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Topic:Histopathology

Histopathology in horses involves the microscopic examination of tissue samples to study the manifestations of disease. This field provides insights into the structural and cellular changes that occur in equine tissues as a result of various pathological conditions. Common applications of histopathology in equine medicine include the diagnosis of neoplastic, inflammatory, and degenerative diseases. Techniques such as tissue staining and immunohistochemistry are employed to identify specific cellular components and pathological markers. This page aggregates peer-reviewed research studies and scholarly articles that explore the methodologies, findings, and implications of histopathological investigations in equine health.
B-cell multicentric lymphoma as a probable cause of abortion in a Quarter horse broodmare.
The Canadian veterinary journal = La revue veterinaire canadienne    September 3, 2013   Volume 54, Issue 3 288-291 
Canisso IF, Pinn TL, Gerdin JA, Ollivett TL, Buckles EL, Schweizer CM, Ainsworth DM.A 5-year-old Quarter horse broodmare was evaluated for inappetence, depression, and diarrhea 13 days after aborting a 9-month gestation fetus. Clinical and laboratory examination ruled out uterine rupture and peritonitis. Ultrasonography of the uterus combined with cytological analysis of peritoneal fluid suggested the existence of diffuse lymphoma. A multicentric B-cell lymphoma involving the uterus and ovary was confirmed at necropsy and histopathological examination. Lymhome multicentrique à cellules B comme cause possible d’avortement chez une jument poulinière Quarter Horse. Une jumen...
Non-neoplastic lesions of equine skin in the central United States and Canada: a retrospective study.
The Canadian veterinary journal = La revue veterinaire canadienne    September 3, 2013   Volume 54, Issue 3 262-266 
Schaffer PA, Wobeser B, Dennis MM, Duncan CG.A retrospective study evaluated the clinical data and histologic features of non-neoplastic dermatologic lesions in skin biopsies from horses, donkeys, and mules submitted over a 10-year period to the Colorado State University Diagnostic Medicine Center and to the University of Saskatchewan Western College of Veterinary Medicine and Prairie Diagnostic Services. A total of 1793 non-neoplastic biopsies were available for analysis. Based on the histologic description and morphologic diagnosis, each submission was classified as inflammatory, or non-neoplastic/non-inflammatory. Results of this stud...
Intradiploic hematoma of the frontal bone with secondary exophthalmos in a mare.
Veterinary ophthalmology    August 18, 2013   Volume 17 Suppl 1 168-173 doi: 10.1111/vop.12091
Kafarnik C, Donaldson D, Payne R, Holloway A.A 13-year-old cob mare was presented with exophthalmos and periocular swelling of the left eye. The diagnostic work-up included ocular ultrasound, sonographic examination through the thinned frontal bone, radiography, standing computed tomography of the skull and exploratory osteoplastic surgery. Histopathology was consistent with an organized hematoma. An intradiploic hematoma of the frontal bone was diagnosed 5 years after head trauma, with progressive expansion and deformation of the skull resulting in exophthalmos. Exophthalmos with facial bone deformation was the only clinical finding of ...
Candida osteomyelitis in a gelding.
The Canadian veterinary journal = La revue veterinaire canadienne    August 2, 2013   Volume 54, Issue 2 176-178 
Doyle A, López A, Pack L, Muckle A.A 2-year-old gelding was referred for evaluation of severe right forelimb lameness. The horse was grade 4/5 lame on the right forelimb. Clinical, laboratory, and radiographic findings were consistent with septic arthritis and osteomyelitis. Due to poor prognosis the owner elected euthanasia. Histopathology confirmed chronic arthritis and osteomyelitis with intralesional yeast (Candida species). Ostéomyélite àCandidachez un hongre. Un hongre âgé de 2 ans a été référé pour l’évaluation d’une boiterie grave du membre antérieur droit. Le cheval avait une boiterie de stade 4/5 du me...
Leukemic small cell lymphoma or chronic lymphocytic leukemia in a horse.
