, few cases have been reported in association with chronic lymphedema of congenital origin. We report the clinical, pathological, and cytogenetic findings in a case of cutaneous epithelioid clear cells angiosarcoma that occurred in a 21-year-old woman with hemibody congenital lymphedema. Surgical biopsies of the tumor mass revealed diffuse epithelioid proliferation of clear atypical cells, for which immunophenotyping highlighted the vascular differentiation. Despite
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DOI: 10.1155/2013/931973
PubMed: 24078891
PubMed Central: 3776547
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type="wicri:Area/Pmc/Checkpoint">002407</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002407</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Cutaneous Epithelioid Clear Cells Angiosarcoma in a Young Woman with Congenital Lymphedema</title><author><name sortKey="Tabareau Delalande, Flore" sort="Tabareau Delalande, Flore" uniqKey="Tabareau Delalande F" first="Flore" last="Tabareau-Delalande">Flore Tabareau-Delalande</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Pathology, Tours University Hospital, 37044 Tours, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Pathology, Tours University Hospital, 37044 Tours</wicri:regionArea><placeName><region type="region" nuts="2">Centre-Val de Loire</region><region type="old region" nuts="2">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="De Muret, Anne" sort="De Muret, Anne" uniqKey="De Muret A" first="Anne" last="De Muret">Anne De Muret</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Pathology, Tours University Hospital, 37044 Tours, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Pathology, Tours University Hospital, 37044 Tours</wicri:regionArea><placeName><region type="region" nuts="2">Centre-Val de Loire</region><region type="old region" nuts="2">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Miquelestorena Standley, Elodie" sort="Miquelestorena Standley, Elodie" uniqKey="Miquelestorena Standley E" first="Elodie" last="Miquelestorena-Standley">Elodie Miquelestorena-Standley</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Pathology, Tours University Hospital, 37044 Tours, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Pathology, Tours University Hospital, 37044 Tours</wicri:regionArea><placeName><region type="region" nuts="2">Centre-Val de Loire</region><region type="old region" nuts="2">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Decouvelaere, Anne Valerie" sort="Decouvelaere, Anne Valerie" uniqKey="Decouvelaere A" first="Anne-Valérie" last="Decouvelaere">Anne-Valérie Decouvelaere</name><affiliation wicri:level="3"><nlm:aff id="I2">Department of Biopathology, Léon Bérard Center, 69008 Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Biopathology, Léon Bérard Center, 69008 Lyon</wicri:regionArea><placeName><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="De Pinieux, Gonzague" sort="De Pinieux, Gonzague" uniqKey="De Pinieux G" first="Gonzague" last="De Pinieux">Gonzague De Pinieux</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Pathology, Tours University Hospital, 37044 Tours, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Pathology, Tours University Hospital, 37044 Tours</wicri:regionArea><placeName><region type="region" nuts="2">Centre-Val de Loire</region><region type="old region" nuts="2">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author></analytic><series><title level="j">Case Reports in Pathology</title><idno type="ISSN">2090-6781</idno><idno type="eISSN">2090-679X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Angiosarcomas are rare aggressive neoplasms that can occur secondary to chronic lymphedema (Stewart-Treves syndrome). Although secondary angiosarcomas are commonly described after-mastectomy and/or after-radiotherapy, few cases have been reported in association with chronic lymphedema of congenital origin. We report the clinical, pathological, and cytogenetic findings in a case of cutaneous epithelioid clear cells angiosarcoma that occurred in a 21-year-old woman with hemibody congenital lymphedema. Surgical biopsies of the tumor mass revealed diffuse epithelioid proliferation of clear atypical cells, for which immunophenotyping highlighted the vascular differentiation. Despite <italic>en bloc</italic> resection of the tumor, the patient died of metastatic disease three months after diagnosis. This case illustrates the clinical and pathology characteristics of angiosarcoma that is a rare entity secondary to chronic lymphedema. It is the first reported case for which the <italic>c-MYC</italic> amplification status was assessed. