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Chang J, Denham L, Dong EK, Malek K, Lum SS. Trends in the Diagnosis of Phyllodes Tumors and Fibroadenomas Before and After Release of WHO Classification Standards. Ann Surg Oncol 2018; 25:3088-3095. [DOI: 10.1245/s10434-018-6622-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 11/18/2022]
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52
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Choi N, Kim K, Shin KH, Kim Y, Moon HG, Park W, Choi DH, Kim SS, Ahn SD, Kim TH, Chun M, Kim YB, Kim S, Choi BO, Kim JH. Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08). Breast Cancer Res Treat 2018; 171:335-344. [DOI: 10.1007/s10549-018-4838-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/25/2018] [Indexed: 12/25/2022]
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53
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Ganesh V, Drost L, Lee J, Wan BA, Zhang L, Rakovitch E, Vesprini D, Slodkowska E, Zeng KL, Sousa P, Yee C, Lam H, Chow E. A retrospective review of phyllodes tumours of the breast: A single institution experience. Breast 2018; 38:52-57. [DOI: 10.1016/j.breast.2017.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 12/28/2022] Open
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Abstract
OBJECTIVE The purpose of this study is to evaluate the sonographic and histopathologic features distinguishing benign from borderline and malignant phyllodes tumors. MATERIALS AND METHODS The ultrasound examinations of women with pathologically proven phyllodes tumors from 2004 to 2011 were retrospectively reviewed. The sonographic features of benign, borderline, and malignant phyllodes tumors were compared and analyzed using the American College of Radiology's BI-RADS ultrasound lexicon. Fisher exact test and Wilcoxon rank sum test were used for statistical analysis. RESULTS Fifty-nine women were included in the study; 28 benign (47%), 19 malignant (32%), and 12 borderline (20%) phyllodes tumors were identified. Significant univariate predictors of increased risk of borderline or malignant phyllodes tumors were patient age greater than 55 years (p = 0.014), irregular lesion shape (p = 0.011), and longest lesion dimension greater than 7 cm (p = 0.0022) at sonography. No significant differences were observed in lesion margins, boundaries, echo patterns, or posterior acoustic features. CONCLUSION There is substantial overlap in the sonographic features of benign and borderline or malignant phyllodes tumors. Understanding the clinical and sonographic features of phyllodes tumors may aid the radiologist in predicting biological behavior, including the likelihood of benign versus borderline or malignant phyllodes tumors at pathologic analysis.
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56
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Moo TA, Alabdulkareem H, Tam A, Fontanet C, Lu Y, Landers A, D’Alfonso T, Simmons R. Association Between Recurrence and Re-Excision for Close and Positive Margins Versus Observation in Patients with Benign Phyllodes Tumors. Ann Surg Oncol 2017; 24:3088-3092. [DOI: 10.1245/s10434-017-5955-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Indexed: 01/21/2023]
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Tranesh G, Nassar A. Malignant phyllodes tumor of the breast with heterologous high-grade angiosarcoma. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tremblay-LeMay R, Hogue JC, Provencher L, Poirier B, Poirier É, Laberge S, Diorio C, Desbiens C. How Wide Should Margins Be for Phyllodes Tumors of the Breast? Breast J 2016; 23:315-322. [DOI: 10.1111/tbj.12727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemarie Tremblay-LeMay
- Département de biologie moléculaire, biochimie médicale et pathologie; Université Laval; Quebec City Quebec Canada
| | - Jean-Charles Hogue
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Louise Provencher
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Brigitte Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Éric Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Sophie Laberge
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
- Service de Pathologie; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Caroline Diorio
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
| | - Christine Desbiens
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
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59
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Liu SY, Joseph NM, Ravindranathan A, Stohr BA, Greenland NY, Vohra P, Hosfield E, Yeh I, Talevich E, Onodera C, Van Ziffle JA, Grenert JP, Bastian BC, Chen YY, Krings G. Genomic profiling of malignant phyllodes tumors reveals aberrations in FGFR1 and PI-3 kinase/RAS signaling pathways and provides insights into intratumoral heterogeneity. Mod Pathol 2016; 29:1012-27. [PMID: 27255162 DOI: 10.1038/modpathol.2016.97] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 12/16/2022]
Abstract
Malignant phyllodes tumors of the breast are poorly understood rare neoplasms with potential for aggressive behavior. Few efficacious treatment options exist for progressed or metastatic disease. The molecular features of malignant phyllodes tumors are poorly defined, and a deeper understanding of the genetics of these tumors may shed light on pathogenesis and progression and potentially identify novel treatment approaches. We sequenced 510 cancer-related genes in 10 malignant phyllodes tumors, including 5 tumors with liposarcomatous differentiation and 1 with myxoid chondrosarcoma-like differentiation. Intratumoral heterogeneity was assessed by sequencing two separate areas in 7 tumors, including non-heterologous and heterologous components of tumors with heterologous differentiation. Activating hotspot mutations in FGFR1 were identified in 2 tumors. Additional recurrently mutated genes included TERT promoter (6/10), TP53 (4/10), PIK3CA (3/10), MED12 (3/10), SETD2 (2/10) and KMT2D (2/10). Together, genomic aberrations in FGFR/EGFR PI-3 kinase and RAS pathways were identified in 8 (80%) tumors and included mutually exclusive and potentially actionable activating FGFR1, PIK3CA and BRAF V600E mutations, inactivating TSC2 mutation, EGFR amplification and PTEN loss. Seven (70%) malignant