Veterinary clinical pathology    August 2, 2013   Volume 42, Issue 3 301-306 doi: 10.1111/vcp.12057
Cian F, Tyner G, Martini V, Comazzi S, Archer J.A 16-year-old, Irish Draft mare was admitted to the referring veterinarian for an annual health check. A mild generalized lymphadenomegaly was noted. Rectal palpation and transrectal ultrasonographic examination revealed prominent mesenteric lymph nodes. A transcutaneous abdominal ultrasonographic evaluation was unremarkable. A CBC revealed a marked leukocytosis (63.06 × 10(3)/μL) and lymphocytosis (58.2 × 10(3)/μL) due to increased numbers of small lymphocytes. No evidence of anemia or thrombocytopenia was found and neutrophil counts were low-normal. Cytologic examination of fine-needle a...
Mast cell tumor invading the cornea in a horse.
Veterinary ophthalmology    August 1, 2013   Volume 17, Issue 3 221-227 doi: 10.1111/vop.12084
Halse S, Pizzirani S, Parry NM, Burgess KE.A 3-year-old Marwari mare was presented for evaluation of an irregular, reddish mass protruding from behind the right third eyelid. The mass appeared to arise at the ventral limbal area, involved the perilimbal bulbar conjunctiva and widely extended into corneal tissue. No other ocular or systemic abnormalities were detected at the time of presentation. The mass was surgically removed by lamellar keratectomy, with defocused CO(2) laser used as adjunctive therapy to treat the surgical exposed area and its surroundings. Histopathologic evaluation showed sheets of densely packed, well-differentia...
Equine tendonitis therapy using mesenchymal stem cells and platelet concentrates: a randomized controlled trial.
Stem cell research & therapy    July 22, 2013   Volume 4, Issue 4 85 doi: 10.1186/scrt236
Carvalho Ade M, Badial PR, Álvarez LE, Yamada AL, Borges AS, Deffune E, Hussni CA, Garcia Alves AL.Tendon injury is a major cause of lameness and decreased performance in athletic equines. Various therapies for tendonitis have been described; however, none of these therapies results in complete tissue regeneration, and the injury recurrence rate is high even after long recovery periods involving rest and physiotherapy. Methods: A lesion was induced with collagenase gel in the superficial digital flexor tendon in the center portion of the metacarpal region of eight equines of mixed breed. After two weeks, the lesions of the animals in the treated and control groups were treated through the i...
Equine glaucoma: a histopathologic retrospective study (1999-2012).
Veterinary ophthalmology    July 16, 2013   Volume 17, Issue 5 334-342 doi: 10.1111/vop.12080
Curto EM, Gemensky-Metzler AJ, Chandler HL, Wilkie DA.To characterize and describe the histopathologic findings in equine globes enucleated due to glaucoma. Methods: Medical records at The Ohio State University from 1999 to 2012 were reviewed retrospectively. Signalment, history, and treatment data were collected, and histologic slides of enucleated globes were examined and lesions recorded. Twenty-three eyes from 23 horses were eligible for inclusion in this study. Results: The majority of affected horses were > 15 years of age (65%). The ages ranged from 5 to 35 years (mean = 17.4 years). The left eye was affected in 10 cases (43%) and the righ...
Dysphagia caused by focal guttural pouch mycosis: mononeuropathy of the pharyngeal ramus of the vagal nerve in a 20-year-old pony mare.
Irish veterinary journal    July 11, 2013   Volume 66, Issue 1 13 doi: 10.1186/2046-0481-66-13
Eichentopf A, Snyder A, Recknagel S, Uhlig A, Waltl V, Schusser GF.A 20-year-old pony mare was presented to the equine hospital with a ten-day history of dysphagia, regurgitation and coughing. An obstruction of the oesophagus was excluded via endoscopy, but the proximal oesophagus appeared to be distended and circular contractions were missing. A guttural pouch endoscopy revealed a single, black-mottled plaque on the pharyngeal ramus of the vagus nerve in the left guttural pouch, causing a local swelling of this nerve. The pharyngeal ramus seemed to be atrophic distal to the lesion. A biopsy was taken from the lesion and histopathological findings proved the ...
Evidence for novel hepaciviruses in rodents.
