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Omori Y, Aoki S, Ono Y, Kokumai T, Yoshimachi S, Sato H, Kusaka A, Iseki M, Douchi D, Miura T, Maeda S, Ishida M, Mizuma M, Nakagawa K, Mizukami Y, Furukawa T, Unno M. Clonal analysis of metachronous double biliary tract cancers. J Pathol 2024; 263:113-127. [PMID: 38482714 DOI: 10.1002/path.6265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
The molecular mechanisms underpinning the development of metachronous tumors in the remnant bile duct following surgical resection of primary biliary tract carcinomas (BTCs) are unknown. This study aimed to elucidate these mechanisms by evaluating the clinicopathologic features of BTCs, the alterations to 31 BTC-related genes on targeted sequencing, and the aberrant expression of p53, p16, SMAD4, ARID1A and β-catenin on immunohistochemistry. Twelve consecutive patients who underwent resection of metachronous BTCs following primary BTC resection with negative bile duct margins were enrolled. Among the 12 metachronous tumors, six exhibited anterograde growth in the lower portion and six exhibited retrograde growth in the upper portion of the biliary tree. Surgical resection of metachronous BTCs resulted in recurrence-free survival in seven, local recurrence in five, and death in two patients. Nine achieved 5-year overall survival after primary surgery. Molecular analyses revealed that recurrently altered genes were: TP53, SMAD4, CDKN2A, ELF3, ARID1A, GNAS, NF1, STK11, RNF43, KMT2D and ERBB3. Each of these was altered in at least three cases. A comparison of the molecular features between 12 paired primary and metachronous BTCs indicated that 10 (83%) metachronous tumors developed in clonal association with corresponding primary tumors either successionally or phylogenically. The remaining two (17%) developed distinctly. The successional tumors consisted of direct or evolved primary tumor clones that spread along the bile duct. The phylogenic tumors consisted of genetically unstable clones and conferred a poor prognosis. Metachronous tumors distinct from their primaries harbored fewer mutations than successional and phylogenic tumors. In conclusion, over 80% of metachronous BTCs that develop following primary BTC resection are probably molecularly associated with their primaries in either a successional or a phylogenetic manner. Comparison between the molecular features of a metachronous tumor and those of a preceding tumor may provide effective therapeutic clues for the treatment of metachronous BTC. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Yuko Omori
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Division of Gastroenterology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takashi Kokumai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shingo Yoshimachi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiko Kusaka
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Daisuke Douchi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shimpei Maeda
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Division of Gastroenterology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Ito T, Hisa T, Ito Y, Kudo A, Yamada T, Osera S, Tomori A, Fukushima H, Aoyagi D, Shiozawa S. Intraductal papillary neoplasm of the bile duct with metachronous development in the downstream bile duct after radical resection. Clin J Gastroenterol 2024; 17:155-163. [PMID: 37837506 DOI: 10.1007/s12328-023-01867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023]
Abstract
We report a case of intraductal papillary neoplasms of the bile duct (IPNB) that metachronously developed twice in the downstream bile duct after radical resection. The first lesion was located in the left intrahepatic bile duct, the second lesion in the perihilar bile duct, and the third lesion in the distal bile duct. All lesions were IPNBs with associated invasive carcinoma (pancreatobiliary type). The depth of invasion was to the Glisson's capsule in the first lesion, to the subserosa in the second lesion, and to the fibromuscular layer in the third lesion, without lympho-vascular/perineural invasion and lymph-node metastasis. These were resected radically and had no biliary intraepithelial neoplasia and hyperplasia in the surrounding mucosa. In immunohistochemical examination, each lesion showed a different pattern. Although the downstream occurrence suggests intrabiliary dissemination, the mechanism of these metachronous developments may be multicentric. A literature review revealed that most metachronous cholangiocarcinomas have a grossly papillary appearance and tend to arise downstream. Our findings suggest that IPNB may develop metachronously in the residual bile duct after radical surgery, which may assist in early detection.
