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Lew M. An Approach to Nonurothelial Malignancies of the Urinary Bladder in Urine Cytology. Adv Anat Pathol 2022; 29:412-422. [PMID: 35687328 DOI: 10.1097/pap.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urine cytology is an economical and convenient method of triaging patients who present with urinary symptoms as well as surveying those who have previously been diagnosed with urothelial carcinoma for recurrent or persistent disease. While the vast majority of malignancies diagnosed in urine cytology are urothelial carcinomas, it is important to recognize nonurothelial elements to inform patient prognosis and raise the possibility of involvement by a urothelial carcinoma variant, nonurothelial malignancy of the bladder, or a nonbladder primary, which may alter patient management pathways. As such, becoming familiar with morphologic features of nonurothelial malignancies in urine cytology as well as their related clinical risk factors, radiologic and cystoscopic features, differential diagnostic considerations, and the utility and pitfalls of ancillary tests can facilitate optimal patient care.
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Affiliation(s)
- Madelyn Lew
- Department of Pathology, University of Michigan Hospital and Health System, Ann Arbor, MI
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2
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Urinary Bladder Adenocarcinoma Metastatic to the Abdominal Wall: Report of a Case with Cytohistologic Correlation. Case Rep Pathol 2016; 2016:8608412. [PMID: 27006847 PMCID: PMC4781945 DOI: 10.1155/2016/8608412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/07/2016] [Indexed: 11/30/2022] Open
Abstract
We report a case of adenocarcinoma metastatic to the abdominal wall in a 71-year-old man with a history of primary bladder adenocarcinoma. CT-guided core biopsy was performed; imprints and histologic sections showed malignant glands lined by tumor cells with hyperchromatic nuclei and prominent nucleoli, infiltrating through skeletal muscle. Immunohistochemistry revealed positivity for CK7, membranous/cytoplasmic β-catenin, caudal-type homeobox transcription factor 2 (CDX2), and α-methylacyl coenzyme A racemase and negativity for CK20, p63, prostate-specific antigen (PSA), and prostate-specific acid phosphatase (PSAP). These findings were interpreted as metastatic adenocarcinoma, consistent with bladder primary. Primary bladder adenocarcinoma is a rare malignancy arising within glandular metaplasia and is associated with cystitis cystica and cystitis glandularis. Predisposing factors include bladder exstrophy, schistosomiasis, and other causes of chronic bladder irritation. This tumor is divided into intestinal, clear cell, and signet ring cell subtypes. Treatment involves radical cystectomy with pelvic lymph node dissection, and prognosis is unfavorable. Primary bladder adenocarcinoma should be differentiated from urachal adenocarcinoma, which arises from urachal remnants near the bladder dome, and secondary adenocarcinoma, or vesical involvement by adenocarcinoma from a different primary. CK7, CK20, CDX2, thrombomodulin, and β-catenin can help distinguish primary bladder adenocarcinoma from colonic adenocarcinoma; PSA and PSAP can help distinguish primary bladder adenocarcinoma from prostate adenocarcinoma.
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Primary Clear Cell Carcinoma of the Urinary Bladder. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:593826. [PMID: 27379325 PMCID: PMC4897347 DOI: 10.1155/2014/593826] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 11/17/2022]
Abstract
Primary clear cell carcinoma of the urinary bladder (PCCUB) is rare. Literature review has revealed 47 cases of PCCUB which commonly affects women. The histogenesis of PCCUB is not certain and Müllerian origin and urotheilal origin have been postulated. The microscopic characteristics of PCCUB include cells with abundant clear cytoplasm, arranged in a solid, glandular, tubulocystic, or papillary pattern. The cells may be flat or cuboidal with abundant clear eosinophilic cytoplasm. Hobnailing may be evident. PCCUB, on immunohistochemistry, stain positively with pan-cytokeratin, cytokeratin 7, and CA 125. PCCUB may manifest with visible haematuria, lower urinary tract symptoms, and discharge. There is no consensus opinion regarding the best treatment option for PCCUBs and patient outcomes are not very clear. Surgery has been the adopted treatment of choice. Differential diagnoses of PCCUB include nephrogenic metaplasia, urothelial carcinoma with clear cell cytoplasm, diffuse large B-cell lymphoma, and metastatic clear cell carcinoma with the primary originating elsewhere. Conclusions. A thorough radiological imaging assessment is required in cases of PCCUB to exclude a primary tumour elsewhere. Urologists and oncologists should report cases of PCCUB they encounter and should enter them into a multicentric trial to ascertain the best management option.
