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Wang MD, Bresler SC, Chan MP, Patel RM, Chapel DB. Acantholytic Dyskeratoses of the Vulva: Clinicopathologic Characterization of 16 Cases and Review of the Literature. Int J Gynecol Pathol 2024:00004347-990000000-00192. [PMID: 39173136 DOI: 10.1097/pgp.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
The vulva and perineum are rarely involved by acantholytic dyskeratoses, including Hailey-Hailey disease, Darier disease, papular acantholytic dyskeratosis of the genitocrural area, acantholytic dyskeratotic acanthoma, and warty dyskeratoma. These entities show broad histomorphologic overlap, generally requiring clinical correlation for definitive classification. This institutional series aims to better characterize vulvar acantholytic dyskeratoses and provide a practical literature review and diagnostic aid for gynecologic pathologists. Our institutional archives contained 16 vulvar acantholytic dyskeratoses diagnosed between 1990 and 2023. Affected patients were 36 to 79 (mean, 58) years old and presented with one or more asymptomatic (n = 9) or pruritic (n = 6) lesions involving the vulva (predominantly the labia majora), with additional perineal involvement in 2. Four patients have known Hailey-Hailey disease. Eleven cases comprised singular, raised, erythematous, or skin-colored papules, measuring 0.2 to 0.6 (mean, 0.3) cm. Two patients had oligofocal (both with known Hailey-Hailey disease) vulvar lesions, and 2 had multifocal vulvar lesions (one with known Hailey-Hailey disease). Histologically, all showed acantholysis and dyskeratoses (abundant in 8, focal in 8, with corps ronds generally more conspicuous than corps grains). Additional features included suprabasal clefting (n = 14), dermal papillomatosis (n = 12), and acanthosis (n = 8). Adnexal involvement was rare (n = 1). No histologic features reliably distinguished sporadic versus syndromic acantholytic dyskeratoses. Sporadic lesions were cured by local excision. Patients with Hailey-Hailey disease were variably responsive to corticosteroids. Neither our series nor the literature indicate a significant correlation between sporadic or syndromic acantholytic dyskeratosis and squamous cell carcinoma. Important differential diagnoses include pemphigus vulgaris and pemphigus vegetans, for which direct immunofluorescence may be performed, when indicated.
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Affiliation(s)
- Maxwell D Wang
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Scott C Bresler
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rajiv M Patel
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Cutaneous Pathology, WCP Laboratories, Inc., Maryland Heights, Missouri
| | - David B Chapel
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Deng D, Niu M, Yang J, Deng L. Simple Lymphangioma of the Scrotum: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:2017-2020. [PMID: 36172247 PMCID: PMC9512018 DOI: 10.2147/ccid.s375428] [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: 05/19/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022]
Abstract
As scrotal simple lymphangioma is a rare benign proliferation of lymphatic vessels in the scrotum, a few reports were documented. A 68-year-old man gradually developed vesicles on the scrotum for ten years and easily ruptured due to friction. Physical examination showed diffuse millet-sized vesicles on the scrotum with milky white fluids and chyle-like exudates. Histopathological examination revealed proliferating and dilated lymphatic vessels with various sizes of lumens in the dermis. An immunohistochemical study showed positive staining for D2-40 and CD31. Therefore, the patient was diagnosed with scrotal lymphangioma and received carbon dioxide laser therapy. After the treatment, the vesicles markedly decreased, and no apparent exudates were observed. During one year of the follow-up, no relapse, scars, or other complications occurred.
