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This analysis is focused on metabolic remodeling associated with various cellular populations within cyst microenvironment, coping with reciprocal re-education through the symbiotic sharing of metabolites, acting both as nutritional elements and as transcriptional regulators, explaining their impact on cyst growth and metastasis. Copyright © 2020 Comito, Ippolito, Chiarugi and Cirri.Background the perfect treatment sequence for localized malignant pleural mesothelioma (MPM)