PLoS pathogens    June 20, 2013   Volume 9, Issue 6 e1003438 doi: 10.1371/journal.ppat.1003438
Drexler JF, Corman VM, Müller MA, Lukashev AN, Gmyl A, Coutard B, Adam A, Ritz D, Leijten LM, van Riel D, Kallies R, Klose SM, Gloza-Rausch F....Hepatitis C virus (HCV) is among the most relevant causes of liver cirrhosis and hepatocellular carcinoma. Research is complicated by a lack of accessible small animal models. The systematic investigation of viruses of small mammals could guide efforts to establish such models, while providing insight into viral evolutionary biology. We have assembled the so-far largest collection of small-mammal samples from around the world, qualified to be screened for bloodborne viruses, including sera and organs from 4,770 rodents (41 species); and sera from 2,939 bats (51 species). Three highly divergent...
Multiple glucagon-producing pancreatic neuroendocrine tumors in a horse (Equus caballus).
Veterinary pathology    June 17, 2013   Volume 51, Issue 3 607-611 doi: 10.1177/0300985813492803
Herbach N, Nagel L, Zwick T, Hermanns W.Pancreatic neuroendocrine tumors of glucagon-producing cells are extremely rare in domestic animals. In this report, we describe for the first time, to our knowledge, the incidental finding of multiple glucagon-producing neuroendocrine tumors of the pancreas of a horse. The animal was euthanized due to severe local infection after tooth extraction. On postmortem examination, multiple white nodules of up to 4 cm in diameter were observed in the pancreas. Histologically, pancreatic nodules had the appearance of neuroendocrine neoplasms with positive immunoreactivity for glucagon, synaptophysin, ...
[Metastatic malignant melanoma with spinal cord compression and resulting recumbency ante partum in a mare. A case report].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    June 15, 2013   Volume 41, Issue 3 190-194 
Hildebrandt L, Jäger K, Snyder A, Sobiraj A.The case report describes a narrowing of the spinal canal in the lumbar and sacroiliac regions with entailing acute recumbency in a nearterm 17-year-old Welsh B Pony mare. The reason for recumbency was metastases of a malignant melanoma in the spinal canal of the lumbo-sacral region, where the tumour had invaded the dura mater and applied severe pression on the spinal cord over a length of 10 cm. Clinical findings, laboratory diagnostics, pathological-anatomical and histopathological findings are presented.
Myxochondroid metaplasia of the plantar foot: a distinctive pseudoneoplastic lesion resembling nuchal fibrocartilaginous pseudotumor and the equine digital cushion.
Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc    June 14, 2013   Volume 26, Issue 12 1561-1567 doi: 10.1038/modpathol.2013.116
Shon W, Folpe AL.Cartilaginous tumors of soft tissue are uncommon, with benign chondromas of soft parts greatly outnumbering rare soft-tissue chondrosarcomas. Over the past several years, we have seen in consultation a distinctive, benign-appearing chondroid soft-tissue lesion of the plantar foot that differs in a number of respects from chondroma of soft parts. Herein we report our experience with this distinctive lesion. A retrospective review of all cases from the foot in our soft-tissue consultation and institutional surgical pathology archives identified 9 similar cases, most often previously coded as 'fi...
Readability and histological biocompatibility of microchip transponders in horses.
Veterinary journal (London, England : 1997)    June 12, 2013   Volume 198, Issue 1 103-108 doi: 10.1016/j.tvjl.2013.04.028
Wulf M, Wohlsein P, Aurich JE, Nees M, Baumgärtner W, Aurich C.Identification of horses by microchip transponder is mandatory within the European Union with only a few exceptions. In this study, the readability of such microchips in 428 horses with three different scanners (A, B and C) and the histological changes at the implantation site in 16 animals were assessed. Identification of microchips differed between scanners (P<0.001), and with 'side of neck' (P<0.001). Scanners A, B and C identified 93.5%, 89.7% and 100% of microchips, respectively, on the 'chip-bearing' side of the neck. From the contralateral side, scanners A, B a...
Colour analysis of the equine endometrium: comparison of spectrophotometry and computer-assisted analysis of photographs within the L*a*b* colour space system.
Veterinary journal (London, England : 1997)    May 23, 2013   Volume 197, Issue 3 753-760 doi: 10.1016/j.tvjl.2013.04.013
Neuhauser S, Handler J.The aims of this study were to compare two different methods of quantifying the colour of the luminal surface of the equine endometrium and to relate the results to histopathological evidence of inflammation and fibrosis. The mucosal surfaces of 17 equine uteri obtained from an abattoir were assessed using a spectrophotometer and by computer-assisted analysis of photographs. Values were converted into L(*)a(*)b(*) colour space. Although there was significant correlation between the two methods of quantification, variations in 'brightness', 'red' and 'yellow' values were noted. Within a given u...
