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1.
Elife ; 132024 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-39037770

RESUMO

Bats have unique characteristics compared to other mammals, including increased longevity and higher resistance to cancer and infectious disease. While previous studies have analyzed the metabolic requirements for flight, it is still unclear how bat metabolism supports these unique features, and no study has integrated metabolomics, transcriptomics, and proteomics to characterize bat metabolism. In this work, we performed a multi-omics data analysis using a computational model of metabolic fluxes to identify fundamental differences in central metabolism between primary lung fibroblast cell lines from the black flying fox fruit bat (Pteropus alecto) and human. Bat cells showed higher expression levels of Complex I components of electron transport chain (ETC), but, remarkably, a lower rate of oxygen consumption. Computational modeling interpreted these results as indicating that Complex II activity may be low or reversed, similar to an ischemic state. An ischemic-like state of bats was also supported by decreased levels of central metabolites and increased ratios of succinate to fumarate in bat cells. Ischemic states tend to produce reactive oxygen species (ROS), which would be incompatible with the longevity of bats. However, bat cells had higher antioxidant reservoirs (higher total glutathione and higher ratio of NADPH to NADP) despite higher mitochondrial ROS levels. In addition, bat cells were more resistant to glucose deprivation and had increased resistance to ferroptosis, one of the characteristics of which is oxidative stress. Thus, our studies revealed distinct differences in the ETC regulation and metabolic stress responses between human and bat cells.


Assuntos
Quirópteros , Fibroblastos , Quirópteros/metabolismo , Humanos , Fibroblastos/metabolismo , Animais , Metabolômica , Espécies Reativas de Oxigênio/metabolismo , Proteômica/métodos , Linhagem Celular , Consumo de Oxigênio , Multiômica
2.
Nat Cancer ; 5(5): 701-715, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38698089

RESUMO

Metabolic changes contribute to cancer initiation and progression through effects on cancer cells, the tumor microenvironment and whole-body metabolism. Alterations in serine metabolism and the control of one-carbon cycles have emerged as critical for the development of many tumor types. In this Review, we focus on the mitochondrial folate cycle. We discuss recent evidence that, in addition to supporting nucleotide synthesis, mitochondrial folate metabolism also contributes to metastasis through support of antioxidant defense, mitochondrial protein synthesis and the overflow of excess formate. These observations offer potential therapeutic opportunities, including the modulation of formate metabolism through dietary interventions and the use of circulating folate cycle metabolites as biomarkers for cancer detection.


Assuntos
Ácido Fólico , Mitocôndrias , Neoplasias , Humanos , Ácido Fólico/metabolismo , Neoplasias/metabolismo , Mitocôndrias/metabolismo , Animais , Formiatos/metabolismo , Microambiente Tumoral , Metástase Neoplásica
3.
Cell Rep ; 42(6): 112562, 2023 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-37245210

RESUMO

Mitochondrial 10-formyltetrahydrofolate (10-formyl-THF) is utilized by three mitochondrial enzymes to produce formate for nucleotide synthesis, NADPH for antioxidant defense, and formyl-methionine (fMet) to initiate mitochondrial mRNA translation. One of these enzymes-aldehyde dehydrogenase 1 family member 2 (ALDH1L2)-produces NADPH by catabolizing 10-formyl-THF into CO2 and THF. Using breast cancer cell lines, we show that reduction of ALDH1L2 expression increases ROS levels and the production of both formate and fMet. Both depletion of ALDH1L2 and direct exposure to formate result in enhanced cancer cell migration that is dependent on the expression of the formyl-peptide receptor (FPR). In various tumor models, increased ALDH1L2 expression lowers formate and fMet accumulation and limits metastatic capacity, while human breast cancer samples show a consistent reduction of ALDH1L2 expression in metastases. Together, our data suggest that loss of ALDH1L2 can support metastatic progression by promoting formate and fMet production, resulting in enhanced FPR-dependent signaling.


