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Jia Y, Poor SMM, Dufault B, Lu V, Nayak JG, Pruthi DK, Gibson IW. Chronic kidney damage pathology score for systematic assessment of the non-neoplastic kidney tissue and prediction of post-operative renal function outcomes. Hum Pathol 2022; 124:76-84. [PMID: 35339565 DOI: 10.1016/j.humpath.2022.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/04/2022]
Abstract
To establish a systematic histological assessment of non-neoplastic kidney (NNK) tissue at the time of nephrectomy to evaluate a patient's risk of developing post-operative renal dysfunction, a combined prospective pathologic assessment of the NNK and a retrospective clinical chart review was conducted. A blinded nephropathologist performed standardized assessment of glomerular sclerosis, tubulointerstitial fibrosis, arteriosclerosis, and hyaline arteriolosclerosis. Combined these formulated the chronic kidney damage pathology score (CKDPS). Multivariate logistic regression models were developed to assess the effect of CKDPS and other clinical factors on renal function up to 24 months following nephrectomy (partial or radical). 156 patients were included in the analysis with a median age of 60 years. 70% patients underwent radical nephrectomy. A history of hypertension and/or diabetes was present in 55.8% and 22.1%, respectively. Higher CKDPS (particularly glomerular global sclerosis and arteriosclerosis scores), radical nephrectomy, and reduced baseline estimated glomerular filtration rate (eGFR) were associated with worsening post-operative renal function outcomes. The systematic assessment of non-neoplastic kidney tissue at the time of renal surgery can help identify patients at risk of post-operative renal dysfunction. CKDPS represents a standardized and prognostically relevant histologic reporting system for non-neoplastic kidney tissue.
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Affiliation(s)
- Yong Jia
- Department of Pathology, University of Manitoba, R3A 1R9, Winnipeg MB, Canada.
| | - Seyed M M Poor
- Section of Urology, Department of Surgery, University of Manitoba, R3A 1R9, Winnipeg MB, Canada.
| | - Brenden Dufault
- Centre for Healthcare Innovation, University of Manitoba, R3E 0T6, Winnipeg MB, Canada.
| | - Vivian Lu
- Department of Pathology, University of Manitoba, R3A 1R9, Winnipeg MB, Canada.
| | - Jasmir G Nayak
- Section of Urology, Department of Surgery, University of Manitoba, R3A 1R9, Winnipeg MB, Canada.
| | - Deepak K Pruthi
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, United States.
| | - Ian W Gibson
- Department of Pathology, University of Manitoba, R3A 1R9, Winnipeg MB, Canada.
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Abedi-Ardekani B, Nasrollahzadeh D, Egevad L, Banks RE, Vasudev N, Holcatova I, Povysil C, Foretova L, Janout V, Mates D, Jinga V, Petrescu A, Milosavljevic S, Ognjanovic M, Ognjanovic S, Viksna J, Warren AY, Lathrop M, Riazalhosseini Y, Carreira C, Chanudet E, McKay J, Brennan P, Scélo G. Morphological findings in frozen non-neoplastic kidney tissues of patients with kidney cancer from large-scale multicentric studies on renal cancer. Virchows Arch 2021; 478:1099-1107. [PMID: 33403511 PMCID: PMC8203524 DOI: 10.1007/s00428-020-02986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/11/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
There are unexplained geographical variations in the incidence of kidney cancer with the high rates reported in Baltic countries, as well as eastern and central Europe. Having access to a large and well-annotated collection of "tumor/non-tumor" pairs of kidney cancer patients from the Czech Republic, Romania, Serbia, UK, and Russia, we aimed to analyze the morphology of non-neoplastic renal tissue in nephrectomy specimens. By applying digital pathology, we performed a microscopic examination of 1012 frozen non-neoplastic kidney tissues from patients with renal cell carcinoma. Four components of renal parenchyma were evaluated and scored for the intensity of interstitial inflammation and fibrosis, tubular atrophy, glomerulosclerosis, and arterial wall thickening, globally called chronic renal parenchymal changes. Moderate or severe changes were observed in 54 (5.3%) of patients with predominance of occurrence in Romania (OR = 2.67, CI 1.07-6.67) and Serbia (OR = 4.37, CI 1.20-15.96) in reference to those from Russia. Further adjustment for comorbidities, tumor characteristics, and stage did not change risk estimates. In multinomial regression model, relative probability of non-glomerular changes was 5.22 times higher for Romania and Serbia compared to Russia. Our findings show that the frequency of chronic renal parenchymal changes, with the predominance of chronic interstitial nephritis pattern, in kidney cancer patients varies by country, significantly more frequent in countries located in central and southeastern Europe where the incidence of kidney cancer has been reported to be moderate to high. The observed association between these pathological features and living in certain geographic areas requires a larger population-based study to confirm this association on a large scale.