Jejunal intussusception associated with lymphoma in a horse.
The Journal of veterinary medical science    April 30, 2013   Volume 75, Issue 9 1253-1256 doi: 10.1292/jvms.13-0060
Matsuda K, Shimada T, Kawamura Y, Sakaguchi K, Tagami M, Taniyama H.A 2-year-old Thoroughbred horse presented with acute onset of colitis, and the intussuscepted jejunum was surgically resected. A transmural mass protruding into the lumen was found at the leading edge of the intussusceptum. Based on histological and immunohistochemical examinations, the mass was diagnosed as diffuse large B-cell lymphoma with metastasis to the mesenteric lymph nodes. Anatomical localization of the mass in the intussusception and absence of other obvious underlying diseases indicated that the intussusception had occurred in association with the mass. To our knowledge, this case...
Vacuolar myopathy in an adult Warmblood horse.
Neuromuscular disorders : NMD    April 23, 2013   Volume 23, Issue 6 473-477 doi: 10.1016/j.nmd.2013.03.007
Massey CA, Walmsley GL, Gliddon TP, Piercy RJ.Histopathological interpretation of semimembranosus muscle samples from an adult Warmblood mare with clinical signs suggestive of exertional rhabdomyolysis and intermittent mild elevations in muscle enzyme activities revealed abundant sarcoplasmic vacuoles in all fibre-types containing fine, apparently proteinaceous debris. Vacuolar contents stained lightly with PAS, but did not appear to contain amylopectate, lipid or acid phosphatase and their periphery was unstained with dystrophin immunohistochemistry. Electron microscopy revealed that vacuoles were not membrane bound. No vacuoles were det...
A histomorphological analysis of human and non-human femora.
International journal of legal medicine    April 21, 2013   Volume 128, Issue 2 369-377 doi: 10.1007/s00414-013-0854-3
Brits D, Steyn M, L'Abbé EN.Histology is used to describe post-mortem bone alterations, trauma, pathology and age estimation and to separate human and non-human bones. Many scholars are however not familiar with the intricate and variable microstructure of bone, and due to the complex nature of some classification systems, bone histomorphology is often incorrectly described or identified. Little information is available on the histomorphology of non-human bones found in southern Africa, and therefore, the aim of this study was to describe the histomorphology of non-human species commonly found in southern Africa, namely,...
Histopathologic findings in the sacrocaudalis dorsalis medialis muscle of horses with vitamin E-responsive muscle atrophy and weakness.
Journal of the American Veterinary Medical Association    April 4, 2013   Volume 242, Issue 8 1127-1137 doi: 10.2460/javma.242.8.1127
Bedford HE, Valberg SJ, Firshman AM, Lucio M, Boyce MK, Trumble TN.To characterize clinical findings, outcomes, muscle characteristics, and serum or muscle concentrations of α-tocopherol for horses with vitamin E-responsive signs of muscle atrophy and weakness consistent with signs of equine motor neuron disease (EMND). Methods: Retrospective case-control study. Methods: 8 affected (case) adult horses with acute (n = 3) or chronic (5) gross muscle atrophy that improved with vitamin E treatment and 14 clinically normal (control) adult horses with adequate (within reference range; 8) or low (6) muscle concentrations of α-tocopherol. Methods: Medical records w...
Vascular abnormalities of the distal deep digital flexor tendon in 8 draught horses identified on histological examination.
Research in veterinary science    March 30, 2013   Volume 95, Issue 1 23-26 doi: 10.1016/j.rvsc.2013.03.006
Crişan MI, Damian A, Gal A, Miclăuş V, Cernea CL, Denoix JM.The purpose of this study was to provide a detailed description of the vascular changes in the distal part of deep digital flexor tendon (DDFT). Eight isolated forelimbs were collected from 8 horses with DDF tendinopathy diagnosed post-mortem by ultrasound and gross anatomopathological examination. The samples were fixed in 10% neutral buffered formalin, softened in 4% phenol and dehydrated with ethylic alcohol. Goldner's Trichrome staining method was used. The histopathological examination revealed vascular proliferation associated with structural disorders of blood vessels. Angiogenesis, fib...
