Splenic marginal zone lymphoma differential diagnosis: Difference between revisions

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Splenic marginal zone lymphoma must be differentiated from other diseases such as  [[chronic lymphocytic leukemia]],  [[follicular lymphoma]], and [[mantle cell lymphoma]].<ref name=cancer.gov> Splenic marginal zone lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf57e3e27c3994bd5327/. Accessed on January 14, 2016</ref>
Splenic marginal zone lymphoma must be differentiated from other diseases such as  [[chronic lymphocytic leukemia]],  [[follicular lymphoma]], and [[mantle cell lymphoma]].<ref name=cancer.gov> Splenic marginal zone lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf57e3e27c3994bd5327/. Accessed on January 14, 2016</ref>
==Differential Diagnosis==
==Differential Diagnosis==
Splenic marginal zone lymphoma must be differentiated from other diseases such as:<ref name=cancer.gov> Splenic marginal zone lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf57e3e27c3994bd5327/. Accessed on January 14, 2016</ref>
Splenic marginal zone lymphoma must be differentiated from other splenic B-cell lymphomas with the help of clinical, morphological, immunophenotypic and genetic data.<ref name="pmid18094718">{{cite journal |vauthors=Matutes E, Oscier D, Montalban C, Berger F, Callet-Bauchu E, Dogan A, Felman P, Franco V, Iannitto E, Mollejo M, Papadaki T, Remstein ED, Salar A, Solé F, Stamatopoulos K, Thieblemont C, Traverse-Glehen A, Wotherspoon A, Coiffier B, Piris MA |title=Splenic marginal zone lymphoma proposals for a revision of diagnostic, staging and therapeutic criteria |journal=Leukemia |volume=22 |issue=3 |pages=487–95 |date=March 2008 |pmid=18094718 |doi=10.1038/sj.leu.2405068 |url=}}</ref><ref name="pmid20479288">{{cite journal |vauthors=Salido M, Baró C, Oscier D, Stamatopoulos K, Dierlamm J, Matutes E, Traverse-Glehen A, Berger F, Felman P, Thieblemont C, Gesk S, Athanasiadou A, Davis Z, Gardiner A, Milla F, Ferrer A, Mollejo M, Calasanz MJ, Florensa L, Espinet B, Luño E, Wlodarska I, Verhoef G, García-Granero M, Salar A, Papadaki T, Serrano S, Piris MA, Solé F |title=Cytogenetic aberrations and their prognostic value in a series of 330 splenic marginal zone B-cell lymphomas: a multicenter study of the Splenic B-Cell Lymphoma Group |journal=Blood |volume=116 |issue=9 |pages=1479–88 |date=September 2010 |pmid=20479288 |doi=10.1182/blood-2010-02-267476 |url=}}</ref><ref name="pmid22891276">{{cite journal |vauthors=Kiel MJ, Velusamy T, Betz BL, Zhao L, Weigelin HG, Chiang MY, Huebner-Chan DR, Bailey NG, Yang DT, Bhagat G, Miranda RN, Bahler DW, Medeiros LJ, Lim MS, Elenitoba-Johnson KS |title=Whole-genome sequencing identifies recurrent somatic NOTCH2 mutations in splenic marginal zone lymphoma |journal=J. Exp. Med. |volume=209 |issue=9 |pages=1553–65 |date=August 2012 |pmid=22891276 |pmc=3428949 |doi=10.1084/jem.20120910 |url=}}</ref><ref name="pmid22891273">{{cite journal |vauthors=Rossi D, Trifonov V, Fangazio M, Bruscaggin A, Rasi S, Spina V, Monti S, Vaisitti T, Arruga F, Famà R, Ciardullo C, Greco M, Cresta S, Piranda D, Holmes A, Fabbri G, Messina M, Rinaldi A, Wang J, Agostinelli C, Piccaluga PP, Lucioni M, Tabbò F, Serra R, Franceschetti S, Deambrogi C, Daniele G, Gattei V, Marasca R, Facchetti F, Arcaini L, Inghirami G, Bertoni F, Pileri SA, Deaglio S, Foà R, Dalla-Favera R, Pasqualucci L, Rabadan R, Gaidano G |title=The coding genome of splenic marginal zone lymphoma: activation of NOTCH2 and other pathways regulating marginal zone development |journal=J. Exp. Med. |volume=209 |issue=9 |pages=1537–51 |date=August 2012 |pmid=22891273 |pmc=3428941 |doi=10.1084/jem.20120904 |url=}}</ref><ref name="pmid21663470">{{cite journal |vauthors=Tiacci E, Trifonov V, Schiavoni G, Holmes A, Kern W, Martelli MP, Pucciarini A, Bigerna B, Pacini R, Wells VA, Sportoletti P, Pettirossi V, Mannucci R, Elliott O, Liso A, Ambrosetti A, Pulsoni A, Forconi F, Trentin L, Semenzato G, Inghirami G, Capponi M, Di Raimondo F, Patti C, Arcaini L, Musto P, Pileri S, Haferlach C, Schnittger S, Pizzolo G, Foà R, Farinelli L, Haferlach T, Pasqualucci L, Rabadan R, Falini B |title=BRAF mutations in hairy-cell leukemia |journal=N. Engl. J. Med. |volume=364 |issue=24 |pages=2305–15 |date=June 2011 |pmid=21663470 |doi=10.1056/NEJMoa1014209 |url=}}</ref><ref name="pmid24241536">{{cite journal |vauthors=Waterfall JJ, Arons E, Walker RL, Pineda M, Roth L, Killian JK, Abaan OD, Davis SR, Kreitman RJ, Meltzer PS |title=High prevalence of MAP2K1 mutations in variant and IGHV4-34-expressing hairy-cell leukemias |journal=Nat. Genet. |volume=46 |issue=1 |pages=8–10 |date=January 2014 |pmid=24241536 |pmc=3905739 |doi=10.1038/ng.2828 |url=}}</ref><ref name="pmid18042795">{{cite journal |vauthors=Traverse-Glehen A, Baseggio L, Bauchu EC, Morel D, Gazzo S, Ffrench M, Verney A, Rolland D, Thieblemont C, Magaud JP, Salles G, Coiffier B, Berger F, Felman P |title=Splenic red pulp lymphoma with numerous basophilic villous lymphocytes: a distinct clinicopathologic and molecular entity? |journal=Blood |volume=111 |issue=4 |pages=2253–60 |date=February 2008 |pmid=18042795 |doi=10.1182/blood-2007-07-098848 |url=}}</ref><ref name="pmid22301699">{{cite journal |vauthors=Braggio E, Dogan A, Keats JJ, Chng WJ, Huang G, Matthews JM, Maurer MJ, Law ME, Bosler DS, Barrett M, Lossos IS, Witzig TE, Fonseca R |title=Genomic analysis of marginal zone and lymphoplasmacytic lymphomas identified common and disease-specific abnormalities |journal=Mod. Pathol. |volume=25 |issue=5 |pages=651–60 |date=May 2012 |pmid=22301699 |pmc=3341516 |doi=10.1038/modpathol.2011.213 |url=}}</ref><ref name="pmid23611359">{{cite journal |vauthors=Traverse-Glehen A, Bachy E, Baseggio L, Callet-Bauchu E, Gazzo S, Verney A, Hayette S, Jallades L, Ffrench M, Salles G, Coiffier B, Felman P, Berger F |title=Immunoarchitectural patterns in splenic marginal zone lymphoma: correlations with chromosomal aberrations, IGHV mutations, and survival. A study of 76 cases |journal=Histopathology |volume=62 |issue=6 |pages=876–93 |date=May 2013 |pmid=23611359 |doi=10.1111/his.12092 |url=}}</ref><ref name="pmid22210875">{{cite journal |vauthors=Xi L, Arons E, Navarro W, Calvo KR, Stetler-Stevenson M, Raffeld M, Kreitman RJ |title=Both variant and IGHV4-34-expressing hairy cell leukemia lack the BRAF V600E mutation |journal=Blood |volume=119 |issue=14 |pages=3330–2 |date=April 2012 |pmid=22210875 |pmc=3321859 |doi=10.1182/blood-2011-09-379339 |url=}}</ref>
* [[Chronic lymphocytic leukemia]]
* [[Follicular lymphoma]]
* [[Mantle cell lymphoma]]
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
|valign=top|
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'''Splenic marginal zone lymphoma'''
'''Splenic marginal zone lymphoma'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
'''Negative'''
* Deletion 7q, [[trisomy]] 3, [[trisomy]] 12, [[trisomy]] 18,
* Genes mutation [[NOTCH2]], NFkB pathway genes (BIRC3, [[TNFAIP3]], [[MAP3K14]], IKBKB, [[MYD88]] [[L265P]])
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
'''Negative'''
'''Negative'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
* [[CD20]]+, [[CD79a]]+[[IgM]]+
* [[CD11c]]+, [[IgD]]+, DBA44+ in more than 50% of the cases
* [[CD5]]+, [[CD25]]+, [[CD103]]+, [[IgG]]+ in less than 50% of the cases
|-
|-


| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Chronic lymphocytic leukemia'''
'''Splenic Diffuse red Pulp lymphoma'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
* Uncommon: 7q deletion, [[trisomy]] 18, 17p deletion ( [[TP53]])
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
'''Negative'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
* [[CD11c]]+,[[CD20]]+, [[CD79a]]+ DBA44+
* [[IgM]]+, [[IgD]]+, [[IgG]]+ in more than 50% of the cases
* [[CD5]]+, [[CD103]]+, [[CD123]]+ in less than 50% of the cases
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Follicular lymphoma'''
'''Hairy cell leukemia variant'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
* Common: Deletion 17p ( [[TP53]]),
* Uncommon: 5q gain, deletion 7q
* Gene mutation: [[MAP2K1]]
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
'''Positive'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
* [[CD11c]]+, [[ CD20]]+, [[CD79a]]+, [[CD103]]+, DBA44+
* [[IgG]]+ in more than 50% of the cases
* [[IgD]]+, [[IgM]]+ in less than 50% of the cases
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Splenic Diffuse red Pulp lymphoma'''
'''Hairy cell leukemia'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
* Uncommon: 5q gain, 7q deletion
* gene mutation: [[BRAF V600E]]
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
'''Negative'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
* [[CD11c]]+, [[CD20]]+, [[CD79a]]+, [[CD25]]+, [[CD103]]+, [[CD123]]+, [[Annexin A1]]+, [[IgM]]+, [[IgD]]+, [[IgG]]+
* [[CD10]]+ in less than 50% of the cases
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Hairy Celll Leukemia variant'''
'''lymphoplasmacytic lymphoma'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
* Common: 6q deletion,
* Uncommon: 13q deletion, 7q deletion
* Gene mutation: [[MYD88]] L265P
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
'''Positive'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
* [[CD11]]+,[[ CD20]]+, [[CD79a]]+ [[IgM]]+
* [[CD25]]+ in more than 50% of the cases
* [[CD5]]+ in less than 50% of the cases
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Mantle cell lymphoma'''
'''Chronic lymphocytic leukemia'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
'''Positive'''
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'''Negative'''
'''Negative'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
''' Positive'''
* [[IgM]]+, [[IgD]]+, [[CD5]]+, [[CD23]]+, [[CD43]]+, [[CD79a]]+, [[LEF1]]+
* [[CD20]]+, DBA44+ in less than 50%
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Hairy cell leukeia'''
'''Follicular lymphoma'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
* t(14;18) translocation
* gene mutation: BCL2
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
'''Positive'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
* [[IgM]]+, [[IgD]]+, [[CD20]]+, [[CD79a]]+, [[BCL6]]+
* [[CD10]]+ in more than 50%
* [[CD23]]+ in less than 50%
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Lymphoplasmocytic lymphoma'''
'''Mantle cell lymphoma'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Positive'''
* t (11;14) translocation
* Gene mutation: CCND1
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
'''Negative'''
'''Negative'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
''' Positive'''
* [[IgM]]+, [[IgD]]+, [[CD5]]+, [[CD20]]+, [[CD43]]+, [[CD79a]]+, [[BCL1]]+, [[SOX11]]+
* [[BCL6]]+ and [[LEF1]]+ in less than 50% for the cases
|}
|}