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Mehra R, Vats P, Kalyana-Sundaram S, Udager AM, Roh M, Alva A, Pan J, Lonigro RJ, Siddiqui J, Weizer A, Lee C, Cao X, Wu YM, Robinson DR, Dhanasekaran SM, Chinnaiyan AM. Primary urethral clear-cell adenocarcinoma: comprehensive analysis by surgical pathology, cytopathology, and next-generation sequencing. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:584-91. [PMID: 24389164 PMCID: PMC3936309 DOI: 10.1016/j.ajpath.2013.11.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/18/2013] [Accepted: 11/19/2013] [Indexed: 12/11/2022]
Abstract
Primary clear-cell adenocarcinoma of the urethra, a rare tumor that histomorphologically resembles clear-cell carcinoma of the female genital tract, occurs predominantly in women and is associated with a relatively poor prognosis. The histogenesis of this rare urethral neoplasm has not been completely resolved, but it is thought to arise from either müllerian rests or metaplastic urothelium. Herein, we present comprehensive surgical pathological and cytopathological findings from a patient with primary urethral clear-cell adenocarcinoma and describe next-generation sequencing results for this patient's unique tumor-the first such reported characterization of molecular aberrations in urethral clear-cell adenocarcinoma at the transcriptomic and genomic levels. Transcriptome analysis revealed novel gene fusion candidates, including ANKRD28-FNDC3B. Whole-exome analysis demonstrated focal copy number loss at the SMAD4 and ARID2 loci and 38 somatic mutations, including a truncating mutation in ATM and a novel nonsynonymous mutation in ALK.
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Affiliation(s)
- Rohit Mehra
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan.
| | - Pankaj Vats
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Shanker Kalyana-Sundaram
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Aaron M Udager
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael Roh
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Ajjai Alva
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jincheng Pan
- Michigan Center for Translational Pathology, Ann Arbor, Michigan; Department of Urology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Robert J Lonigro
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Alon Weizer
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Cheryl Lee
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Xuhong Cao
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Yi-Mi Wu
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Dan R Robinson
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | | | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan; Howard Hughes Medical Institute, Ann Arbor, Michigan
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Han JY, Kim KH, Kim L, Choi SJ, Park IS, Kim JM, Chu YC, Yoon SM. Cytologic findings of clear cell adenocarcinoma of the urethra: a case report. KOREAN JOURNAL OF PATHOLOGY 2012; 46:210-4. [PMID: 23110004 PMCID: PMC3479785 DOI: 10.4132/koreanjpathol.2012.46.2.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/06/2012] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
Abstract
Clear cell adenocarcinoma of the urethra is a rare disease entity with an uncertain histogenesis. Here, we present a case of primary clear cell adenocarcinoma of the female urethra with its cytological findings. A 54-year-old woman presented with a painless gross hematuria lasting 3 months. On vaginal sonography, there was a sausage-like, elongated mass in the urethra, measuring 3.8×4.3 cm. The voided urine cytology revealed small clusters of rounded or papillary cells. The necrotic debris and inflammatory cells were present within some clusters of tumor cells. These tumor cells were enlarged and had abundant clear or granular cytoplasm with cytoplasmic vacuoles. The nucleus was granular and contained vesicular chromatin with prominent nucleoli. The hobnail cells and hyaline globules were also present as in a histologic section. The histologic findings were compatible with clear cell adenocarcinoma. The tumor showed distinctive cytological features. Cytologically, however, it is necessary to make a differential diagnosis from other adenocarcinoma or high-grade urothelial carcinoma.