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Pathol</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Pathol</journal-id><journal-id journal-id-type="publisher-id">CRIM.PATHOLOGY</journal-id><journal-title-group><journal-title>Case Reports in Pathology</journal-title></journal-title-group><issn pub-type="ppub">2090-6781</issn><issn pub-type="epub">2090-679X</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24078891</article-id><article-id pub-id-type="pmc">3776547</article-id><article-id pub-id-type="doi">10.1155/2013/931973</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Cutaneous Epithelioid Clear Cells Angiosarcoma in a Young Woman with Congenital Lymphedema</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tabareau-Delalande</surname><given-names>Flore</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>de Muret</surname><given-names>Anne</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Miquelestorena-Standley</surname><given-names>Elodie</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Decouvelaere</surname><given-names>Anne-Valérie</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>de Pinieux</surname><given-names>Gonzague</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Pathology, Tours University Hospital, 37044 Tours, France</aff><aff id="I2"><sup>2</sup>Department of Biopathology, Léon Bérard Center, 69008 Lyon, France</aff><author-notes><corresp id="cor1">*Gonzague de Pinieux: <email>depinieux@med.univ-tours.fr</email></corresp><fn fn-type="other"><p>Academic Editors: I. Meattini, T. Strecker, and W. P. Wang</p></fn></author-notes><pub-date pub-type="ppub"><year>2013</year></pub-date><pub-date pub-type="epub"><day>3</day><month>9</month><year>2013</year></pub-date><volume>2013</volume><elocation-id>931973</elocation-id><history><date date-type="received"><day>5</day><month>5</month><year>2013</year></date><date date-type="accepted"><day>1</day><month>8</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2013 Flore Tabareau-Delalande et al.</copyright-statement><copyright-year>2013</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Angiosarcomas are rare aggressive neoplasms that can occur secondary to chronic lymphedema (Stewart-Treves syndrome). Although secondary angiosarcomas are commonly described after-mastectomy and/or after-radiotherapy, few cases have been reported in association with chronic lymphedema of congenital origin. We report the clinical, pathological, and cytogenetic findings in a case of cutaneous epithelioid clear cells angiosarcoma that occurred in a 21-year-old woman with hemibody congenital lymphedema. Surgical biopsies of the tumor mass revealed diffuse epithelioid proliferation of clear atypical cells, for which immunophenotyping highlighted the vascular differentiation. Despite <italic>en bloc</italic> resection of the tumor, the patient died of metastatic disease three months after diagnosis. This case illustrates the clinical and pathology characteristics of angiosarcoma that is a rare entity secondary to chronic lymphedema. It is the first reported case for which the <italic>c-MYC</italic> amplification status was assessed. The diagnostic value of this amplification should be further evaluated in this specific context.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><graphic xlink:href="CRIM.PATHOLOGY2013-931973.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><graphic xlink:href="CRIM.PATHOLOGY2013-931973.002"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Clinical features of patients with cutaneous angiosarcoma associated with congenital lymphedema described in the literature (modified from Offori et al., 1993 [<xref rid="B12" ref-type="bibr">12</xref>] and Bernardi et al., 2009 [<xref rid="B18" ref-type="bibr">18</xref>] ).</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Author</th><th align="center" rowspan="1" colspan="1">Sex</th><th align="center" rowspan="1" colspan="1">Age at diagnosis</th><th align="center" rowspan="1" colspan="1">Tumor site</th><th align="left" rowspan="1" colspan="1">Clinical appearance</th><th align="center" rowspan="1" colspan="1">Interval in diagnosis</th><th align="left" rowspan="1" colspan="1">Treatment</th><th align="center" rowspan="1" colspan="1">Survival</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Kettle [<xref rid="B19" ref-type="bibr">19</xref>]</td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">44 y</td><td align="center" rowspan="1" colspan="1">RL</td><td align="left" rowspan="1" colspan="1">Blue-red dislocation</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Amputation</td><td align="center" rowspan="1" colspan="1">Not stated</td></tr><tr><td align="left" rowspan="1" colspan="1">Liszauer et al. [<xref rid="B20" ref-type="bibr">20</xref>] </td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">28 y</td><td align="center" rowspan="1" colspan="1">RLL</td><td