1
|
Ouzzaouit H, Kaitouni BI, Zouaidia F, Hamza S, Hrora A, Raiss M. Pseudotumor inflammatory of the spleen: A rare entity with diagnostic and therapeutic challenges: A case report. Int J Surg Case Rep 2024; 115:109215. [PMID: 38280342 PMCID: PMC10839638 DOI: 10.1016/j.ijscr.2023.109215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Inflammatory pseudotumor (IPT) of the spleen is a rare entity that can be difficult distinguishing it from malignancies, both in clinical presentation and radiological imaging. CASE PRESENTATION We present the case of a 43-year-old female presented with 15-cm left hypochondrial mass, Initial imaging studies raised concerns of malignancy, leading to a splenectomy. However, the final pathological examination determined that the patient had IPT of the spleen with focal expression of Smooth Muscle Antibody (SMA). CLINICAL DISCUSSION This case highlights the importance of considering IPT as a potential diagnosis of splenic masses that was difficult to diagnose before surgery. CONCLUSION The uniqueness of the case under consideration lies in the rarity and the atypical localization of IPT of the spleen.
Collapse
Affiliation(s)
- Hamza Ouzzaouit
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.
| | - Boubker Idrissi Kaitouni
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Fouad Zouaidia
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco; Anatomopathology department, Ibn Sina University Hospital, Rabat, Morocco
| | - Sekkat Hamza
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| |
Collapse
|
2
|
Milosavljević VM, Tadić BS, Grubor NM, Eric DV, Matić SV. Laparoscopic splenectomy in the treatment of the splenic pseudotumor and preservation accessory spleen. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
3
|
Hassan M, Pujani M, Jairajpuri ZS, Rana S, Goel A, Jetley S. Inflammatory Pseudotumor of the Spleen Masquerading as Splenic Malignancy. Oman Med J 2016; 31:154-7. [PMID: 27168929 DOI: 10.5001/omj.2016.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Inflammatory pseudotumors (IPTs) of the spleen are extremely rare, benign tumors of unknown etiology, and are most frequently detected incidentally. We report a case of IPT of the spleen in a 19-year-old male, who presented to the Hamdard Institute of Medical Sciences and Research, New Delhi, with a history of pain and heaviness in the left hypochondrium. On clinical examination, splenomegaly was detected. Ultrasonography and contrast-enhanced computed tomography of the abdomen revealed an enlarged spleen with a mass lesion completely occupying the lower pole of the spleen. Therefore, a diagnosis of splenomegaly with a malignant splenic lesion was suggested. Open splenectomy was performed. On gross examination, a well-circumscribed nodular growth measuring 9 × 8 × 5 cm in diameter was seen on the lower pole of the spleen, which on cut section appeared tan white with foci of yellowish discoloration. Microscopic examination of the nodular growth revealed spindle cells in a hyalinized stroma with inflammatory infiltration of predominantly plasma cells and lymphocytes. On immunohistochemistry, the spindle cells were positive for smooth muscle actin. A diagnosis of IPT of the spleen was rendered following histopathology testing. Splenectomy is both diagnostic and curative for this rare entity, and prognosis is usually favorable following the procedure.
Collapse
Affiliation(s)
- Mohammad Hassan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Mukta Pujani
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Zeeba Shamim Jairajpuri
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Safia Rana
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Amit Goel
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| |
Collapse
|
4
|
Ugalde P, García Bernardo C, Granero P, Miyar A, González C, González-Pinto I, Barneo L, Vazquez L. Inflammatory pseudotumor of spleen: a case report. Int J Surg Case Rep 2015; 7C:145-8. [PMID: 25648471 PMCID: PMC4336391 DOI: 10.1016/j.ijscr.2015.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
We present a case of nflammatory pseudotumor of spleen. It is an extremely rare condition of unknown etiology. It is considered as a benign lesion with multiple differential diagnoses. Splenectomy is indicated to confirm diagnosis.
Introduction Inflammatory pseudotumor of spleen is an extremely rare benign condition of uncertain etiology that presents with nonspecific symptoms or as an incidental finding in patients studied by other processes. Since the first description in 1984 by Cotelingam and Jaffe, only 114 cases have been reported. Presentation of case We present a case of a fifty-six years old woman with a splenic injury in ultrasound and computed tomography. The patient undergoes laparoscopic splenectomy and the histologic study of the specimen revealed findings consistent with inflammatory pseudotumor of spleen. Discussion This rare entity whose pathogenesis is still unknown, can present with nonspecific symptoms. Radiologic studies may lead the diagnosis being useful CT and MRI. The definitive diagnosis is established with the histological findings, characterized by the presence of inflammatory cells with areas of necrosis and fibrosis. There are multiple differentials diagnoses: metastasis, lymphoma, splenic infarction, hemangiomas, vascular malformations, lymphangioma, plasmacytoma, reactive lymphoid hyperplasia, abscess and infectious granulomatous processes; therefore suspicion of malignant neoplasm must be considered, being indicated splenectomy to confirm the diagnosis. Conclusion Inflammatory pseudotumor of spleen is a benign disease, in which diagnostic approach must bear in mind the possibility of a malignant lesion. For this reason, the surgical approach is appropriate to confirm the diagnosis and rule out malignancy with histology.