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Affiliation(s)
- Jee-Young Han
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Whitworth SA, Subhawong AP, Rosenthal DL, Ali SZ. Clear cell adenocarcinoma of the lower urinary tract: cytopathologic characteristics and differential diagnoses. Cancer Cytopathol 2012; 120:308-12. [PMID: 22517612 DOI: 10.1002/cncy.21197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 01/26/2012] [Accepted: 02/21/2012] [Indexed: 11/06/2022]
Abstract
Clear cell adenocarcinomas (CCAs) of the lower urinary tract are uncommon neoplasms that may present in routinely processed urinary cytology specimens. There is only limited discussion of the features of CCA of the lower urinary tract in the cytology literature. The authors report a series of 3 cases of this unusual tumor, and correlate cytomorphology with histologic specimens. Two of the cases were diagnosed accurately as adenocarcinoma, and 1 case was diagnosed as atypical cells of undetermined significance. Cytomorphologic features included variably cellular samples with 3-dimensional fragments of malignant cells that had enlarged nuclei, prominent nucleoli, and occasional hobnail configurations. Some fragments showed luminal formation with collections of neutrophils. CCA must be included in the differential diagnosis of malignant cells in a urinary specimen, particularly if the features are not typical of urothelial carcinoma. Other diagnostic considerations include metastatic adenocarcinomas, nephrogenic adenomas, and benign glandular lesions involving the bladder and urinary tract such as mullerianosis.
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Affiliation(s)
- Scott A Whitworth
- Department of Pathology, Division of Cytopathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Liu SV, Truskinovsky AM, Dudek AZ, Ramanathan RK. Metastatic Clear Cell Adenocarcinoma of the Urethra in a Male Patient: Report of a Case. Clin Genitourin Cancer 2012; 10:47-9. [DOI: 10.1016/j.clgc.2011.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/20/2011] [Accepted: 10/04/2011] [Indexed: 11/30/2022]
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Sakuma T, Furuta M, Mimura A, Tanigawa N, Takamizu R, Kawano K. Urine cytology of micropapillary carcinoma of the urinary bladder. Diagn Cytopathol 2010; 39:852-6. [DOI: 10.1002/dc.21573] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 09/20/2010] [Indexed: 11/07/2022]
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Clear-cell adenocarcinoma of vesical origin: a case study of metastatic disease treated with chemotherapy. CHEMOTHERAPY RESEARCH AND PRACTICE 2010; 2010:426973. [PMID: 22482051 PMCID: PMC3265239 DOI: 10.1155/2010/426973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 06/28/2010] [Accepted: 09/29/2010] [Indexed: 11/17/2022]
Abstract
Vesical clear cell adenocarcinoma is an uncommon tumour. The description of nearly all published cases focuses on histological issues, providing few clinical particulars and limited followup. The treatment choice is resection. No publications have been found regarding systemic treatments for advanced disease. We present a case of metastatic clear cell adenocarcinoma of the bladder treated with chemotherapy.
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Adeniran AJ, Tamboli P. Clear cell adenocarcinoma of the urinary bladder: a short review. Arch Pathol Lab Med 2009; 133:987-91. [PMID: 19492895 DOI: 10.5858/133.6.987] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2008] [Indexed: 11/06/2022]
Abstract
In this short review, we discuss clear cell adenocarcinoma of the urinary bladder, a rare tumor that primarily affects women. The histogenesis of this neoplasm is uncertain; in some tumors the clinicopathologic and histologic features are suggestive of a müllerian origin. Clear cell adenocarcinoma consists of cells with abundant clear cytoplasm, arranged in solid, glandular, or tubulocystic patterns. These tumors are positive for pancytokeratin, cytokeratin 7, and CA 125 immunohistochemical stains. Patients typically present with gross hematuria, dysuria, and discharge. The natural history is poorly understood and patient outcomes remain unclear. Currently, surgery is the treatment of choice. Nephrogenic adenoma is the most important differential diagnostic consideration, followed by metastatic clear cell carcinoma.
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Alsharif M, Aslan DL, Jessurun J, Gulbahce HE, Pambuccian SE. Cytologic diagnosis of metastatic seminoma to the prostate and urinary bladder: a case report. Diagn Cytopathol 2008; 36:734-8. [PMID: 18773441 DOI: 10.1002/dc.20881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 42-year-old man presented with severe abdominal pain, constipation, and hematuria. The patient had a history of seminoma treated by chemotherapy followed by bilateral orchiectomy and retroperitoneal lymph node dissection 16 years earlier. A computed tomography (CT) scan showed a 8.0 x 6.0 x 5.0 cm mass in the retrovesical space, encompassing the left side of his proximal bladder, the prostate, and the rectum. A urine cytologic specimen showed loosely cohesive cell clusters composed of highly atypical large cells and occasional large, single cells with macronucleoli present in a background of mainly lymphocytes and histiocytes was diagnosed as recurrent seminoma. Prostate biopsies showed extensively necrotic seminoma with accompanying granulomatous reaction. The tumor cells were immunoreactive for c-kit (CD117), placental-like alkaline phosphatase (PLAP), D2-40, and OCT4. To our knowledge, this is the second report on urine cytology of metastatic seminoma.