Assuntos
Neoplasias da Mama , Formiatos , Oxirredutases atuantes sobre Doadores de Grupo CH-NH , Feminino , Humanos , Neoplasias da Mama/metabolismo , Formiatos/metabolismo , Metionina , NADP , Espécies Reativas de Oxigênio , Oxirredutases atuantes sobre Doadores de Grupo CH-NH/metabolismo
4.
J Cell Sci ; 135(15)2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35775474

RESUMO

Accelerated aerobic glycolysis is a distinctive metabolic property of cancer cells that confers dependency on glucose for survival. However, the therapeutic strategies targeting this vulnerability are still inefficient and have unacceptable side effects in clinical trials. Therefore, developing biomarkers to predict therapeutic efficacy would be essential to improve the selective targeting of cancer cells. Here, we found that cell lines that are sensitive to glucose deprivation have high expression of cystine/glutamate antiporter xCT (also known as SLC7A11). We found that cystine uptake and glutamate export through xCT contributed to rapid NADPH depletion under glucose deprivation. This collapse of the redox system oxidized and inactivated AMP-activated protein kinase (AMPK), a major regulator of metabolic adaptation, resulting in a metabolic catastrophe and cell death. Although this phenomenon was prevented by pharmacological or genetic inhibition of xCT, overexpression of xCT sensitized resistant cancer cells to glucose deprivation. Taken together, these findings suggest a novel crosstalk between AMPK and xCT that links metabolism and signal transduction, and reveal a metabolic vulnerability to glucose deprivation in cancer cells expressing high levels of xCT.


Assuntos
Cistina , Neoplasias , Proteínas Quinases Ativadas por AMP/metabolismo , Sistema y+ de Transporte de Aminoácidos/genética , Sistema y+ de Transporte de Aminoácidos/metabolismo , Linhagem Celular Tumoral , Cistina/metabolismo , Glucose/metabolismo , Ácido Glutâmico/metabolismo , Neoplasias/genética , Oxirredução
5.
Eur Radiol ; 31(10): 7594-7604, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33876298

RESUMO

OBJECTIVES: According to LI-RADS, a major discriminating feature between hepatocellular carcinoma (HCC) and non-HCC malignancies is the subtype of arterial phase hyperenhancement (APHE). The aim of this study was to investigate whether APHE subtypes are consistent across multi-arterial phase (mHAP) MRI acquisitions while evaluating reader agreement. Secondarily, we investigated factors that may affect reader agreement for APHE subtype. METHODS: In this retrospective study, consecutive patients with liver cirrhosis and focal observations who underwent mHAP were included. Five radiologists reviewed MR images in 2 reading sessions. In reading session 1, individual AP series were reviewed and scored for presence of APHE and subtype. In reading session 2, readers scored observations' major and ancillary features and LI-RADS category in the complete MRI examination. Reader agreement was calculated using Fleiss' kappa for binary outcomes and Kendall's coefficient of concordance for LI-RADS categories. Univariate mixed effects logistic regressions were performed to investigate factors affecting agreement. RESULTS: In total, 61 patients with 77 focal observations were analyzed. Of observations unanimously scored as having APHE, 27.7% showed both rim and nonrim subtypes on mHAP. Inter-reader agreement for APHE subtype ranged from 0.49 (95% CI: 0.33, 0.64) to 0.57 (95% CI: 0.40, 0.74) between reading sessions. Observation size had a trend level effect on rim APHE agreement (p = 0.052). CONCLUSION: Approximately 1/3 of observations demonstrated inconsistent APHE subtype during mHAP acquisition. Small lesions were particularly challenging. Further guidance on APHE subtype classification, especially when applied to mHAP, could be a focus of LI-RADS refinement. KEY POINTS: • In a cohort of patients at risk for HCC, 28% of the observations showed inconsistent arterial phase hyperenhancement (APHE) subtypes (rim and nonrim) on multi-arterial phase imaging according to the majority score of 5 independent readers. • Inconsistent APHE subtypes may challenge reliable imaging diagnosis, i.e., LI-RADS categorization, of focal liver observations in patients at risk for HCC.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Meios de Contraste , Humanos , Fígado , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Mol Brain ; 13(1): 88, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513210