Collapse
Affiliation(s)
- Paúl Ugalde
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Carmen García Bernardo
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Granero
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alberto Miyar
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen González
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio González-Pinto
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Barneo
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lino Vazquez
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| |
Collapse
|
5
|
Loughlin P, Brady A, Devlin E, McManus DT, Spence RAJ. Epstein-Barr virus positive inflammatory pseudo-tumour of the spleen: A case report and literature review. Int J Surg Case Rep 2014; 5:186-8. [PMID: 24632301 PMCID: PMC3980515 DOI: 10.1016/j.ijscr.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 11/12/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Epstein–Barr virus positive inflammatory pseudo-tumour (IPT) of the spleen is an uncommon, frequently asymptomatic entity, which is typically picked up as an incidental finding on imaging. PRESENTATION OF CASE We present a case of EBV positive IPT of the spleen which presented as an incidental finding on CT in a patient with a history of malignancy. Splenectomy was performed. DISCUSSION IPTs are benign spindle cell lesions of varying aetiology, which can arise in a variety of tissues, including the spleen. In situ hybridisation showed strong staining for Epstein–Barr virus RNA in our case, in common with many similar lesions described in the literature. The differential diagnosis of such spindle cell tumours is discussed. CONCLUSION Radiologically, EBV positive spindle cell tumours are indistinguishable from malignant lesions such as lymphoma and diagnosis is made on histology, usually at splenectomy.
Collapse
Affiliation(s)
- P Loughlin
- Department of Surgery, Belfast City Hospital, United Kingdom.
| | - A Brady
- Department of Pathology, Belfast City Hospital, United Kingdom
| | - E Devlin
- Department of Surgery, Belfast City Hospital, United Kingdom
| | - D T McManus
- Department of Pathology, Belfast City Hospital, United Kingdom
| | - R A J Spence
- Department of Surgery, Belfast City Hospital, United Kingdom
| |
Collapse
|
6
|
Ma ZH, Tian XF, Ma J, Zhao YF. Inflammatory pseudotumor of the spleen: A case report and review of published cases. Oncol Lett 2013; 5:1955-1957. [PMID: 23833674 PMCID: PMC3701001 DOI: 10.3892/ol.2013.1286] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/12/2013] [Indexed: 12/28/2022] Open
Abstract
Inflammatory pseudotumor of the spleen (IPTS) is an extremely rare condition. To the best of our knowledge, only ∼113 cases have been reported in the literature since the first 2 cases were reported in 1984. The present study reports the case of an IPTS in a 72-year-old male patient. The splenic tumor was identified incidentally 1 year prior to the patient being admitted to the Second Affiliated Hospital of Dalian Medical University (Dailan, China). There were no specific clinical symptoms. The initial diagnosis was of splenic lymphoma based on the pre-operative radiological findings. However, the patient underwent a splenectomy and the final pathological diagnosis of IPTS was declared. The present study also highlighted the difficulty of forming accurate pre-operative diagnoses, even when using modern imaging techniques. A partial resection of the spleen or splenectomy was considered to be the required treatment to form a definitive diagnosis and exclude malignancy. The prognosis of IPTS is generally considered to be favorable following splenectomy. The clinical and pathological features of previously reported cases are also briefly reviewed in the present study to aid in improving the accuracy of the diagnosis of this rare disease.
Collapse
Affiliation(s)
- Zhen-Hai Ma
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | | | | | | |
Collapse
|
7
|
Yarmohammadi H, Nakamoto D, Faulhaber PF, Miedler J, Azar N. Inflammatory pseudotumor of the spleen: review of clinical presentation and diagnostic methods. J Radiol Case Rep 2011; 5:16-22. [PMID: 22470813 DOI: 10.3941/jrcr.v5i9.758] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe a 91-year-old woman with a clinical history of invasive ductal carcinoma of the breast diagnosed in 1991 who was admitted because of dizziness, poor appetite, and some swelling and tenderness over her cheeks. The patient's initial work up revealed a 5-cm well-demarcated hypodense solid lesion in her spleen with abnormally intense uptake on PET/CT scan raising suspicion for malignancy i.e. breast metastasis versus lymphoma. Further review demonstrated the presence of this splenic lesion, though slightly smaller, on a CT scan from ten years earlier (2000). An ultrasonographic guided core needle splenic biopsy was performed and the pathology result revealed histological findings compatible with inflammatory pseudotumor of the spleen. As a result, unnecessary splenectomy was avoided.