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Affiliation(s)
- Mariam Alsharif
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Herlitz LC, Tong GX, Hamele-Bena D, Greenebaum E. Nephrogenic adenoma identified on urine cytology using PAX-2 immunostaining. Diagn Cytopathol 2008; 36:47-9. [PMID: 18064687 DOI: 10.1002/dc.20751] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Urine cytology is a sensitive and specific method in detecting urothelial carcinoma of the urinary bladder, particularly the high-grade ones. However, the cytologic features of nonneoplastic lesions of the lower urinary tract, including nephrogenic adenoma, are nonspecific and may cause false positive diagnosis. Recent evidence has demonstrated that nephrogenic adenoma is a true "nephrogenic" lesion derived from the exfoliated and implanted renal tubular cells in the urinary tract. This has promoted the use of immunostaining of renal transcription factor PAX2 in tissue biopsies to differentiate nephrogenic adenoma from the common malignant tumors of the lower urinary tract. We report here that PAX2 immunostaining can also be used in urine cytology specimen to identify nephrogenic adenoma. Combination of PAX2 immunostaining and cytologic analysis may increase the accuracy in identifying this benign lesion in urine cytology specimen and therefore reduce unnecessary repeat cystoscopy and biopsy procedures. This may be a cost effective follow- up method for patients with an established diagnosis of nephrogenic adenoma.
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Affiliation(s)
- Leal C Herlitz
- Department of Pathology, Columbia University Medical Center, New York, New York 10032, USA
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Signori G, Tonini G, Aulenti V, Taher B, Rad FK, Tosana M, Ungari M, Zorzi F. Clear cell adenocarcinoma of the bladder in a male patient: clinicopathologic analysis of a case. Urol Int 2003; 71:228-30. [PMID: 12890970 DOI: 10.1159/000071856] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2001] [Accepted: 01/29/2002] [Indexed: 11/19/2022]
Abstract
Clear cell adenocarcinoma arising in the lower urinary tract is unusual. We report a case of clear cell adenocarcinoma of the bladder in a 54-year-old male. Cystoscopic examination revealed a tumour arising from the dome of the urinary bladder. Histologically, the tumour was chiefly composed of tubulocystic and papillary glands lined by glycogen-rich, cubical or hobnail cells with clear to eosinophilic cytoplasm. The tumour infiltrated into the inner muscular layer. The patient was treated by partial cystectomy.
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Seseke F, Zöller G, Kunze E. Clear cell adenocarcinoma of the male urethra in association with so-called nephrogenic metaplasia. Urol Int 2002; 67:104-8. [PMID: 11464132 DOI: 10.1159/000050960] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A clear cell adenocarcinoma of the urethra associated with so-called nephrogenic metaplasia occurring in a 57-year-old male patient is presented. Ten months following total urethrectomy, multiple pulmonary metastases had developed. The patient died 2.5 years after surgery. The possible histogenesis of clear cell adenocarcinoma of the lower urinary tract - reported to develop in the male urethra only in a very few cases - is reviewed briefly. We favor an origin from preexisting nephrogenic metaplasia as one of the possible histogenetic pathways.
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Affiliation(s)
- F Seseke
- Departments of Urology and Pathology, University of Göttingen, Germany.
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Abstract
Nephrogenic adenoma of the urinary bladder and urethra is an uncommon benign lesion of the urinary epithelium that can cytologically and histologically mimic malignancy. We report on the cytologic findings of a case of nephrogenic adenoma of the urethra that mimicked malignancy in an 84-yr-old woman. The differential diagnosis of this problematic lesion is discussed, and the literature describing the cytologic features is reviewed.
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Affiliation(s)
- A C Henke
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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