Histomorphometric evaluation of the effect of early exercise on subchondral vascularity in the third carpal bone of horses.
American journal of veterinary research    March 28, 2013   Volume 74, Issue 4 542-549 doi: 10.2460/ajvr.74.4.542
Kim W, McArdle BH, Kawcak CE, McIlwraith CW, Firth EC, Broom ND.To investigate histomorphometric changes in the cartilage and subchondral bone of the third carpal bone associated with conditioning exercise in young Thoroughbreds. Methods: Nine 18-month-old Thoroughbreds. Procedures-Both third carpal bones of 9 horses (4 exercised spontaneously at pasture only and 5 given additional conditioning exercise beginning at a mean age of 3 weeks) were evaluated. Histomorphometric variables (hyaline and calcified cartilage thickness and collagen orientation; vascular channel area, number, and orientation; and osteochondral junction rugosity) of the third carpal bon...
Expression of 11β-HSD in steroid-induced avascular necrosis of the femoral head.
Molecular medicine reports    March 28, 2013   Volume 7, Issue 5 1482-1486 doi: 10.3892/mmr.2013.1401
Wang L, Luo DK, Pan ZY.The aim of the present study was to investigate the association between glucocorticoid receptors and steroid‑induced avascular necrosis of the femoral head (SANFH). Healthy New Zealand rabbits were randomly divided into 3 groups (n=16/group); the normal (no treatment), control (horse serum injections) and treatment (horse serum and methylprednisolone injections) groups. Methylprednisolone and horse serum injections were used to establish a SANFH model in rabbits; magnetic resonance imaging (MRI) and histopathological analysis were used to evaluate the SANFH rabbit model. Total cholesterol an...
Equine multisystemic eosinophilic epitheliotropic disease: a case report and review of literature.
New Zealand veterinary journal    February 27, 2013   Volume 61, Issue 3 177-182 doi: 10.1080/00480169.2012.753569
Bosseler L, Verryken K, Bauwens C, de Vries C, Deprez P, Ducatelle R, Vandenabeele S.A 2-year-old Standardbred gelding presented with a history of fever over 1 week, anorexia and skin lesions on all four legs. The lesions were associated with severe pruritus and oedema, and there was no response to therapy. Results: The horse was in poor body condition, was lethargic and severely pruritic. Skin lesions consisted of diffuse alopecia and crusting of the distal extremities. Initially it was slightly febrile, but subsequently its temperature increased up to 40°C. Ten days after admission it developed profuse watery diarrhoea and the skin lesions progressed. Skin biopsies revealed...
Equestrian chilblain: another outdoor recreational hazard.
Journal of cutaneous pathology    February 22, 2013   Volume 40, Issue 5 485-490 doi: 10.1111/cup.12082
Yang AY, Schwartz L, Divers AK, Sternberg L, Lee JB.Herein, we describe two cases and review 14 cases of equestrian chilblain or 'equestrian cold panniculitis' in the literature. The first, a 23-year-old healthy female horse trainer, presented with burning nodular swelling on her lateral thighs. The second was a 34-year-old healthy woman with recurrent nodular eruption on the lateral thighs after horseback riding in the winter. Physical examination of both patients revealed erythematous to violaceous nodules with eczema craquelé-like changes. Laboratory workup for systemic and autoimmune connective tissue disease was negative. Punch biopsies f...
In equine grass sickness, serum amyloid A and fibrinogen are elevated, and can aid differential diagnosis from non-inflammatory causes of colic.
The Veterinary record    February 21, 2013   Volume 172, Issue 15 395 doi: 10.1136/vr.101224
Copas VE, Durham AE, Stratford CH, McGorum BC, Waggett B, Pirie RS.Equine grass sickness (EGS) is a debilitating and often fatal neurodegenerative disease. A presumptive diagnosis of EGS may be made on the basis of clinical signs and subjective ancillary tests, but a definitive antemortem diagnosis can only be made following histopathological examination of intestinal biopsies. It has previously been reported that horses with EGS may show clinical and clinicopathological signs of systemic inflammation. The objective of this study was to (a) quantify acute inflammatory markers in blood samples collected from acute, subacute and chronic EGS cases, and (b) compa...
Histiocytic sarcoma of the nasal cavity in a horse.