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Affiliation(s)
- Behnoush Abedi-Ardekani
- International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France.
| | - Dariush Nasrollahzadeh
- International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Rosamonde E Banks
- Leeds Institute of Medical Research @ St James's, University of Leeds, Leeds, UK
| | - Naveen Vasudev
- Leeds Institute of Medical Research @ St James's, University of Leeds, Leeds, UK
| | - Ivana Holcatova
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Ctibor Povysil
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Vladimir Janout
- Centre of Science and Research, Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - Viorel Jinga
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Amelia Petrescu
- Pathology Department, Professor Dr. Th. Burghele Clinical Hospital, Bucharest, Romania
| | - Sasa Milosavljevic
- International Organization for Cancer Prevention and Research, Belgrade, Serbia
| | - Miodrag Ognjanovic
- International Organization for Cancer Prevention and Research, Belgrade, Serbia
| | - Simona Ognjanovic
- International Organization for Cancer Prevention and Research, Belgrade, Serbia
| | - Juris Viksna
- Institute of Mathematics and Computer Science, University of Latvia, Riga, Latvia
| | - Anne Y Warren
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Mark Lathrop
- McGill University and Génome Québec Innovation Centre, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Yasser Riazalhosseini
- McGill University and Génome Québec Innovation Centre, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Christine Carreira
- International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France
| | - Estelle Chanudet
- International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France
| | - James McKay
- International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France
| | - Paul Brennan
- International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France
| | - Ghislaine Scélo
- International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France
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Kläger JP, Al-Taleb A, Pavlovic M, Haitel A, Comperat E, Fajkovic H, Kikić Ž, Kain R, Kozakowski N. More than ancillary records: clinical implications of renal pathology examination in tumor nephrectomy specimens. J Nephrol 2021; 34:1833-1844. [PMID: 33900582 PMCID: PMC8610937 DOI: 10.1007/s40620-021-01030-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/16/2021] [Indexed: 01/20/2023]
Abstract
Background Nephrectomy is the management of choice for the treatment of renal tumors. Surgical pathologists primarily focus on tumor diagnosis and investigations relating to prognosis or therapy. Pathological changes in non-neoplastic tissue may, however, be relevant for further management and should be thoroughly assessed. Methods Here, we examined the non-neoplastic renal parenchyma in 206 tumor nephrectomy specimens for the presence of glomerular, tubulo-interstitial, or vascular lesions, and correlated them with clinical parameters and outcome of renal function. Results We analyzed 188 malignant and 18 benign or pseudo-tumorous lesions. The most common tumor type was clear cell renal cell carcinoma (CCRCC, n = 106) followed by papillary or urothelial carcinomas (n = 25). Renal pathology examination revealed the presence of kidney disease in 39 cases (18.9%). Glomerulonephritis was found in 15 cases (7.3%), and the most frequent was IgA nephropathy (n = 6; 2.9%). Vasculitis was found in two cases (0.9%). In 15 cases we found tubulo-interstitial nephritis, and in 9 severe diabetic or hypertensive nephropathy. Partial nephrectomy was not linked to better eGFR at follow-up. Age, vascular nephropathy, glomerular scarring and interstitial fibrosis were the leading independent negative factors influencing eGFR at time of surgery, whereas proteinuria was associated with reduced eGFR at 1 year. Conclusion Our large study population indicates a high incidence of renal diseases potentially relevant for the postoperative management of patients with renal neoplasia. Consistent and systematic reporting of non-neoplastic renal pathology in tumor nephrectomy specimens should therefore be mandatory. Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01030-0.