Revision as of 02:21, 2 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Overview

Splenic marginal zone lymphoma must be differentiated from other diseases such as chronic lymphocytic leukemia, follicular lymphoma, and mantle cell lymphoma.[1]

Differential Diagnosis

Splenic marginal zone lymphoma must be differentiated from other splenic B-cell lymphomas with the help of clinical, morphological, immunophenotypic and genetic data.[2][3][4][5][6][7][8][9][10][11]

Differential Diagnosis Cytogenetics Morphology Immunophenotype

Splenic marginal zone lymphoma

Negative

Splenic Diffuse red Pulp lymphoma

  • Uncommon: 7q deletion, trisomy 18, 17p deletion ( TP53)

Negative

Hairy cell leukemia variant

  • Common: Deletion 17p ( TP53),
  • Uncommon: 5q gain, deletion 7q
  • Gene mutation: MAP2K1

Positive

Hairy cell leukemia

  • Uncommon: 5q gain, 7q deletion
  • gene mutation: BRAF V600E

Negative

lymphoplasmacytic lymphoma

  • Common: 6q deletion,
  • Uncommon: 13q deletion, 7q deletion
  • Gene mutation: MYD88 L265P

Positive

Chronic lymphocytic leukemia

Positive

Negative

Follicular lymphoma

  • t(14;18) translocation
  • gene mutation: BCL2

Positive

Mantle cell lymphoma

  • t (11;14) translocation
  • Gene mutation: CCND1

Negative

References

  1. Splenic marginal zone lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf57e3e27c3994bd5327/. Accessed on January 14, 2016
  2. Matutes E, Oscier D, Montalban C, Berger F, Callet-Bauchu E, Dogan A, Felman P, Franco V, Iannitto E, Mollejo M, Papadaki T, Remstein ED, Salar A, Solé F, Stamatopoulos K, Thieblemont C, Traverse-Glehen A, Wotherspoon A, Coiffier B, Piris MA (March 2008). "Splenic marginal zone lymphoma proposals for a revision of diagnostic, staging and therapeutic criteria". Leukemia. 22 (3): 487–95. doi:10.1038/sj.leu.2405068. PMID 18094718.
  3. Salido M, Baró C, Oscier D, Stamatopoulos K, Dierlamm J, Matutes E, Traverse-Glehen A, Berger F, Felman P, Thieblemont C, Gesk S, Athanasiadou A, Davis Z, Gardiner A, Milla F, Ferrer A, Mollejo M, Calasanz MJ, Florensa L, Espinet B, Luño E, Wlodarska I, Verhoef G, García-Granero M, Salar A, Papadaki T, Serrano S, Piris MA, Solé F (September 2010). "Cytogenetic aberrations and their prognostic value in a series of 330 splenic marginal zone B-cell lymphomas: a multicenter study of the Splenic B-Cell Lymphoma Group". Blood. 116 (9): 1479–88. doi:10.1182/blood-2010-02-267476. PMID 20479288.
  4. Kiel MJ, Velusamy T, Betz BL, Zhao L, Weigelin HG, Chiang MY, Huebner-Chan DR, Bailey NG, Yang DT, Bhagat G, Miranda RN, Bahler DW, Medeiros LJ, Lim MS, Elenitoba-Johnson KS (August 2012). "Whole-genome sequencing identifies recurrent somatic NOTCH2 mutations in splenic marginal zone lymphoma". J. Exp. Med. 209 (9): 1553–65. doi:10.1084/jem.20120910. PMC 3428949. PMID 22891276.
