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Bavan L, Eastley N, Stevenson J, Mifsud M, Bayliss L, Mahmoud S, Baker G, Cusick L, Nail R, Rankin K, Crooks S, Cool P, Williams D, Kandarakis G, Duncan R, Kothari A. Aneurysmal bone cysts: A UK wide tumor center experience. J Surg Oncol 2024; 129:601-608. [PMID: 37965813 DOI: 10.1002/jso.27499] [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: 06/12/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND OBJECTIVES This multicenter retrospective series of consecutive extra-spinal aneurysmal bone cysts aims to identify risk factors for treatment failure. METHODS Aneurysmal bone cysts treated within seven collaborating centers with over 12-months follow-up were eligible for inclusion. Survival analyses were performed to identify variables associated with recurrence using log-rank tests and Cox proportional hazard regression. RESULTS One hundred and fifteen (M:F 60:55) patients were included. Median age at presentation was 13 years and median follow-up was 27 months. Seventy-five patients underwent surgical curettage and 27% of these required further intervention for recurrence. Of the 30 patients who underwent biopsy with limited percutaneous curettage as initial procedure, 47% required no further treatment. Patients under 13 years (log-rank p = 0.006, HR 2.3, p = 0.011) and those treated who had limited curettage (log-rank p = 0.001, HR 2.7, p = 0.002) had a higher risk of recurrence/persistence. CONCLUSIONS There is a high risk of recurrence following surgical treatment for aneurysmal bone cysts and this risk is higher in young patients. However, the cyst heals in a substantial number of patients who have a limited curettage at the time of biopsy.
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Affiliation(s)
- Luckshman Bavan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Jonathan Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston Medical School, Aston University, Birmingham, UK
| | | | - Lee Bayliss
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Shady Mahmoud
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gavin Baker
- Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca Nail
- Newcastle Upon Tyne Hospital NHS Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Kenneth Rankin
- Newcastle Upon Tyne Hospital NHS Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Sophie Crooks
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Paul Cool
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Derfel Williams
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | | | | | - Alpesh Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Ferré-Aniorte A, Alentorn-Geli E, Cuscó X, Barastegui D, Seijas R, Álvarez-Díaz P, Navarro J, Laiz P, Cugat R. Treatment of Aneurysmal Bone Cyst with Endoscopic Resection and Bone Allograft with Platelet-Rich Plasma: A Case Report. Surg J (N Y) 2023; 9:e67-e70. [PMID: 37151568 PMCID: PMC10156445 DOI: 10.1055/s-0043-1764459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/07/2023] [Indexed: 05/09/2023] Open
Abstract
An aneurysmal bone cyst (ABC) is a rare bone tumor usually observed in long bones. The surgical treatment of this pathology is often related to high recurrence rates, so novel biological techniques can help to enhance tissue regeneration and bone consolidation. We present a case of a patient with ABC of the calcaneus treated with an endoscopic resection followed by grafting with an autologous-based matrix composed of allograft bone chips and autologous platelet-rich plasma (PRP) in semisolid and liquid states. Patient demonstrated excellent defect filling in both magnetic resonance imaging and radiologic exams and returned to pre-injury activity with no recurrence at 2 years follow-up. Endoscopic curettage together with allograft bone and autologous PRP is effective in treating ABC patients and could be a good adjuvant treatment to prevent reinjury and enhance consolidation.