align="left" rowspan="1" colspan="1">Ulcerated lesion</td><td align="center" rowspan="1" colspan="1">4 m</td><td align="left" rowspan="1" colspan="1">Local excision</td><td align="center" rowspan="1" colspan="1">Died at 11 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Scott et al. [<xref rid="B21" ref-type="bibr">21</xref>]</td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">50 y</td><td align="center" rowspan="1" colspan="1">LUL</td><td align="left" rowspan="1" colspan="1">Papillomatous nodules</td><td align="center" rowspan="1" colspan="1">>7 m</td><td align="left" rowspan="1" colspan="1">Local excision/amputation</td><td align="center" rowspan="1" colspan="1">Died at 37 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Taswell et al. [<xref rid="B22" ref-type="bibr">22</xref>] </td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">17 y</td><td align="center" rowspan="1" colspan="1">LUL</td><td align="left" rowspan="1" colspan="1">Ulcerated lesion</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Disarticulation</td><td align="center" rowspan="1" colspan="1">Died at 24 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Bunch [<xref rid="B23" ref-type="bibr">23</xref>] </td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">13 y</td><td align="center" rowspan="1" colspan="1">UL</td><td align="left" rowspan="1" colspan="1">Not stated</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Interscapular amputation</td><td align="center" rowspan="1" colspan="1">Died at 1 y</td></tr><tr><td align="left" rowspan="1" colspan="1">Finlay-Jones [<xref rid="B24" ref-type="bibr">24</xref>] </td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">34 y</td><td align="center" rowspan="1" colspan="1">LLL</td><td align="left" rowspan="1" colspan="1">Ulcerated blue tumor</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Excision and combined therapy</td><td align="center" rowspan="1" colspan="1">Died at 31 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Merrick et al. [<xref rid="B25" ref-type="bibr">25</xref>] </td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">52 y</td><td align="center" rowspan="1" colspan="1">LUL</td><td align="left" rowspan="1" colspan="1">Swelling/blue nodules</td><td align="center" rowspan="1" colspan="1">6 m</td><td align="left" rowspan="1" colspan="1">Wide local excision/amputation/radiotherapy</td><td align="center" rowspan="1" colspan="1">Died at 36 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Mackenzie [<xref rid="B26" ref-type="bibr">26</xref>] </td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">64 y</td><td align="center" rowspan="1" colspan="1">RLL</td><td align="left" rowspan="1" colspan="1">Nodules/ulceration</td><td align="center" rowspan="1" colspan="1">2 m</td><td align="left" rowspan="1" colspan="1">Hindquarter amputation/radiotherapy</td><td align="center" rowspan="1" colspan="1">Alive at 24 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Dubin et al. [<xref rid="B27" ref-type="bibr">27</xref>] </td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">29 y</td><td align="center" rowspan="1" colspan="1">LUL</td><td align="left" rowspan="1" colspan="1">Ulcerated lesion</td><td align="center" rowspan="1" colspan="1">3 y</td><td align="left" rowspan="1" colspan="1">Disarticulation</td><td align="center" rowspan="1" colspan="1">Died at 45 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Laskas et al. [<xref rid="B28" ref-type="bibr">28</xref>]</td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">85 y</td><td align="center" rowspan="1" colspan="1">RUL</td><td align="left" rowspan="1" colspan="1">Purple papules and blisters/ulceration</td><td align="center" rowspan="1" colspan="1">10 m</td><td align="left" rowspan="1" colspan="1">Palliative midhumeral amputation</td><td align="center" rowspan="1" colspan="1">Died at 14 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Banathy et al. [<xref rid="B29" ref-type="bibr">29</xref>] </td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">50 y</td><td align="center" rowspan="1" colspan="1">LUL</td><td align="left" rowspan="1" colspan="1">Purple nodules</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Midhumeral amputation</td><td align="center" rowspan="1" colspan="1">Died at 26 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Sordillo et al. [<xref rid="B30" ref-type="bibr">30</xref>] </td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">23 y</td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Not stated</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Hemipelvectomy</td><td align="center" rowspan="1" colspan="1">Alive at 19 y</td></tr><tr><td align="left" rowspan="1" colspan="1">Bostrom et al. [<xref