  5. Rossi D, Trifonov V, Fangazio M, Bruscaggin A, Rasi S, Spina V, Monti S, Vaisitti T, Arruga F, Famà R, Ciardullo C, Greco M, Cresta S, Piranda D, Holmes A, Fabbri G, Messina M, Rinaldi A, Wang J, Agostinelli C, Piccaluga PP, Lucioni M, Tabbò F, Serra R, Franceschetti S, Deambrogi C, Daniele G, Gattei V, Marasca R, Facchetti F, Arcaini L, Inghirami G, Bertoni F, Pileri SA, Deaglio S, Foà R, Dalla-Favera R, Pasqualucci L, Rabadan R, Gaidano G (August 2012). "The coding genome of splenic marginal zone lymphoma: activation of NOTCH2 and other pathways regulating marginal zone development". J. Exp. Med. 209 (9): 1537–51. doi:10.1084/jem.20120904. PMC 3428941. PMID 22891273.
  6. Tiacci E, Trifonov V, Schiavoni G, Holmes A, Kern W, Martelli MP, Pucciarini A, Bigerna B, Pacini R, Wells VA, Sportoletti P, Pettirossi V, Mannucci R, Elliott O, Liso A, Ambrosetti A, Pulsoni A, Forconi F, Trentin L, Semenzato G, Inghirami G, Capponi M, Di Raimondo F, Patti C, Arcaini L, Musto P, Pileri S, Haferlach C, Schnittger S, Pizzolo G, Foà R, Farinelli L, Haferlach T, Pasqualucci L, Rabadan R, Falini B (June 2011). "BRAF mutations in hairy-cell leukemia". N. Engl. J. Med. 364 (24): 2305–15. doi:10.1056/NEJMoa1014209. PMID 21663470.
  7. Waterfall JJ, Arons E, Walker RL, Pineda M, Roth L, Killian JK, Abaan OD, Davis SR, Kreitman RJ, Meltzer PS (January 2014). "High prevalence of MAP2K1 mutations in variant and IGHV4-34-expressing hairy-cell leukemias". Nat. Genet. 46 (1): 8–10. doi:10.1038/ng.2828. PMC 3905739. PMID 24241536.
  8. Traverse-Glehen A, Baseggio L, Bauchu EC, Morel D, Gazzo S, Ffrench M, Verney A, Rolland D, Thieblemont C, Magaud JP, Salles G, Coiffier B, Berger F, Felman P (February 2008). "Splenic red pulp lymphoma with numerous basophilic villous lymphocytes: a distinct clinicopathologic and molecular entity?". Blood. 111 (4): 2253–60. doi:10.1182/blood-2007-07-098848. PMID 18042795.
  9. Braggio E, Dogan A, Keats JJ, Chng WJ, Huang G, Matthews JM, Maurer MJ, Law ME, Bosler DS, Barrett M, Lossos IS, Witzig TE, Fonseca R (May 2012). "Genomic analysis of marginal zone and lymphoplasmacytic lymphomas identified common and disease-specific abnormalities". Mod. Pathol. 25 (5): 651–60. doi:10.1038/modpathol.2011.213. PMC 3341516. PMID 22301699.
  10. Traverse-Glehen A, Bachy E, Baseggio L, Callet-Bauchu E, Gazzo S, Verney A, Hayette S, Jallades L, Ffrench M, Salles G, Coiffier B, Felman P, Berger F (May 2013). "Immunoarchitectural patterns in splenic marginal zone lymphoma: correlations with chromosomal aberrations, IGHV mutations, and survival. A study of 76 cases". Histopathology. 62 (6): 876–93. doi:10.1111/his.12092. PMID 23611359.
  11. Xi L, Arons E, Navarro W, Calvo KR, Stetler-Stevenson M, Raffeld M, Kreitman RJ (April 2012). "Both variant and IGHV4-34-expressing hairy cell leukemia lack the BRAF V600E mutation". Blood. 119 (14): 3330–2. doi:10.1182/blood-2011-09-379339. PMC 3321859. PMID 22210875.

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