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Affiliation(s)
- Alfred Ferré-Aniorte
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Address for correspondence Alfred Ferré-Aniorte, PT, MSc Fundación García CugatBarcelona, Catalunya 08023Spain
| | - Eduard Alentorn-Geli
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
- Mutualidad de Futbolistas Españoles - Delegación Cataluña, Barcelona, Spain
| | - Xavier Cuscó
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
| | - David Barastegui
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
- Mutualidad de Futbolistas Españoles - Delegación Cataluña, Barcelona, Spain
| | - Roberto Seijas
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
- Mutualidad de Futbolistas Españoles - Delegación Cataluña, Barcelona, Spain
| | - Pedro Álvarez-Díaz
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
- Mutualidad de Futbolistas Españoles - Delegación Cataluña, Barcelona, Spain
- Universidad Internacional de Cataluña, Barcelona, Spain
| | - Jordi Navarro
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
| | - Patricia Laiz
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
| | - Ramón Cugat
- Fundación García Cugat, Barcelona, Catalunya, Spain
- Instituto Cugat, Hospital Quirónsalud, Barcelona, Spain
- Mutualidad de Futbolistas Españoles - Delegación Cataluña, Barcelona, Spain
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Woldow A, Foy VM. Aneurysmal bone cyst of the skull: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221117727. [PMID: 35991952 PMCID: PMC9386866 DOI: 10.1177/2050313x221117727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors present a case report of a 14-year-old male with a single temporal scalp nodule. After imaging and surgical resection, the diagnosis of an aneurysmal bone cyst was made. Although aneurysmal bone cysts are benign, they tend to grow rapidly and cause subsequent complications. In this case report, the authors explore the importance of physical examination in order to make more accurate diagnoses.
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Affiliation(s)
| | - Valerie M Foy
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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Abstract
AIMS Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones. METHODS A systematic review of the published literature was performed to identify all articles relating to the management of primary ABCs. Studies required a minimum 12-month follow-up and case series reporting on under ten participants were not included. RESULTS A total of 28 articles meeting the eligibility criteria were included in this review, and all but one were retrospective in design. Due to heterogeneity in study design, treatment, and outcome reporting, data synthesis and group comparison was not possible. The most common treatment option reported on was surgical curettage with or without a form of adjuvant therapy, followed by injection-based therapies. Of the 594 patients treated with curettage across 17 studies, 86 (14.4%) failed to heal or experienced a recurrence. Similar outcomes were reported for 57 (14.70%) of the 387 patients treated with injection therapy across 12 studies. Only one study directly compared curettage with injection therapy (polidocanol), randomizing 94 patients into both treatment groups. This study was at risk of bias and provided low-quality evidence of a lack of difference between the two interventions, reporting success rates of 93.3% and 84.8% for injection and surgical treatment groups, respectively. CONCLUSION While both surgery and sclerotherapy are widely implemented for treatment of ABCs, there is currently no good quality evidence to support the use of one option over the other. There is a need for prospective multicentre randomized controlled trials (RCTs) on interventions for the treatment of ABCs. Cite this article: Bone Jt Open 2021;2(2):125-133.
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Affiliation(s)
- Luckshman Bavan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Asanka Wijendra
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alpesh Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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5
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Richardson J, Litman E, Stanbouly D, Lee KC, Philipone E. Aneurysmal bone cyst of the head & neck: A review of reported cases in the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:59-63. [PMID: 33529841 DOI: 10.1016/j.jormas.2021.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 01/07/2023]
Abstract
The aneurysmal bone cyst (ABC) is a benign, blood-filled bony lesion that notoriously affects the vertebral column and long bones of the body. Rarely, ABCs can manifest in the head and neck (HNABC). The purpose of this paper is to provide a comprehensive review of existing literature on HNABC. This review includes: case reports and case series on ABCs manifesting in the head and neck region published in the English language. All cases identified via PubMed were analyzed individually. Articles were included according to specified eligibility criteria. The total number of cases analyzed were 72 (39 case reports; 33 case series). The average age at the time of HNABC diagnosis was 19.1 years (range: 0.42-62 years). The ratio of prevalence by gender affected exhibited an even 1:1 male-to-female split. CT in combination with MRI proved to be the most prevalent imaging modality utilized (37.2%). HNABC was most commonly detected in the mandible (37.1%), followed by the sinus (14.3%) and cranium (11.4%). The most frequently employed single treatment modality was surgical excision (94.1%). 94.4% of patients were alive with no evidence of disease at follow-up, while 5.6% of patients exhibited disease at follow-up. The average follow-up period was 3.59 years (range: 0.17-17.0 years). Aneurysmal bone cyst of the head and neck region is a rare condition that should be considered in the differential diagnosis of bony, vascular lesions presenting in the aforementioned locations. Since aneurysmal bone cyst of the head and neck region can present as a rapidly growing, expansive and destructive lesion, it is crucial that clinicians are aware of this entity so that patients are accurately diagnosed and treated.