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Affiliation(s)
- Taito Ito
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan
| | - Takeshi Hisa
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan.
| | - Yui Ito
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan
| | - Akiharu Kudo
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan
| | - Takahiro Yamada
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan
| | - Shozo Osera
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan
| | - Akihisa Tomori
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan
| | - Hideki Fukushima
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Nagano, 385-0051, Japan
| | - Daiju Aoyagi
- Department of Clinical Pathology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Satoshi Shiozawa
- Department of Clinical Pathology, Saku Central Hospital Advanced Care Center, Nagano, Japan
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Tachibana S, Mizukami Y, Ono Y, Sugiyama Y, Okada T, Kitazaki A, Sasajima J, Tominaga M, Sakamoto J, Kimura K, Omori Y, Furukawa T, Kimura T, Tanaka S, Nagashima K, Karasaki H, Ohta T, Okumura T. Genetic Tracing of Clonal Expansion and Progression of Pancreatic Ductal Adenocarcinoma: A Case Report and Multi-Region Sequencing Analysis. Front Oncol 2020; 10:728. [PMID: 32582528 PMCID: PMC7280449 DOI: 10.3389/fonc.2020.00728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Pancreatobiliary tumors frequently contain multiple malignant and precancerous lesions; however, the origin of the driver mutations and the mechanisms that underlie the generation of distinct clones within an organ field remain unclear. Herein, we describe a 76-year-old male suffering from moderately differentiated adenocarcinomas of the pancreas that primarily involved the distal bile duct and multiple “dispersing” invasive lesions in the pancreatic head. The patient underwent pylorus-preserving pancreaticoduodenectomy with superior mesenteric vein resection, and targeted sequencing of 18 genes associated with pancreatic tumorigenesis and immunohistochemical analysis of RNF43 and ARID1A were performed on each tumor compartment, including the invasive and non-invasive areas. Multi-region sequencing revealed shared KRAS and TGFBR1 mutations in all invasive foci, including those involving the distal bile duct. Distinct KRAS variants were found to be present in other non-continuous and non-invasive lesions in the pancreas. Intraductal lesions with KRAS G12D and RNF43 V50R mutations were evident in the main pancreatic duct. This appeared to be a founder clone, given that the mutation profile was common to the invasive foci as well as the additional high-grade dysplasia harboring ARID1A mutations, thereby suggesting a clonal branch-off during tumor evolution. In addition, we also observed independent intraductal papillary mucinous neoplasms with KRAS G12V and GNAS R201H mutations. Our theory, learned from this patient, was that lesions skipped dissemination and wide-spread movement potentially through the pancreatic ductal system as a process of pancreatic cancer development.
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Affiliation(s)
- Shion Tachibana
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yuya Sugiyama
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tetsuhiro Okada
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Arisa Kitazaki
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Junpei Sasajima
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Motoya Tominaga
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Jun Sakamoto
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Keisuke Kimura
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yuko Omori
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taichi Kimura
- Department of Pathology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuo Nagashima
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Hidenori Karasaki
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Tomoyuki Ohta
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toshikatsu Okumura
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Nakanishi Y, Okamura K, Tsuchikawa T, Nakamura T, Noji T, Asano T, Matsui A, Tanaka K, Murakami S, Ebihara Y, Kurashima Y, Narasaki H, Amano T, Shichinohe T, Hirano S. Time to Recurrence After Surgical Resection and Survival After Recurrence Among Patients with Perihilar and Distal Cholangiocarcinomas. Ann Surg Oncol 2020; 27:4171-4180. [PMID: 32363510 DOI: 10.1245/s10434-020-08534-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The differences between perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC) regarding recurrence and the factors that affect recurrence after surgery are unclear. This study aims to investigate the differences in recurrence patterns between patients with PHCC and those with DCC after surgical resection with curative intent. It also investigates the risk factors associated with recurrence and survival thereafter. PATIENTS AND METHODS The postoperative courses of 366 patients with extrahepatic cholangiocarcinomas (EHCCs), including 236 with PHCC and 130 with DCC, who underwent surgical resections were investigated retrospectively. RESULTS During follow-up, tumors recurred in 143 (60.6%) patients with PHCC and in 72 (55.4%) patients with DCC. Overall survival (OS) after surgery, recurrence-free survival (RFS), and OS after recurrence were similar for the patients with PHCC and those with DCC. The cumulative probability of recurrence declined 3 years after surgery in the patients with PHCC and those with DCC. A multivariable analysis determined that, among the patients with PHCC and those with DCC, regional lymph node metastasis was a significant risk factor associated with RFS. Ten patients with PHCC and eight patients with DCC with two or fewer sites of recurrence in a single organ underwent resections. A multivariable analysis determined that recurrent tumor resection was an independent prognostic factor associated with OS after recurrence in the patients with PHCC and those with DCC. CONCLUSIONS Postoperative survival did not differ between the patients with PHCC and those with DCC. Frequent surveillances for recurrence are needed for 3 years after surgical resection of EHCCs. In selected patients, surgery for recurrent EHCCs might be associated with improved outcomes.