RESUMO

Microglia are macrophages resident in the central nervous system. C-X3-C motif chemokine receptor 1 (CX3CR1) is a Gαi-coupled seven-transmembrane protein exclusively expressed in the mononuclear phagocyte system including microglia, as well as intestinal and kidney macrophages. Cx3cr1CreERT2 mice express Cre recombinase in a tamoxifen-inducible manner and have been widely used to delete target genes in microglia, since microglia are long-lived cells and outlive peripheral macrophages, which continuously turn over and lose their gene modification over time. ATG7 is an E1-like enzyme that plays an essential role in two ubiquitin-like reactions, ATG12-ATG5 conjugation and LC3-lipidation in autophagy. To study the role of ATG7 in adult microglia, we generated Cx3cr1CreERT2:Atg7fl/fl mice and deleted Atg7 at the age of 8 weeks, and found induction of intestinal adhesion. Since intestinal adhesion is caused by excessive inflammation, these results suggest that deletion of Atg7 in intestinal macrophages even for a short time results in inflammation that cannot be rescued by replenishment with wild-type intestinal macrophages. Our finding suggests that, depending on the roles of the gene, Cx3cr1-Cre-mediated gene deletion may yield unanticipated physiological outcomes outside the central nervous system, and careful necropsy is necessary to assure the microglia-specific roles of the target gene.


Assuntos
Proteína 7 Relacionada à Autofagia/metabolismo , Receptor 1 de Quimiocina CX3C/metabolismo , Deleção de Genes , Integrases/metabolismo , Intestinos/patologia , Aderências Teciduais/genética , Animais , Camundongos , Tamoxifeno/farmacologia
7.
Autophagy ; 15(5): 753-770, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30523761

RESUMO

Macroautophagy/autophagy is a lysosome-dependent catabolic process for the turnover of proteins and organelles in eukaryotes. Autophagy plays an important role in immunity and inflammation, as well as metabolism and cell survival. Diverse immune and inflammatory signals induce autophagy in macrophages through pattern recognition receptors, such as toll-like receptors (TLRs). However, the physiological role of autophagy and its signaling mechanisms in microglia remain poorly understood. Microglia are phagocytic immune cells that are resident in the central nervous system and share many characteristics with macrophages. Here, we show that autophagic flux and expression of autophagy-related (Atg) genes in microglia are significantly suppressed upon TLR4 activation by lipopolysaccharide (LPS), in contrast to their stimulation by LPS in macrophages. Metabolomics analysis of the levels of phosphatidylinositol (PtdIns) and its 3-phosphorylated form, PtdIns3P, in combination with bioinformatics prediction, revealed an LPS-induced reduction in the synthesis of PtdIns and PtdIns3P in microglia but not macrophages. Interestingly, inhibition of PI3K, but not MTOR or MAPK1/3, restored autophagic flux with concomitant dephosphorylation and nuclear translocation of FOXO3. A constitutively active form of FOXO3 also induced autophagy, suggesting FOXO3 as a downstream target of the PI3K pathway for autophagy inhibition. LPS treatment impaired phagocytic capacity of microglia, including MAP1LC3B/LC3-associated phagocytosis (LAP) and amyloid ß (Aß) clearance. PI3K inhibition restored LAP and degradation capacity of microglia against Aß. These findings suggest a unique mechanism for the regulation of microglial autophagy and point to the PI3K-FOXO3 pathway as a potential therapeutic target to regulate microglial function in brain disorders. Abbreviations: Atg: autophagy-related gene; Aß: amyloid-ß; BafA1: bafilomycin A1; BECN1: beclin 1, autophagy related; BMDM: bone marrow-derived macrophage; CA: constitutively active; CNS: central nervous system; ZFYVE1/DFCP1: zinc finger, FYVE domain containing 1; FOXO: forkhead box O; ELISA:enzyme-linked immunosorbent assay; HBSS: Hanks balanced salt solution; LAP: LC3-associated phagocytosis; MAP1LC3B: microtubule-associated protein 1 light chain 3; LPS: lipopolysaccharide; LY: LY294002; MTOR: mechanistic target of rapamycin kinase; Pam3CSK4: N-palmitoyl-S-dipalmitoylglyceryl Cys-Ser-(Lys)4; PtdIns: phosphatidylinositol; PtdIns3P: phosphatidylinositol-3-phosphate; PLA: proximity ligation assay; Poly(I:C): polyinosinic-polycytidylic acid; qRT-PCR: quantitative real-time polymerase chain reaction; RPS6KB1: ribosomal protein S6 kinase, polypeptide 1; TLR: Toll-like receptor; TNF: tumor necrosis factor; TFEB: transcription factor EB; TSPO: translocator protein.