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Affiliation(s)
- Jordan Richardson
- Michigan State University College of Osteopathic Medicine, East Lansing, MI 48824, United States.
| | - Eric Litman
- Michigan State University College of Osteopathic Medicine, East Lansing, MI 48824, United States.
| | - Dani Stanbouly
- Columbia University College of Dental Medicine, New York, NY 10032, United States.
| | - Kevin C Lee
- Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, United States.
| | - Elizabeth Philipone
- Division of Oral & Maxillofacial Pathology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, United States.
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Dorosh J, Vyas P. Aneurysmal Bone Cyst of the Distal Femoral Metaphysis in a Four-year-old Female Patient Presenting with a Pathologic Fracture: A Case Report. Cureus 2019; 11:e4846. [PMID: 31410329 PMCID: PMC6684122 DOI: 10.7759/cureus.4846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aneurysmal bone cysts (ABCs) are benign osteolytic vascular lesions that are capable of aggressive local expansion and bone destruction. These tumors are most common in adolescent patients and constitute approximately 9% of benign tumors. ABCs can present a diagnostic challenge, as they share several histological and radiographic characteristics with more aggressive lesions, including giant cell tumors and malignant telangiectatic osteosarcomas. The management of ABCs is diverse, but the most common approach includes lesion curettage with bone grafting. Here, we present the case of a large, central ABC of the distal femur in a young, previously healthy female who presented to the emergency room with a pathologic fracture.
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Affiliation(s)
- James Dorosh
- Orthopedic Oncology, Sanford Medical Center, Fargo, USA
| | - Parth Vyas
- Orthopedic Oncology, Sanford Medical Center, Fargo, USA
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Woon JTK, Hoon D, Graydon A, Flint M, Doyle AJ. Aneurysmal bone cyst treated with percutaneous doxycycline: is a single treatment sufficient? Skeletal Radiol 2019; 48:765-771. [PMID: 30809704 DOI: 10.1007/s00256-019-03188-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this case series is to report on the effectiveness of a single percutaneous injection of doxycycline as a primary treatment for aneurysmal bone cyst (ABC). MATERIALS AND METHODS A retrospective cohort study was conducted on seven patients diagnosed with ABC at various anatomical sites, with the intention to treat by a single percutaneous injection of doxycycline. Mean patient age was 14 years. RESULTS Signs of treatment response were seen in six of seven patients after one injection. Three of the seven received a second treatment, despite signs of response. Another had expansion of the lesion after treatment, requiring excision. In total, three patients had a single injection of doxycycline as their sole treatment and another three showed signs of response after a single injection. CONCLUSIONS A single percutaneous injection of doxycycline should be considered a viable primary treatment option for ABC.
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Affiliation(s)
- Jason T K Woon
- Anatomy and Medical Imaging, University of Auckland, Park Road, Grafton, Auckland, 1023, New Zealand.,Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Damien Hoon
- Radiology Department, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Graydon
- Orthopaedic Department, Starship Childrens Hospital, Auckland, New Zealand
| | - Mike Flint
- Orthopaedic Department, Middlemore Hospital, Auckland, New Zealand
| | - Anthony J Doyle
- Anatomy and Medical Imaging, University of Auckland, Park Road, Grafton, Auckland, 1023, New Zealand. .,Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.