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Affiliation(s)
- Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Aya Matsui
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hajime Narasaki
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toraji Amano
- Clinical Research and Medical Innovation Centre, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Shinohara K, Shimoyama Y, Ebata T, Yokoyama Y, Mizuno T, Nakaguro M, Nagino M. Clinicopathologic study on metachronous double cholangiocarcinomas of perihilar and subsequent distal bile duct origin. Surgery 2017; 162:84-93. [DOI: 10.1016/j.surg.2016.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 12/17/2022]
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Allendorf J. Comment on: Clinicopathological study on metachronous double cholangiocarcinomas of perihilar and subsequent distal bile duct origin. Surgery 2017; 162:94-95. [PMID: 28318553 DOI: 10.1016/j.surg.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/28/2022]
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Kim DH, Choi DW, Choi SH, Heo JS. Pancreaticoduodenectomy for secondary periampullary cancer following extrahepatic bile duct cancer resection. Ann Surg Treat Res 2014; 87:94-9. [PMID: 25114889 PMCID: PMC4127899 DOI: 10.4174/astr.2014.87.2.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study addressed the feasibility and effect of surgical treatment of metachronous periampullary carcinoma after resection of the primary extrahepatic bile duct cancer. The performance of this secondary curative surgery is not well-documented. METHODS We reviewed, retrospectively, the medical records of 10 patients who underwent pancreaticoduodenectomy (PD) for secondary periampullary cancer following extrahepatic bileduct cancer resection from 1995 to 2011. RESULTS The mean age of the 10 patients at the second operation was 61 years (range, 45-70 years). The primary cancers were 7 hilar cholangiocarcinomas, 2 middle common bile duct cancers, and one cystic duct cancer. The secondary cancers were 8 distal common bile duct cancers and 2 carcinomas of the ampulla of Vater. The second operations were 6 Whipple procedures and 4 pylorus-preserving pancreaticoduodenectomies. The mean interval between primary treatment and metachronous periampullary cancer was 20.6 months (range, 3.4-36.6 months). The distal resection margin after primary resection was positive for high grade dysplasia in one patient. Metachronous tumor was confirmed by periampullary pathology in all cases. Four of the 10 patients had delayed gastric emptying (n = 2) or pancreatic fistula (n = 2) after reoperation. There were no perioperative deaths. Median survival after PD was 44.6 months (range, 8.5-120.5 months). CONCLUSION Based on the postoperative survival rate, PD may provide an acceptable protocol for resection in patients with metachronous periampullary cancer after resection of the extrahepatic bile duct cancer.
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Affiliation(s)
- Dong Hun Kim
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Dong Wook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Ho Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Maekawa H, Fujikawa T, Tanaka A. Metachronous biliary carcinoma with intraductal pancreatic adenocarcinoma 13 years after curative resection of hilar bile duct cancer. BMJ Case Rep 2014; 2014:bcr-2013-202744. [PMID: 24596413 DOI: 10.1136/bcr-2013-202744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We report a case of a 68-year-old woman with metachronous bile duct cancer and a pancreatic adenocarcinoma. She had undergone extended left hepatic lobectomy for hilar bile duct carcinoma. However, when she was admitted to our hospital 13 years later for an annual follow-up, abdominal CT revealed a mass in the dilated remnant of her lower bile duct. This was diagnosed as a second primary tumour, a pancreaticoduodenectomy was performed and 15 months after the second operation, she remains recurrence-free. Nineteen cases of patients with metachronous bile duct carcinomas were identified in the literature and have been reviewed.
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Affiliation(s)
- Hisatsugu Maekawa
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
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