Assuntos
Autofagia/genética , Proteína Forkhead Box O3/genética , Microglia/fisiologia , Fagocitose/genética , Receptor 4 Toll-Like/fisiologia , Peptídeos beta-Amiloides/farmacologia , Animais , Animais Recém-Nascidos , Autofagia/efeitos dos fármacos , Células Cultivadas , Regulação para Baixo/efeitos dos fármacos , Regulação para Baixo/genética , Proteína Forkhead Box O3/metabolismo , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Fosfatidilinositol 3-Quinases/metabolismo , Células RAW 264.7 , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/metabolismo
8.
Behav Brain Res ; 306: 137-45, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-26996316

RESUMO

Swertisin, a C-glucosylflavone isolated from Swertia japonica, has been known to have anti-inflammatory or antidiabetic activities. Until yet, however, its cognitive function is not investigated. In the present study, we endeavored to elucidate the effects of swertisin on cholinergic blockade-induced memory impairment. Swertisin (5 or 10mg/kg, p.o.) significantly ameliorated scopolamine-induced cognitive impairment in the several behavioral tasks. Also, single administration of swertisin (10mg/kg, p.o.) in normal naïve mice enhanced the latency time in the passive avoidance task. In addition, the ameliorating effect of swertisin on scopolamine-induced memory impairment was significantly antagonized by a sub-effective dose of N6-cyclopentyladenosine (CPA, 0.1mg/kg, i.p). The adenosine A1 receptor antagonistic property of swertisin was confirmed by receptor binding assay. Furthermore, the administration of swertisin significantly increased the phosphorylation levels of hippocampal or cortical protein kinase A (PKA, 5 or 10mg/kg) and CREB (10mg/kg), and co-administration of CPA (0.1mg/kg, i.p) blocked the increased phosphorylated levels of PKA and CREB in the both cortex and hippocampus. Taken together, these results indicate that the memory-ameliorating effects of swertisin may be, in part, mediated through the adenosinergic neurotransmitter system, and that swertisin may be useful for the treatment of cognitive dysfunction observed in several diseases such as Alzheimer's disease.


Assuntos
Antagonistas do Receptor A1 de Adenosina/uso terapêutico , Apigenina/uso terapêutico , Transtornos da Memória/tratamento farmacológico , Adenosina/análogos & derivados , Adenosina/farmacologia , Antagonistas do Receptor A1 de Adenosina/química , Animais , Apigenina/química , Aprendizagem da Esquiva/efeitos dos fármacos , Células CHO , Proteína de Ligação a CREB/metabolismo , Antagonistas Colinérgicos/toxicidade , Cricetulus , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Modelos Animais de Doenças , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Transtornos da Memória/induzido quimicamente , Camundongos , Camundongos Endogâmicos ICR , Ligação Proteica/efeitos dos fármacos , Agonistas do Receptor Purinérgico P1/farmacologia , Retenção Psicológica/efeitos dos fármacos , Escopolamina/toxicidade
9.
Neurochem Res ; 40(7): 1438-47, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25998887

RESUMO

In our previous study, we demonstrated that nodakenin, a coumarin compound isolated from Angelica decursiva, ameliorates learning and memory impairments induced by scopolamine. In the present study, we investigated the effects of nodakenin on the cognitive function in the normal naïve mice in a passive avoidance task, and the results showed that nodakenin significantly increased the latency time in normal naïve mice. In addition, sub-chronic administration of nodakenin increased the number of 5-bromo-2-deoxyuridine (BrdU)-positive cells in the hippocampal dentate gyrus (DG) region. The percentage of BrdU and NeuN (neuronal cell marker)-immunopositive cells was also significantly increased by the nodakenin administration. Western blotting results showed that the expression levels of phosphorylated protein kinase B (Akt) and phosphorylated glycogen synthase kinase-3ß (GSK-3ß) were significantly increased in hippocampal tissue by sub-chronic nodakenin administration. These findings suggest that the sub-chronic administration of nodakenin enhances adult hippocampal neurogenesis in the DG region via Akt-GSK-3ß signaling and this increase may be associated with nodakenin's positive effect on cognitive processing.


Assuntos
Cognição/efeitos dos fármacos , Cumarínicos/farmacologia , Glucosídeos/farmacologia , Hipocampo/efeitos dos fármacos , Neurogênese/efeitos dos fármacos , Animais , Animais Recém-Nascidos , Aprendizagem da Esquiva , Diferenciação Celular/efeitos dos fármacos , Quinase 3 da Glicogênio Sintase/metabolismo , Glicogênio Sintase Quinase 3 beta , Hipocampo/enzimologia , Hipocampo/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos ICR , Proteínas Proto-Oncogênicas c-akt/metabolismo
10.
Neuropharmacology ; 86: 49-56, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24997455

RESUMO

Schizophrenia is a severe neuropsychiatric disorder that is characterized by core psychiatric symptoms, including positive, negative, and cognitive symptoms. Current treatments for schizophrenia have an effect on positive symptoms but have a limited efficacy on negative or cognitive symptoms. Oleanolic acid is a plant-derived pentacyclic terpenoid that is known to exhibit anti-oxidative and anti-inflammatory activities. Here, we investigated the effects of oleanolic acid on schizophrenia-like behaviors in mice elicited by MK-801, an N-methyl-d-aspartate (NMDA) receptor antagonist. A single administration of oleanolic acid blocked MK-801-induced hyperlocomotion in the open field test. In the acoustic startle response test, oleanolic acid itself did not have any effects on the acoustic startle response or prepulse inhibition (PPI) level, whereas the MK-801-induced PPI deficit was ameliorated by oleanolic acid. In the novel object recognition test, the attention and recognition memory impairments induced by MK-801 were reversed by a single administration of oleanolic acid. Additionally, oleanolic acid normalized the MK-801-induced alterations of signaling molecules including phosphorylation levels of Akt and GSK-3ß in the frontal cortex. These results suggest that oleanolic acid could be a candidate for the treatment of several symptoms of schizophrenia, including positive symptoms, sensorimotor gating disruption, and cognitive impairments.


Assuntos
Antipsicóticos/farmacologia , Ácido Oleanólico/farmacologia , Esquizofrenia/tratamento farmacológico , Animais , Antipsicóticos/química , Atenção/efeitos dos fármacos , Atenção/fisiologia , Modelos Animais de Doenças , Maleato de Dizocilpina , Lobo Frontal/efeitos dos fármacos , Lobo Frontal/fisiopatologia , Quinase 3 da Glicogênio Sintase/metabolismo , Glicogênio Sintase Quinase 3 beta , Hipercinese/tratamento farmacológico , Hipercinese/fisiopatologia , Masculino , Transtornos da Memória/tratamento farmacológico , Transtornos da Memória/fisiopatologia , Camundongos Endogâmicos ICR , Ácido Oleanólico/química , Fosforilação/efeitos dos fármacos , Inibição Pré-Pulso/efeitos dos fármacos , Inibição Pré-Pulso/fisiologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Reconhecimento Psicológico/efeitos dos fármacos , Reconhecimento Psicológico/fisiologia , Reflexo de Sobressalto/efeitos dos fármacos , Reflexo de Sobressalto/fisiologia , Esquizofrenia/fisiopatologia
11.
Brain Res ; 1552: 17-25, 2014 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-24468204