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Tsagozis P, Brosjö O. Current Strategies for the Treatment of Aneurysmal Bone Cysts. Orthop Rev (Pavia) 2015; 7:6182. [PMID: 26793296 PMCID: PMC4703914 DOI: 10.4081/or.2015.6182] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 11/22/2022] Open
Abstract
Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.
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Affiliation(s)
- Panagiotis Tsagozis
- Section of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden
| | - Otte Brosjö
- Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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Reddy KIA, Sinnaeve F, Gaston CL, Grimer RJ, Carter SR. Aneurysmal bone cysts: do simple treatments work? Clin Orthop Relat Res 2014; 472:1901-10. [PMID: 24532435 PMCID: PMC4016447 DOI: 10.1007/s11999-014-3513-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 02/05/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary aneurysmal bone cysts (ABCs) are benign, expansile bone lesions commonly treated with aggressive curettage with or without adjuvants such as cryotherapy, methacrylate cement, or phenol. It has been reported that occasionally these lesions heal spontaneously or after a pathologic fracture, and we observed that some ABCs treated at our center healed after biopsy alone. Because of this, we introduced a novel biopsy technique we call "curopsy," which is a percutaneous limited curettage at the time of biopsy, obtaining the lining membrane from various quadrants of the cyst leading to consolidation (curopsy = biopsy with intention to cure). QUESTIONS/PURPOSES We asked whether (1) a curopsy results in comparable likelihood of healing of the ABC compared with more aggressive approaches involving curettage, (2) the two approaches differ in terms of the likelihood of recurrence after treatment, and (3) the two approaches differ in terms of complications after surgery. METHODS Between January 1, 1999 and June 30, 2012, 221 patients with a diagnosis of primary ABC were registered in our oncology database. Patients presenting with a pathologic fracture and those seeking a second opinion were excluded. One hundred ninety patients were included in the study. One hundred two (54%) were treated with curopsy and 88 (46%) were treated with curettage after a core needle biopsy. Complete followups were available for 88% (90 of 102) and 93% (80 of 88) of patients in those groups, respectively. During that period, a curopsy was performed for all patients with benign bone lesions with imaging suggestive of classic primary ABCs and for whom the core needle biopsy simply showed blood with no solid component. Curettage after a core needle biopsy was reserved for histologically confirmed primary ABCs, lesions with impending fractures, large lesions, if the ABC was thought to be a secondary disorder, and patients for whom the curopsy failed. All patients were followed up until consolidation of the lesion (mean, 9.6 weeks, range, 3-25 weeks, 95% CI, 8.32-10.9 for curopsy; mean, 11.4 weeks, range, 8-32 weeks, 95% CI, 10.6-12.3 for curettage). The median followup for all patients was 14 months (range, 6-36 months). RESULTS Of the 102 patients who had curopsy and observation, 83 (81%) required no additional treatment and the lesion resolved. Of the 88 patients who underwent curettage (with or without adjuvant therapy) after core needle biopsy, the success rate was 90% (79 of 88). Local recurrences in both groups (curopsy or curettage) were treated successfully with additional curettage in all but one case. Curopsy in comparison to curettage provided a mean shorter healing time (9.6 versus 11.4, p = 0.01) but there was a higher local recurrence and need for additional intervention rate (18.6% versus 10.2%, p = 0.04). There were no differences in the complications between the treatment groups. CONCLUSIONS A curopsy is a novel biopsy technique that was successful in resolving ABCs in 81% of the patients in our study. Curopsy, as a biopsy technique, for ABCs needs consideration as it potentially minimizes the number of patients needing a second procedure (a core needle biopsy being the first) as is the current practice. Furthermore, it does not disadvantage the patient or surgeon should additional intervention be needed in the form of curettage with or without adjuvants. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Krishna I. A. Reddy
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - F. Sinnaeve
- />Department of Oncologic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Czar Louie Gaston
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - Robert J. Grimer
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - Simon R. Carter
- />The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
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