Collapse
Affiliation(s)
- Hooman Yarmohammadi
- Department of Diagnostic Radiology, University Hospitals Case Medical Center, Cleveland, OH 44106-5056, USA.
| | | | | | | | | |
Collapse
|
8
|
Granulomatous inflammatory pseudotumor of the spleen: association with Epstein-Barr virus. Appl Immunohistochem Mol Morphol 2009; 17:259-63. [PMID: 18987550 DOI: 10.1097/pai.0b013e318189f10f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 74-year-old woman with a clinical history of invasive ductal carcinoma of the breast was found to have a splenic mass during a routine radiographic survey. Splenectomy revealed a 3-cm well-demarcated lesion, which on histopathologic examination consisted of heterogeneous inflammatory cells. A striking feature of the lesion was the presence of innumerable well-formed non-necrotizing granulomas. Immunohistochemical studies confirmed the lesion to be composed mainly of mixed T and B lymphocytes, histiocytes, and plasma cells. No spindle cell component was evident on light microscopic examination or by immunohistochemical staining for smooth muscle actin, anaplastic lymphoma kinase, or follicular dendritic cell markers CD21 and CD35. Interestingly, Epstein-Barr virus-encoded RNA and latent membrane protein were detected by in situ hybridization and immunohistochemistry in numerous lymphohistiocytic cells within the lesion, but not in surrounding uninvolved splenic tissue. To our knowledge, this case represents a rare example of splenic inflammatory pseudotumor with exuberant granulomatous reaction in association with Epstein-Barr viral infection.
Collapse
|
9
|
Martínez Celada M, Rivas Carmenado M, García Pravia C, Fresno Forcelledo M. [37 Year old woman with abdominal discomfort and splenic focal lesion]. Rev Clin Esp 2007; 207:135-7. [PMID: 17397636 DOI: 10.1157/13100228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- M Martínez Celada
- Servicios de Medicina Interna I, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | | | | |
Collapse
|
10
|
Shapiro AJ, Adams ED. Inflammatory pseudotumor of the spleen managed laparoscopically. Can preoperative imaging establish the diagnosis? Case report and literature review. Surg Laparosc Endosc Percutan Tech 2007; 16:357-61. [PMID: 17057583 DOI: 10.1097/01.sle.0000213738.77654.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammatory pseudotumor of the spleen, or inflammatory myofibroblastic tumor, is an uncommon condition easily mistaken for a malignant process. Patients may be asymptomatic or may present with nonspecific abdominal complaints. Mild constitutional symptoms have also been reported. The ability to diagnose this entity radiographically preoperatively may allow the uniform application of laparoscopy to manage this condition and spare patients open splenectomy. METHODS Chart review and literature review. RESULTS Inflammatory pseudotumor of the spleen was successfully managed laparoscopically. Preoperative evaluation suggested but could not confirm the diagnosis. CONCLUSIONS A hypovascular solid splenic mass by Doppler ultrasound or CT scan suggests the diagnosis of inflammatory pseudotumor. Stellate central calcifications seen on CT scan make the diagnosis very likely. Laparoscopic splenectomy can be used for definitive diagnosis and symptomatic relief with minimal morbidity and mortality.
Collapse
Affiliation(s)
- Andrew J Shapiro
- General Surgery Service, Bayne-Jones Army Community Hospital, Ft Polk, LA, USA.
| | | |
Collapse
|
11
|
Gasljević G, Lamovec J. Malignant lymphoma of the stomach in association with inflammatory myofibroblastic tumor of the spleen. A case report. Pathol Res Pract 2004; 199:745-9. [PMID: 14708641 DOI: 10.1078/0344-0338-00491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report on a case of a 40-year-old male patient who underwent a gastrectomy because of a biopsy-proven large B-cell lymphoma of the stomach. On surgery, a nodule in the spleen also was noted. Grossly and microscopically, the two lesions were different: the tumor of the stomach appeared white-gray on the cut surface and was a centroblastic variant of diffuse large B-cell lymphoma. Histologically, one perigastric lymph node was involved. Grossly, the splenic nodule was gray-yellow and had a histological appearance of an inflammatory myofibroblastic tumor (IMT). The association between malignant tumor and IMT is rare. In such an association, the latter lesion most often has been reported in the spleen. As EBV may be involved in the genesis of both lymphoma and IMT, we tested both lesions for its presence using in situ hybridization, but the tests were negative. It remains to be verified whether the association between lymphoma and IMT is more than fortuitous.