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Affiliation(s)
- Johannes Philipp Kläger
- Department of Pathology, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ahmad Al-Taleb
- Department of Pathology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Mladen Pavlovic
- Department of Pathology, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andrea Haitel
- Department of Pathology, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Comperat
- Department of Pathology, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Željko Kikić
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Nicolas Kozakowski
- Department of Pathology, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,UMRS 1155, Institut National de la Santé et de la Recherche Médicale (INSERM), Tenon Hospital, Paris, France.
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Ellis RJ, Kalma B, Del Vecchio SJ, Aliano DN, Ng KL, Dimeski G, Ma L, Guard D, Bertram JF, Morais C, Oliver K, Wood ST, Gobe GC, Francis RS. Chronic kidney cortical damage is associated with baseline kidney function and albuminuria in patients managed with radical nephrectomy for kidney tumours. Pathology 2018; 51:32-38. [PMID: 30477884 DOI: 10.1016/j.pathol.2018.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/12/2023]
Abstract
This study evaluated the relationship between histological markers of chronic kidney damage in patients undergoing radical nephrectomy for kidney tumours and preoperative kidney function, degree of albuminuria, and changes in glomerular volume. A schema to grade chronic kidney damage could be used to identify patients at risk of developing CKD following nephrectomy. Non-neoplastic cortical tissue was sourced from 150 patients undergoing radical nephrectomy for suspected kidney cancer. This tissue was evaluated for indicators of chronic damage, specifically: glomerulosclerosis, arteriosclerosis, interstitial fibrosis, and tubular atrophy. Glomerular volume was determined using the Weibel and Gomez method. Associations between these parameters and both estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) were determined using either a Mann-Whitney U-test or a Kruskal-Wallis ANOVA. Associations between both eGFR and ACR and glomerular volume were assessed using linear regression. eGFR was inversely associated with the degree of glomerulosclerosis (p < 0.001), vascular narrowing (p = 0.002), tubular atrophy (p < 0.001), and interstitial fibrosis (p < 0.001). ACR was associated only with the degree of interstitial fibrosis (p = 0.02) and tubular atrophy (p = 0.02). Glomerular volume was greater for males, diabetics, hypertensive patients, and patients with a greater degree of interstitial fibrosis. Glomerular volume was positively associated with ACR. A schema to grade chronic damage was developed. The proposed schema is associated with baseline clinical indices of kidney function and damage. Longitudinal validation is necessary to determine the prognostic utility of this schema.
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Affiliation(s)
- Robert J Ellis
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia.
| | - Benjamin Kalma
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
| | - Sharon J Del Vecchio
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
| | - Danielle N Aliano
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
| | - Keng Lim Ng
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
| | - Goce Dimeski
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
| | - Li Ma
- Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - David Guard
- Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - John F Bertram
- Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Vic, Australia
| | - Christudas Morais
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
| | | | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia; School of Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia; NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Qld, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia
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Wang X, Liu Q, Kong W, Huang J, Chen Y, Huang Y, Zhang J. Pathologic analysis of non-neoplastic parenchyma in renal cell carcinoma: a comprehensive observation in radical nephrectomy specimens. BMC Cancer 2017; 17:900. [PMID: 29282004 PMCID: PMC5745993 DOI: 10.1186/s12885-017-3849-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study provides a comprehensive examination of the histological features of non-neoplastic parenchyma in renal cell carcinoma (RCC). We prospectively collected radical nephrectomy (RN) specimens, to analyze the histological changes within peritumoral and distant parenchyma. Methods Data of patients who underwent RN and had no known history of diabetes, hypertension, hyperlipidemia, or chronic kidney disease etc., were prospectively collected. Tumor pseudo-capsule (PC), and parenchyma