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Affiliation(s)
- Dongmei Deng
- Department of Cosmetic Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, People's Republic of China
| | - Mu Niu
- Department of Cosmetic Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, People's Republic of China
| | - Jie Yang
- Department of Cosmetic Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, People's Republic of China
| | - Lijun Deng
- Department of Dermatovenereology, Wuzhong People's Hospital, Suzhou, People's Republic of China
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Bellinato F, Maurelli M, Gisondi P, Girolomoni G. Clinical features and treatments of transient acantholytic dermatosis (Grover's disease): a systematic review. J Dtsch Dermatol Ges 2020; 18:826-833. [PMID: 32767513 DOI: 10.1111/ddg.14202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/07/2020] [Indexed: 01/27/2023]
Abstract
Grover's disease (GD) is an itchy acantholytic disorder occurring on the trunk of middle-aged men. Based on the best evidence, this study aimed to provide a summary of the clinical characteristics, disease course and treatments of GD. A systematic review was performed according to PRISMA guidelines for original articles published between 01.01.1970-08.15.2019, assessing clinical features and/or any type of intervention for GD. A total of 263 articles were retrieved, and 116 original reports that were deemed relevant and satisfied the inclusion criteria were included in the analysis (88 case reports, 26 case series and two retrospective reviews). From these articles, 317 patients were identified, with a male-to-female ratio of 3.95. The mean age was 59 years (range 11-92). Typical lesions were itchy papules and vesicle-papules, generally located on the trunk. Spontaneous resolution within one week to eight months was described in 42 % of cases. Topical corticosteroids (TCSs) were the most frequent treatment (response rate of 70 %) followed by systemic retinoids and corticosteroids with response rates of 86 % and 64 %, respectively. According to the results of this review, TCS appears to be the most frequently employed treatment, and we suggest TCS as first-line therapy. Second-line treatments could include systemic retinoids or systemic corticosteroids.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Bellinato F, Maurelli M, Gisondi P, Girolomoni G. Klinische Merkmale und Behandlungen der transitorischen akantholytischen Dermatose (Morbus Grover): ein systematischer Review. J Dtsch Dermatol Ges 2020; 18:826-834. [DOI: 10.1111/ddg.14202_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
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El-Nabarawy EA, Saleh N, Abdel-Halim MRE. Peculiar papular eruption on the vulva and inguinal folds. J Clin Pathol 2018; 72:185. [PMID: 30573528 DOI: 10.1136/jclinpath-2018-205434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/11/2018] [Indexed: 11/04/2022]
Affiliation(s)
| | - Nadia Saleh
- Department of Dermatology, Cairo University, Cairo, Egypt
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Successful Management of Papular Acantholytic Dyskeratosis Using Carbon Dioxide Laser: A Case Report and Literature Review. J Low Genit Tract Dis 2017; 21:e42-e44. [PMID: 28953131 DOI: 10.1097/lgt.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Torres KMT, Junkins-Hopkins JM. Cystic acantholytic dyskeratosis of the vulva: An unusual presentation of a follicular adnexal neoplasm. Indian Dermatol Online J 2016; 7:272-4. [PMID: 27559500 PMCID: PMC4976404 DOI: 10.4103/2229-5178.185482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acantholytic dyskeratosis (AD) is a histologic pattern seen in Darier's disease or dyskeratosis follicularis, warty dyskeratoma, and transient AD. This pattern is characterized by suprabasilar clefting, acantholysis, and formation of corps ronds and grains. We present a case of AD that is unique based on its genital location and cystic architecture. A 53-year-old woman presented with an otherwise asymptomatic cyst on her left vulva of uncertain duration. On microscopic examination, there were fragments of cystic epithelium with areas of hypergranulosis, acantholysis, corps ronds, and corps grains formation. These features are felt by the authors to be a unique presentation of a follicular adnexal neoplasm.
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Affiliation(s)
- Kara Melissa Tiangco Torres
- Department of Dermatology-Dermatopathology, The Ackerman Academy of Dermatopathology, New York City, New York, USA
| | - Jacqueline M Junkins-Hopkins
- Department of Dermatology-Dermatopathology, The Ackerman Academy of Dermatopathology, New York City, New York, USA
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Al-Muriesh M, Abdul-Fattah B, Wang X, Zhao M, Chen S, Huang C. Papular acantholytic dyskeratosis of the anogenital and genitocrural area: case series and review of the literature. J Cutan Pathol 2016; 43:749-58. [PMID: 27161553 DOI: 10.1111/cup.12736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Papular acantholytic dyskeratosis (PAD) of the anogenital/genitocrural area is described as a rare distinct clinicopathological entity known to dermatopathologists, although its characteristic histopathologic pattern resembles both Hailey-Hailey disease and Darier disease. The objective of this study is to describe the clinical characteristics, histopathologic features and response to treatment of PAD. METHODS We report in detail six cases of PAD. A literature search of the keyword 'papular acantholytic dyskeratosis' was performed on Google scholar and PubMed, 21 cases of this entity were found. A total of 27 patients including our six cases are reviewed in this study. RESULTS The mean age at diagnosis was 38.8 years with a male to female ratio of 0.8 : 1. Clinically, papular lesions (55.6%) are the typical manifestation of PAD, and the anogenital area (63%) is the most commonly involved site. Lesions were resistant to topical steroids, subcutaneous interferon and antibiotics while one case showed complete resolution of the lesions after retinoid therapy. Laser therapy showed good results in one case. None of the patients had spontaneous remission. CONCLUSION Awareness of the clinicopathological hallmarks herein may be important to avoid underdiagnosis of PAD and may contribute to understanding the pathogenesis of this rare disease.
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Affiliation(s)
- Maher Al-Muriesh
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bilal Abdul-Fattah
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xia Wang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengjie Zhao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Siyuan Chen
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changzheng Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dowd ML, Ansell LH, