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Kiosov O, Tkachov V, Gulevskyi S. Endoscopic Resection of Tailgut Cyst. Case Rep Gastrointest Med 2024; 2024:5538439. [PMID: 38939693 PMCID: PMC11208811 DOI: 10.1155/2024/5538439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/13/2024] [Accepted: 05/09/2024] [Indexed: 06/29/2024] Open
Abstract
Tailgut cyst or retrorectal cystic hamartoma is a rare congenital lesion, thought to arise from a portion of the embryological hindgut, usually benign, with no or unspecific symptoms, mainly diagnosed in middle-aged women. Complete surgical resection of the cyst is recommended to avoid complications and confirm the diagnosis. In this report, we present our experience in the successful endoscopic management of a tailgut cyst, outlining the endoscopic resection technique and discussing under what conditions this approach may be applicable.
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Affiliation(s)
- Oleksandr Kiosov
- Department of Faculty Surgery, Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
- Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
| | - Vladyslav Tkachov
- Department of Faculty Surgery, Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
- Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
| | - Sergii Gulevskyi
- Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
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Mastoraki A, Giannakodimos I, Panagiotou K, Frountzas M, Chrysikos D, Kykalos S, Theodoropoulos GE, Schizas D. Epidemiology, diagnostic approach and therapeutic management of tailgut cysts: A systematic review. Int J Clin Pract 2021; 75:e14546. [PMID: 34137134 DOI: 10.1111/ijcp.14546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tailgut cysts (TGCs) are benign congenital abnormalities that usually present with non-specific symptoms, constituting a diagnostic dilemma for physicians. The aim of this study was to systematically review the literature concerning clinical manifestations, diagnostic modalities and histologic findings of TGCs and highlight current knowledge on therapeutic management of this rare entity. METHODS PubMed and Embase databases were systematically searched by two independent investigators (last search 18 February 2021) for studies concerning TGCs published in the past two decades. RESULTS Totally, 144 articles, including 135 case reports and 9 case series, met our inclusion criteria. One hundred eighty-four patients were included (3:1/female:male) with an age of 42.3 ± 18.7 years (mean, SD), while 5 cases concerned new-born infants. Pain was the prevailing clinical manifestation (41.8%), whereas 16.8% were asymptomatic. MRI and CT were utilized for diagnosis in 58.7% and 54.7% of cases, respectively. The majority of cysts were multilocular, while ciliated columnar epithelium and smooth muscles of the cyst wall were the prevailed histological findings. Malignant degeneration of TGCs was reported in 32.1% of cases, while carcinoid tumours were the most frequent malignancies. Surgical resection was performed in 155 cases, while laparoscopic and robotic approach was preferred in 18 and 2 cases, respectively. A posterior approach was implemented in 80.9%, anterior technique in 9% and combined technique in 6.7% of cases. Postoperative complications and recurrence of the cystic lesion were reported in 17.4% and 7.6% of cases, respectively. CONCLUSIONS TGCs constitute a dilemma for the physicians. Surgical resection comprises the ultimate treatment to avoid complications or malignant transformation of the cyst. Concrete follow-up strategies and optimal therapeutic options should be outlined through consensus guidelines and at the time being, such decisions can be made only on the basis of extrapolation and on a case-by-case approach.
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Affiliation(s)
- Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ilias Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Karmia Panagiotou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Georgios E Theodoropoulos
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Nicoll K, Bartrop C, Walsh S, Foster R, Duncan G, Payne C, Carden C. Malignant transformation of tailgut cysts is significantly higher than previously reported: systematic review of cases in the literature. Colorectal Dis 2019; 21:869-878. [PMID: 30932326 DOI: 10.1111/codi.14628] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/16/2019] [Indexed: 02/08/2023]
Abstract
AIM The best treatment for tailgut cysts has not been firmly established. We report a systematic review of the cases in the available literature in order to provide an evidence base for treatment. METHOD A systematic search of articles wholly or partly in English was made of PubMed, Embase and Google Scholar; additional studies were discovered by searching reference lists and contacting authors directly. Search terms 'tailgut cyst', 'tail gut cyst', 'retrorectal hamartoma' and 'retrorectal tumour' were used for case reports or case series; no publication date restrictions were imposed. Only studies with histological confirmation of diagnosis and reporting the age and gender of patients were included. Papers were excluded by consensus between the first two authors. RESULTS A total of 196 individual cases were analysed in detail including 51 cases of neoplasia. The overall rate of neoplastic transformation was 26.6%. Although the male:female cyst incidence ratio was 1:4, men over 18 had a significantly greater relative risk of neoplasm at 1.94 (P = 0.0055). Radiological evidence of nodular thickening of the cyst wall significantly increased the relative risk of the presence of cancer (P = 0.0023). CONCLUSIONS Current orthodoxy that these are not dangerous embryological remnants is unfounded and may be false. The available data suggest the risk of malignant transformation is high and will apply to any residual tissue after excision. The same rationale behind total mesorectal excision in rectal cancer applies to tailgut cysts. Consequently they should be resected with similar oncological margins.
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Aydin Y, Tokgöz VY, Basgun N, Erdemir R. Laparoscopic management of a low-lying tailgut cyst: a rare case. J OBSTET GYNAECOL 2019; 39:1181-1183. [DOI: 10.1080/01443615.2019.1587601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yunus Aydin
- Department of Obstetrics and Gynecology, Saglik Hospital, Denizli, Turkey
| | - Vehbi Yavuz Tokgöz
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Nuri Basgun
- Department of Radiology, Saglik Hospital, Denizli, Turkey
| | - Ridvan Erdemir
- Department of Obstetrics and Gynecology, Saglik Hospital, Denizli, Turkey
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Al Khaldi M, Mesbah A, Dubé P, Isler M, Mitchell A, Doyon J, Sideris L. Neuroendocrine carcinoma arising in a tailgut cyst. Int J Surg Case Rep 2018; 49:91-95. [PMID: 29966957 PMCID: PMC6039892 DOI: 10.1016/j.ijscr.2018.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A tailgut cyst, also called retrorectal cystic hamartoma, is a rare congenital lesion that forms most commonly in the retrorectal space. It is presumed to arise from remnants of early embryogenesis. PRESENTATION OF CASE The following report describes a unique case of a retrorectal cystic hamartoma in a 53 year-old French Canadian man with a history of low back pain. The tumour underwent malignant transformation into a well-differentiated neuroendocrine carcinoma three years after the beginning of symptoms. DISCUSSION This condition can be found at any age, but occurs especially among middle-aged women. Not only is it frequently misdiagnosed, but also several complications associated to the cyst have been reported such as infection and malignant transformation. This is why complete surgical excision of the tailgut cyst is currently recommended.
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Affiliation(s)
- Maher Al Khaldi
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada.
| | - Amanda Mesbah
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Pierre Dubé
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Marc Isler
- Department of Surgery, Division of Orthopedic Surgery, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Andrew Mitchell
- Department of Pathology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Josée Doyon
- Department of Pathology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Lucas Sideris
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
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A systematic review of minimally invasive surgery for retrorectal tumors. Tech Coloproctol 2018; 22:255-263. [PMID: 29679245 DOI: 10.1007/s10151-018-1781-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023]
Abstract
Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (n = 65; 79.2%), with a mean age of 41.7 years (range 18-89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic-perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (n = 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1-8 and 2-10 days, respectively. No tumor recurrence was noted during follow-up [median 28 months (range 5-71 months)]. A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.
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Baek SK, Hwang GS, Vinci A, Jafari MD, Jafari F, Moghadamyeghaneh Z, Pigazzi A. Retrorectal Tumors: A Comprehensive Literature Review. World J Surg 2017; 40:2001-15. [PMID: 27083451 DOI: 10.1007/s00268-016-3501-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Retrorectal tumors are rare lesions that comprise a multitude of histologic types. Reports are limited to small single-institution case series, and recommendations on the ideal surgical approaches are lacking. OBJECTIVE The purpose of the study was to provide a comprehensive review of the epidemiology, pathologic subtypes, surgical approaches, and clinical outcomes of retrorectal tumors. EVIDENCE REVIEW We conducted a review of the literature using PubMed and searched the reference lists of published studies. RESULTS A total of 341 studies comprising 1708 patients were included. Overall, 68 % of patients were female. The mean age was 44.6 ± 13.7 years. Of all patients, 1194 (70 %) had benign lesions, and 514 patients (30 %) had malignant tumors. Congenital tumors (60.5 %) were the most frequent histologic type. Other pathologic types were neurogenic tumors (14.8 %), osseous tumors (3.1 %), inflammatory tumors (2.6 %), and miscellaneous tumors (19.1 %). Biopsy was performed in 27 % of the patients. Of these patients, incorrect diagnoses occurred in 44 %. An anterior surgical approach (AA) was performed in 299 patients (35 %); a posterior approach (PA) was performed in 443 (52 %), and a combined approach (CA) was performed in 119 patients (14 %). The mean length of stay (LOS) of PA was 7 ± 5 days compared to 8 ± 7 days for AA and 11 ± 7 days for CA (p < 0.05). The overall morbidity rate was 13.2 %: 19.3 % associated with anterior approach, 7.2 % associated with posterior approach, and 24.7 % after a combined approach (p < 0.05). Overall postoperative recurrence rate was 21.6 %; 6.7 % after an anterior approach, 26.6 % after a posterior approach, and 28.6 % after a combined approach (p < 0.05). A minimally invasive approach (MIS) was employed in 83 patients. MIS provided shorter hospital stays than open surgery (4 ± 2 vs. 9 ± 7 days; p < 0.05). Differences in complication rate were 19.8 % in MIS and 12.2 % in open surgery and not statistically significant. CONCLUSIONS AND RELEVANCE Retrorectal tumors are most commonly benign in etiology, of a congenital nature, and have a female predominance. Complete surgical resection is the cornerstone of retrorectal tumor management. A minimal access surgery approach, when feasible, appears to be a safe option for the management of retrorectal tumors, with shorter operative time and length of stay.