Research in veterinary science    February 8, 2013   Volume 94, Issue 3 648-650 doi: 10.1016/j.rvsc.2013.01.005
Paciello O, Passantino G, Costagliola A, Papparella S, Perillo A.Histiocytic diseases in veterinary medicine have been revised in the last few decades, but these are considered relatively rare in horses. This report describes a 9-year-old female horse, Dutch Warmblood, presented for investigation of severe nasal bleeding. A multinodular bilateral mass of 5 cm, reddish to white in color, that invaded and destroyed the surrounding tissues, was observed during a clinical examination of the nostril The morphological features of the tumor cells were represented by cytologically bizarre, highly phagocytic, multinucleated giant cells. These findings, together with...
Distribution of venous remodeling in exercise-induced pulmonary hemorrhage of horses follows reported blood flow distribution in the equine lung.
Journal of applied physiology (Bethesda, Md. : 1985)    January 31, 2013   Volume 114, Issue 7 869-878 doi: 10.1152/japplphysiol.01170.2012
Williams KJ, Robinson NE, Defeijter-Rupp H, Millerick-May M, Stack A, Hauptman J, Derksen FJ.Exercise-induced pulmonary hemorrhage (EIPH), which has been reported in humans and a variety of domestic animals following strenuous exercise, is most often documented in racehorses. Remodeling of pulmonary veins (VR) in equine EIPH was recently described, suggesting that it contributes to the pathogenesis of the disease. The cause of VR is unknown. We tested the hypothesis that the development of VR follows pulmonary blood flow distribution, preferentially occurring in the caudodorsal lung region. Furthermore, we hypothesized that VR underpins development of the other lesions of EIPH patholo...
The feral horse foot. Part B: radiographic, gross visual and histopathological parameters of foot health in 100 Australian feral horses.
Australian veterinary journal    January 30, 2013   Volume 91, Issue 1-2 23-30 doi: 10.1111/avj.12017
Hampson BA, de Laat MA, Mills PC, Walsh DM, Pollitt CC.It has been proposed that the feral horse foot is a benchmark model for foot health in horses. However, the foot health of feral horses has not been formally investigated. Objective: To investigate the foot health of Australian feral horses and determine if foot health is affected by environmental factors, such as substrate properties and distance travelled. Methods: Twenty adult feral horses from five populations (n = 100) were investigated. Populations were selected on the basis of substrate hardness and the amount of travel typical for the population. Feet were radiographed and photographed...
Pemphigus vulgaris in a Welsh pony stallion: case report and demonstration of antidesmoglein autoantibodies.
Veterinary dermatology    January 25, 2013   Volume 24, Issue 2 269-e60 doi: 10.1111/vde.12002
Winfield LD, White SD, Affolter VK, Renier AC, Dawson D, Olivry T, Outerbridge CA, Wang YH, Iyori K, Nishifuji K.To describe the clinical, histological and immunological findings of an equine case of pemphigus vulgaris, including the demonstration of antidesmoglein (anti-Dsg) autoantibodies. Methods: The diagnosis of pemphigus vulgaris was confirmed in a 9-year-old Welsh pony stallion with both direct and indirect immunofluorescence and immunoprecipitation studies, the latter identifying circulating anti-Dsg3 IgG. Treatment with immunosuppressive medications was initiated. Lesions were seen in the perineal area, sheath, mane, tail, eyelids, coronary bands and mucosa of the mouth and oesophagus. Initial c...
Equine sarcoidosis: clinical signs, diagnosis, treatment and outcome of 22 cases.
Veterinary dermatology    January 22, 2013   Volume 24, Issue 1 218-24.e48 doi: 10.1111/j.1365-3164.2012.01108.x
Sloet van Oldruitenborgh-Oosterbaan MM, Grinwis GC.Equine sarcoidosis may present as a generalized or localized exfoliative dermatitis and/or as a granulomatous inflammation of multiple organs. Objective: To report the clinical signs, diagnosis, treatment and outcome for 22 horses with histologically confirmed sarcoidosis. Methods: Twenty-two horses of different breeds, between 3 and 17 years of age. Methods: Diagnosis was based on clinical signs and histopathological findings. Results: The following three forms of equine sarcoidosis were identified: generalized (13.6%), partially generalized (18.2%) and localized (68.2%). High-dose systemic c...
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