phyllodes tumors harbored TERT aberrations (six promoter mutations, one amplification). For comparison, TERT promoter mutations were identified by Sanger sequencing in 33% borderline (n=12) and no (0%, n=8) benign phyllodes tumors (P=0.391 and P=0.013 vs malignant tumors, respectively). Genetic features specific to liposarcoma, including CDK4/MDM2 amplification, were not identified. Copy number analysis revealed intratumoral heterogeneity and evidence for divergent tumor evolution in malignant phyllodes tumors with and without heterologous differentiation. Tumors with liposarcomatous differentiation revealed more chromosomal aberrations in non-heterologous components compared with liposarcomatous components. EGFR amplification was heterogeneous and present only in the non-heterologous component of one tumor with liposarcomatous differentiation. The results identify novel pathways involved in the pathogenesis of malignant phyllodes tumors, which significantly increase our understanding of tumor biology and have potential clinical impact.
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Affiliation(s)
- Su-Yang Liu
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Nancy M Joseph
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Ajay Ravindranathan
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Bradley A Stohr
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Nancy Y Greenland
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Poonam Vohra
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.,Department of Pathology, San Francisco General Hospital, San Francisco, CA, USA
| | | | - Iwei Yeh
- Department of Dermatology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Eric Talevich
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Courtney Onodera
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Jessica A Van Ziffle
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - James P Grenert
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Boris C Bastian
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.,Department of Dermatology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Gregor Krings
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
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60
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Gentile LF, Gaillard WF, Wallace JA, Spiguel LRP, Alizadeh L, Lentz A, Shaw C. A Case of a Giant Borderline Phyllodes Tumor Early in Pregnancy Treated with Mastectomy and Immediate Breast Reconstruction. Breast J 2016; 22:683-687. [PMID: 27565020 DOI: 10.1111/tbj.12663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Breast tumors in pregnancy are often times diagnosed at advanced stages secondary to difficulty distinguishing between pathologic from normal physiologic changes. Often benign, phyllodes tumors are rare fibroepithelial stromal tumors of the breast, most commonly diagnosed in the 4th and 5th decades of life. However, these tumors may be characterized by malignancy with metastases in 10% of cases. In this paper, we report a novel case of a young woman presenting at 8 weeks gestation with a large borderline phyllodes tumor. An exceedingly rare condition, with only nine previously reported cases, phyllodes tumors in pregnancy frequently display more aggressive characteristics with larger median tumor size, more malignant potential, and more rapid growth rate. Here, we describe our experience safely and effectively treating this rare condition in a young gravid women with mastectomy and immediate breast reconstruction in the second trimester.
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Affiliation(s)
- Lori F Gentile
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | | | - Jodi-Ann Wallace
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Lisa R P Spiguel
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Layla Alizadeh
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida
| | - Ashley Lentz
- Department of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Christiana Shaw
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
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61
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Amer A, Ainley P, Thompson R, Mathers H. Postoperative follow-up practice of phyllodes tumour in the UK: Results from a national survey. Surgeon 2016; 16:74-81. [PMID: 27363618 DOI: 10.1016/j.surge.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 05/05/2016] [Accepted: 05/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resected phyllodes tumours (PT) of the breast carry a small but significant risk of recurrence. Nevertheless, there are no national guidelines on the postoperative follow-up of these tumours potentially resulting in a wide variation in practice among breast surgeons in the UK. METHODS A web-based questionnaire was sent to breast surgeons across the UK to assess individual follow-up practices including availability of local guidelines, methods of follow-up and influence of risk factors. RESULTS Only 38% of 121 responses indicated the availability of local guidelines on PT follow-up. Modal follow-up duration for borderline and malignant disease was 5 years (53.7% and 79.3% of responses respectively), compared to 1 year for benign disease (43%) although 28% of respondents continue to review benign cases for 5 years. Immediate post-operative discharge and self-directed aftercare for benign and borderline cases remains uncommon practice in the UK. Within hospitals represented by more than one respondent in this survey, only around 30% demonstrated consistent practices pertaining to length and frequency of postoperative PT follow-up. Recurrent disease and margin status influenced the follow-up practice of 60% of respondents in our survey. More than 75% indicated that they combine clinical examination with radiological investigations (mammography and/or ultrasound) to follow up PT postoperatively. CONCLUSION This survey highlights the wide variation in follow-up practice for resected PT. This may affect the detection of disease relapse or, conversely, result in wasted clinical resources and unnecessary patient distress. Evidence-based national guidelines are necessary to resolve this issue and inform best follow-up practice.