within 2 cm from tumor margin, were pathologically assessed. The parenchyma beyond PC or tumor margin was divided into 20 subsections of 1 mm in width. Histological changes, including chronic inflammation, glomerulosclerosis, arteriosclerosis and nephrosclerosis, were given scores of 0, 1, 2 or 3 for each subsection of each specimen, according to their severity. The 20 subsections of each specimen were further divided into four groups according to the distance from the tumor edge (group 1: 0–2 mm; group 2: 2–5 mm; group 3: 5–10 mm; group 4: 10–20 mm), to better compare the peritumoral parenchyma with the distant parenchyma. Results In total, 53 patients were involved in this study. All tumors were confirmed RCCs (clear cell vs. papillary vs. chromophobe were 83% vs. 5.7% vs. 11.3%, respectively), with a mean size of 5.6 cm. Histological changes were more severe in peritumoral parenchyma close to PC or tumor edge (0–5 mm), and less common within parenchyma more distant from the tumor (5–20 mm) (p < 0.001). chronic inflammation and nephrosclerosis were the most common changes especially in peritumoral parenchyma (0-2 mm). PC was present in 49 tumors (92.5%), and PC invasion occurred in 5 cases (10.2%). Mean PC thickness was 0.7 mm. PCs were more likely to be present in clear cell RCC or papillary RCC than in chromophobe RCC (100% vs. 100% vs. 33.3%, respectively; p < 0.001). Conclusions Most RCCs have a well-developed PC, especially clear cell RCC. Histological changes mainly occur in peritumoral parenchyma, being rather uncommon in distant parenchyma. A compression band filled with severe histological changes was typically observed in renal parenchyma close to the tumor. Its preservation while performing an enucleation margin may not be entirely necessary. Electronic supplementary material The online version of this article (10.1186/s12885-017-3849-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xun Wang
- Department of Urology Renji Hospital affiliated to Shanghai Jiaotong, University School of Medicine, No.1630, Dongfang Road, Shanghai, 200127, China
| | - Qiang Liu
- Department of Pathology Renji Hospital affiliated to Shanghai Jiaotong, University School of Medicine, No.1630, Dongfang Road, Shanghai, 200127, China
| | - Wen Kong
- Department of Urology Renji Hospital affiliated to Shanghai Jiaotong, University School of Medicine, No.1630, Dongfang Road, Shanghai, 200127, China
| | - Jiwei Huang
- Department of Urology Renji Hospital affiliated to Shanghai Jiaotong, University School of Medicine, No.1630, Dongfang Road, Shanghai, 200127, China
| | - Yonghui Chen
- Department of Urology Renji Hospital affiliated to Shanghai Jiaotong, University School of Medicine, No.1630, Dongfang Road, Shanghai, 200127, China
| | - Yiran Huang
- Department of Urology Renji Hospital affiliated to Shanghai Jiaotong, University School of Medicine, No.1630, Dongfang Road, Shanghai, 200127, China
| | - Jin Zhang
- Department of Urology Renji Hospital affiliated to Shanghai Jiaotong, University School of Medicine, No.1630, Dongfang Road, Shanghai, 200127, China.
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Chopra S, Wu MLC. Specimens from biopsies of colorectal polyps often harbor additional diagnoses. PATHOLOGY RESEARCH INTERNATIONAL 2013; 2013:570526. [PMID: 24455417 PMCID: PMC3886612 DOI: 10.1155/2013/570526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/13/2013] [Indexed: 12/11/2022]
Abstract
Objectives. The utility of examining specimens from colorectal biopsies of polyps for nonneoplastic diseases is currently unknown. Our objectives were to characterize such additional diagnoses that could be rendered. Methods. We retrospectively and prospectively reviewed specimens from endoscopic biopsies of colorectal polyps obtained during routine screening or surveillance. Results. 17 of 168 specimens (10.1%) contained additional diagnoses, including schistosomiasis, eosinophilic colitis, intestinal spirochetosis, melanosis coli, and other entities. These findings were easily overlooked because they often affected mucosa that was spared by the polyps or were often evident only at high magnification. Schistosomiasis, eosinophilic colitis, and intestinal spirochetosis were clinically occult. Conclusions. Specimens from biopsies of colorectal polyps often harbor other diagnoses, in addition to polyps, and can be simultaneously screened for polyps and examined for nonneoplastic diseases. Detection of other diagnoses in addition to polyps requires awareness, examination at high magnification, and examination of areas spared by the polyps.
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Affiliation(s)
- Shefali Chopra
- Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, Irvine, CA 92868, USA
| | - Mark Li-cheng Wu
- Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, Irvine, CA 92868, USA
- *Mark Li-cheng Wu:
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