Collapse
Affiliation(s)
- Gorana Gasljević
- Department of Pathology, Institute of Oncology, Ljubljana, Slovenia
| | | |
Collapse
|
12
|
Oz Puyan F, Bilgi S, Unlu E, Yalcin O, Altaner S, Demir M, Cakir B. Inflammatory pseudotumor of the spleen with EBV positivity: report of a case. Eur J Haematol 2004; 72:285-91. [PMID: 15089768 DOI: 10.1111/j.0902-4441.2003.00208.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Inflammatory pseudotumor (IPT) of the spleen is a rare benign tumor with unknown etiology. It causes problems in the diagnosis because of mimicking some hematopoetic malignancies. Here we report the case of a 36-yr-old woman complaining of nausea and insomnia. Laboratory investigations were limited to increase of leukocyte and thrombocyte count. Ultrasonography and magnetic resonance (MR) imaging showed circumscribed solid lobulated mass, measuring about 6.5 cm in diameter, located in the dorsal region of the spleen. Splenectomy was performed with the differential diagnosis including hamartoma and lymphoma of the spleen. Histological examination of the sharply demarcated splenic mass consisted of myofibroblasts and admixture of inflammatory cells. Immunohistochemistry and in situ hybridization were performed. IPT of the spleen was diagnosed. Epstein-Barr virus (EBV) was detected in the tumor by in situ hybridization. This rare entity is presented because of its clinical, radiological and pathological difficulties in the differential diagnosis.
Collapse
Affiliation(s)
- F Oz Puyan
- Department of Pathology, Trakya University Medical Faculty, Edirne, Turkey.
| | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
This short review is dedicated to a precise pathologic characterization of 2 uncommon and poorly defined lesions of the spleen and to their distinction from histologically similar processes. Splenic hamartoma represents an abnormally formed red pulp and is characterized by the presence of sinus-like structures lined by CD8(+) endothelia. The great variety of its morphologic appearances may result from the preponderant growth of one or another of the several components of the red pulp, ie, CD34(+) capillaries, myoid cells and macrophages. Therefore, it is proposed that "cord capillary hemangioma," myoid angio-endothelioma, and histiocyte-rich tumors are part of the spectrum of splenic hamartoma. Inflammatory pseudotumor (IPT) of the spleen is a reactive lesion, probably of multiple etiologies, characterized by a mixture of inflammatory cells and a minor, disorganized component of spindle cells. The latter include fibroblasts, SMA(+) myofibroblasts, and CD68(+) spindled histiocytes, establishing a close similarity with the IPT of the lymph node. This benign process needs to be distinguished from 2 others that have a predominant spindle cell component arranged in parallel bundles: the IPT-like follicular dendritic cell tumor, which is consistently associated with Epstein-Barr Virus; and the inflammatory myofibroblastic tumor, also often Epstein-Barr Virus-related and similar to those of the soft tissues, lung and other organs. These 2 lesions are neoplastic and therefore have a potentially worse prognosis than IPT.
Collapse
Affiliation(s)
- Jayashree Krishnan
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | | |
Collapse
|
14
|
Matsubayashi H, Kuraoka K, Kobayashi Y, Yokota T, Iiri Y, Shichijo K, Tada T, Satoh K, Kijima H. Ruptured epidermoid cyst and haematoma of spleen: a diagnostic clue of high levels of serum carcinoembryonic antigen, carbohydrate antigen 19-9 and Sialyl Lewis x. Dig Liver Dis 2001; 33:595-9. [PMID: 11816551 DOI: 10.1016/s1590-8658(01)80114-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Splenic epidermoid cyst is a rare disease and that with haematoma is even more rare. The case of epidermoid cyst of the spleen is described, in a 36-year-old Japanese female, manifesting as left hypochondralgia and rupture of the cyst. Clinical features were splenic lesion 14 cm in diameter and consisting of round-hypovascular and crescent-hypervascular sublesions. Extravasation of cystic fluid was detected in abdominal cavity Preoperative diagnosis was difficult due to such uncommon features, however high levels of serum tumour markers (carcinoembryonic antigen, carbohydrate antigen 19-9, Sialyl Lewis x) strongly suggested epidermoid cyst. Laparotomic splenectomy and cholecystectomy were performed for splenic lesion and gallstones, and serum tumour markers decreased following surgery. Pathological diagnosis of the round-hypovascular lesion was epidermoid cyst and crescent-hypervascular lesion was haemorrhage (haematoma).
Collapse
Affiliation(s)
- H Matsubayashi
- Department of Gastroenterology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|