rid="B31" ref-type="bibr">31</xref>] </td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">19 y</td><td align="center" rowspan="1" colspan="1">RUL</td><td align="left" rowspan="1" colspan="1">Infected lesion</td><td align="center" rowspan="1" colspan="1">4 m</td><td align="left" rowspan="1" colspan="1">Amputation/disarticulation</td><td align="center" rowspan="1" colspan="1">Died at 12 m</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">10 y</td><td align="center" rowspan="1" colspan="1">LLL</td><td align="left" rowspan="1" colspan="1">Blue/red nodules</td><td align="center" rowspan="1" colspan="1">8 m</td><td align="left" rowspan="1" colspan="1">Amputation/disarticulation</td><td align="center" rowspan="1" colspan="1">Alive at 10 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Offori et al., 1993 [<xref rid="B12" ref-type="bibr">12</xref>]</td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">43 y</td><td align="center" rowspan="1" colspan="1">LLL</td><td align="left" rowspan="1" colspan="1">Blue/purple nodules</td><td align="center" rowspan="1" colspan="1">2 m</td><td align="left" rowspan="1" colspan="1">Amputation</td><td align="center" rowspan="1" colspan="1">Alive at 9 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Andersson et al. [<xref rid="B32" ref-type="bibr">32</xref>] </td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">35 y</td><td align="center" rowspan="1" colspan="1">RL</td><td align="left" rowspan="1" colspan="1">Blue nodules</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Hemipelvectomy, chemotherapy</td><td align="center" rowspan="1" colspan="1">Not stated</td></tr><tr><td align="left" rowspan="1" colspan="1">Cerri et al. [<xref rid="B33" ref-type="bibr">33</xref>] </td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">42 y</td><td align="center" rowspan="1" colspan="1">Pubis</td><td align="left" rowspan="1" colspan="1">Ecchymotic plaque</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Hemipelvectomy, radiotherapy</td><td align="center" rowspan="1" colspan="1">Not stated</td></tr><tr><td align="left" rowspan="1" colspan="1">Bernardi et al. [<xref rid="B18" ref-type="bibr">18</xref>]</td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">4 y</td><td align="center" rowspan="1" colspan="1">LLL</td><td align="left" rowspan="1" colspan="1">Ulcerated lesion/blue nodules</td><td align="center" rowspan="1" colspan="1">1 y</td><td align="left" rowspan="1" colspan="1">Local excision</td><td align="center" rowspan="1" colspan="1">Alive at 14 m</td></tr><tr><td align="left" rowspan="1" colspan="1">Deyrup et al., 2011 [<xref rid="B14" ref-type="bibr">14</xref>]</td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">2 y</td><td align="center" rowspan="1" colspan="1">Foot</td><td align="left" rowspan="1" colspan="1">Not stated</td><td align="center" rowspan="1" colspan="1">Not stated</td><td align="left" rowspan="1" colspan="1">Local excision</td><td align="center" rowspan="1" colspan="1">Died at 1 y</td></tr><tr><td align="left" rowspan="1" colspan="1">Present case</td><td align="center" rowspan="1" colspan="1">F</td><td align="center" rowspan="1" colspan="1">21 y</td><td align="center" rowspan="1" colspan="1">Groin</td><td align="left" rowspan="1" colspan="1">Purple/reddish infiltrated and ulcerated mass</td><td align="center" rowspan="1" colspan="1">10 m</td><td align="left" rowspan="1" colspan="1">Local excision</td><td align="center" rowspan="1" colspan="1">Died at 3 m</td></tr></tbody></table><table-wrap-foot><fn><p>LLL: left lower limb; RLL: right lower limb; LUL: left upper limb; RUL: right upper limb; m: months; and y: years.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Centre-Val de Loire</li><li>Rhône-Alpes</li><li>Région Centre</li></region><settlement><li>Lyon</li><li>Tours</li></settlement></list><tree><country name="France"><region name="Centre-Val de Loire"><name sortKey="Tabareau Delalande, Flore" sort="Tabareau Delalande, Flore" uniqKey="Tabareau Delalande F" first="Flore" last="Tabareau-Delalande">Flore Tabareau-Delalande</name></region><name sortKey="De Muret, Anne" sort="De Muret, Anne" uniqKey="De Muret A" first="Anne" last="De Muret">Anne De Muret</name><name sortKey="De Pinieux, Gonzague" sort="De Pinieux, Gonzague" uniqKey="De Pinieux G" first="Gonzague" last="De Pinieux">Gonzague De Pinieux</name><name sortKey="Decouvelaere, Anne Valerie" sort="Decouvelaere, Anne Valerie" uniqKey="Decouvelaere A" first="Anne-Valérie" last="Decouvelaere">Anne-Valérie Decouvelaere</name><name sortKey="Miquelestorena Standley, Elodie" sort="Miquelestorena Standley, Elodie" uniqKey="Miquelestorena Standley E" first="Elodie" last="Miquelestorena-Standley">Elodie Miquelestorena-Standley</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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