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Affiliation(s)
- Aimen Amer
- The Breast Unit, Altnagelvin Area Hospital, Glenshane Road, Derry, Londonderry, BT47 6SB, UK
| | - Paul Ainley
- Medical Biology Centre, Queens University Belfast, Lisburn Road, Belfast, BT9 7BL, UK
| | - Ronald Thompson
- The Breast Unit, Altnagelvin Area Hospital, Glenshane Road, Derry, Londonderry, BT47 6SB, UK
| | - Helen Mathers
- The Breast Unit, Altnagelvin Area Hospital, Glenshane Road, Derry, Londonderry, BT47 6SB, UK.
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62
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Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, Calvo JP, Dabbs DJ, Ellis IO, Eusebi V, Farshid G, Fox SB, Ichihara S, Lakhani SR, Rakha EA, Reis-Filho JS, Richardson AL, Sahin A, Schmitt FC, Schnitt SJ, Siziopikou KP, Soares FA, Tse GM, Vincent-Salomon A, Tan PH. Phyllodes tumours of the breast: a consensus review. Histopathology 2016; 68:5-21. [PMID: 26768026 PMCID: PMC5027876 DOI: 10.1111/his.12876] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Phyllodes tumours constitute an uncommon but complex group of mammary fibroepithelial lesions. Accurate and reproducible grading of these tumours has long been challenging, owing to the need to assess multiple stratified histological parameters, which may be weighted differently by individual pathologists. Distinction of benign phyllodes tumours from cellular fibroadenomas is fraught with difficulty, due to overlapping microscopic features. Similarly, separation of the malignant phyllodes tumour from spindle cell metaplastic carcinoma and primary breast sarcoma can be problematic. Phyllodes tumours are treated by surgical excision. However, there is no consensus on the definition of an appropriate surgical margin to ensure completeness of excision and reduction of recurrence risk. Interpretive subjectivity, overlapping histological diagnostic criteria, suboptimal correlation between histological classification and clinical behaviour and the lack of robust molecular predictors of outcome make further investigation of the pathogenesis of these fascinating tumours a matter of active research. This review consolidates the current understanding of their pathobiology and clinical behaviour, and includes proposals for a rational approach to the classification and management of phyllodes tumours.
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Affiliation(s)
- Benjamin Y Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - Geza Acs
- Women's Pathology Consultants, Ruffolo Hooper & Associates, Tampa, FL, USA
| | - Sophia K Apple
- Department of Pathology, UCLA Medical Center, Santa Monica, CA, USA
| | - Sunil Badve
- Departments of Pathology and Internal Medicine, Clarian Pathology Laboratory of Indiana University, Indianapolis, IN, USA
| | - Ira J Bleiweiss
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - José P Calvo
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - David J Dabbs
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ian O Ellis
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Vincenzo Eusebi
- Sezione Anatomia e Istologia Patologica, 'M. Malpighi' Università di Bologna, Bologna, Italy
| | - Gelareh Farshid
- BreastScreen SA, Discipline of Medicine, Adelaide University and Directorate of Surgical Pathology, SA Pathology, Adelaide, South Australia
| | - Stephen B Fox
- Pathology Department, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Vic., Australia
| | - Shu Ichihara
- Department of Pathology, Nagoya Medical Center, Nagoya, Japan
| | - Sunil R Lakhani
- School of Medicine and Pathology Queensland, The Royal Brisbane & Women's Hospital, University of Queensland Centre for Clinical Research, Brisbane, Qld, Australia
| | - Emad A Rakha
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Richardson
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Aysegul Sahin
- Department of Pathology, Division of Pathology/Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Stuart J Schnitt
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kalliopi P Siziopikou
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Fernando A Soares
- Department of Anatomic Pathology, A. C. Camargo Cancer Centre, São Paulo, Brazil
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
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