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Affiliation(s)
- Seong Kyu Baek
- Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Grace Soon Hwang
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.,Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alessio Vinci
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Mehraneh D Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Fariba Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Zhobin Moghadamyeghaneh
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
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Zhou JL, Wu B, Xiao Y, Lin GL, Wang WZ, Zhang GN, Qiu HZ. A laparoscopic approach to benign retrorectal tumors. Tech Coloproctol 2014; 18:825-33. [PMID: 24718777 DOI: 10.1007/s10151-014-1146-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/25/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Retrorectal tumors (RTs) are rare in adults. Their surgical excision is often difficult because of their anatomic location. The aim of this study was to evaluate the results of straight laparoscopic resection of RTs in our institution. METHODS Eight patients (six women and two men) with benign RTs were treated by laparoscopic resection in our tertiary care center between September 2012 and June 2013. Exclusion criteria included malignant tumors, lesions with fistula formation, and anterior sacral meningoceles. Clinical data, imaging features, operative details, pathological results, and treatment outcomes were reviewed and analyzed. RESULTS Eight cases of benign RT with an average diameter of 8.9 ± 1.7 cm were treated by a straight laparoscopic procedure. The mean operative time was 122 ± 36 min, and the average intraoperative blood loss was 46 ± 33 ml. The median postoperative stay was 5 days (range 3-8 days), and all patients were discharged without serious complications. During a median follow-up of 11 months, no tumor recurrence was observed. CONCLUSIONS In our experience, a laparoscopic approach is safe for removing benign tumors in the retrorectal space. This approach may provide access to this difficult-to-reach space and has the advantages of allowing excellent visualization, meticulous dissection, less morbidities, and fast recuperation.
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Affiliation(s)
- J L Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dong Dan, Dong Cheng District, Beijing, 100730, China
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Vilos AG, Vilos GA, Marks J, Pollett A. Retroperitoneal pelvic cyst: a diagnostic and therapeutic challenge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:164-167. [PMID: 23470067 DOI: 10.1016/s1701-2163(15)31022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retroperitoneal cysts can be asymptomatic or can present with vague symptoms such as abdominal pain or distension. Their clinical implications vary significantly. CASE A 45-year-old woman, gravida 2, para 2, presented with vague, non-specific pelvic symptomatology. Imaging indicated a right-sided pelvic cyst 5 cm in diameter. At laparoscopy a retroperitoneal cyst was identified, with a normal pelvis and intra-abdominal organs. No attempt was made at laparoscopy to drain, biopsy, or excise the cyst. CT-guided biopsy of the cyst was performed and small intestine mucosa was identified with goblet cells and smooth muscle. Repeat biopsy confirmed areas of tissue necrosis and small intestine mucosa, with additional tissue containing respiratory epithelium. Following laparotomy and excision of the cyst, the final pathologic diagnosis was benign epithelial cyst consistent with a duplication or hindgut cyst. CONCLUSION Although most retroperitoneal cysts are benign, surgical excision is required to rule out malignancy definitively.
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Affiliation(s)
- Angelos G Vilos
- Department of Obstetrics and Gynaecology, Western University, London ON
| | - George A Vilos
- Department of Obstetrics and Gynaecology, Western University, London ON
| | - Jennifer Marks
- Department of Obstetrics and Gynaecology, Western University, London ON
| | - Aaron Pollett
- Department of Pathology, University of Toronto, Toronto ON
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Bathla L, Singh L, Agarwal PN. Retrorectal cystic hamartoma (tailgut cyst): report of a case and review of literature. Indian J Surg 2012; 75:204-7. [PMID: 24426565 DOI: 10.1007/s12262-012-0633-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/12/2012] [Indexed: 02/07/2023] Open
Abstract
Retrorectal cystic hamartoma is a rare type of congenital cystic lesion usually diagnosed in middle-aged women. Although mostly asymptomatic, patients may present with symptoms resulting from local mass effect or with a complication. The most important complications of these cysts are infection with secondary fistulization and malignant degeneration. Because of such non-specific nature of symptoms and rare incidence, it is not unusual to have a delay in clinical diagnosis. MRI has evolved to be the investigation of choice for the evaluation of presacral tumors as it can provide excellent anatomic detail and soft tissue contrast. Role of preoperative biopsy is controversial especially with improvements in the imaging techniques. When diagnosed these lesions should be excised because of the risk of malignant transformation.
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Affiliation(s)
- Lokesh Bathla
- Section of Transplant Surgery, University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE 68198-3285 USA ; Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Lakhvinder Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Mueller F, Wunschel A, Ulrich U. Laparoscopic treatment of a tailgut cyst. Eur J Obstet Gynecol Reprod Biol 2011; 159:233-4. [PMID: 21733617 DOI: 10.1016/j.ejogrb.2011.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/23/2011] [Accepted: 06/09/2011] [Indexed: 11/25/2022]
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