RESUMO

It is well known that the hippocampus plays a role in spatial and contextual memory, and that spatial information is tightly regulated by the hippocampus. However, it is still highly controversial whether the hippocampus plays a role in object recognition memory. In a pilot study, the administration of bicuculline, a GABAA receptor antagonist, enhanced memory in the passive avoidance task, but not in the novel object recognition task. In the present study, we hypothesized that these different results are related to the characteristics of each task and the different roles of hippocampus and perirhinal cortex. A region-specific drug-treatment model was employed to clarify the role of the hippocampus and perirhinal cortex in object recognition memory. After a single habituation in the novel object recognition task, intra-perirhinal cortical injection of bicuculline increased and intra-hippocampal injection decreased the exploration time ratio to novel object. In addition, when animals were repeatedly habituated to the context, intra-perirhinal cortical administration of bicuculline still increased exploration time ratio to novel object, but the effect of intra-hippocampal administration disappeared. Concurrent increases of c-Fos expression and ERK phosphorylation were observed in the perirhinal cortex of the object with context-exposed group either after single or repeated habituation to the context, but no changes were noted in the hippocampus. Altogether, these results suggest that object recognition memory formation requires the perirhinal cortex but not the hippocampus, and that hippocampal activation interferes with object recognition memory by the information encoding of unfamiliar environment.


Assuntos
Bicuculina/farmacologia , Antagonistas de Receptores de GABA-A/farmacologia , Hipocampo/fisiologia , Giro Para-Hipocampal/fisiologia , Receptores de GABA-A/fisiologia , Reconhecimento Psicológico/fisiologia , Animais , Comportamento Exploratório/efeitos dos fármacos , Comportamento Exploratório/fisiologia , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Genes fos , Habituação Psicofisiológica/efeitos dos fármacos , Habituação Psicofisiológica/fisiologia , Masculino , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Especificidade de Órgãos , Fosforilação , Processamento de Proteína Pós-Traducional , Proteínas Proto-Oncogênicas c-fos/biossíntese , Ratos , Ratos Sprague-Dawley , Reconhecimento Psicológico/efeitos dos fármacos
12.
Breast ; 12(3): 179-82, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-14659324

RESUMO

This study was purposed to evaluate malignant and benign breast diseases on the basis of detecting choline compounds by in vivo localized 1H-MR spectroscopy. Thirty-five patients, prior to surgical treatments, including 19 cancers and 16 benign diseases were examined with breast imaging coil and inversion recovery 1H-PRESS (TR/TE/TI: 2000 ms/288 ms/160 ms) MR spectroscopy. Detection of choline was compared with the results of biopsy in each case. Choline was observed in all 19 cancer patients, while it was not detected in all other benign diseases. Detecting sensitivity of choline widely varied over the cancer cases in the range of 2.4-12.7 (average SNR value of 5.4) depending on the water/fat suppression and voxel size. Localized 1H-MRS using breast imaging coil can provide excellent sensitivity and spectral resolution to detect choline compounds present in reasonably small voxel (<1.5 cm3) of breast cancer lesion. Substantially this finding would be useful for differential diagnosis between malignant and benign breast diseases on the basis of choline observation by 1H-MRS when combined use with MR imaging.


Assuntos
Neoplasias da Mama/química , Carcinoma Ductal de Mama/química , Colina/análise , Fibroadenoma/química , Doença da Mama Fibrocística/química , Espectroscopia de Ressonância Magnética , Adolescente , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Diagnóstico Diferencial , Feminino , Fibroadenoma/patologia , Fibroadenoma/cirurgia , Doença da Mama Fibrocística/patologia , Doença da Mama Fibrocística/cirurgia , Humanos , Hiperplasia/patologia , Hiperplasia/cirurgia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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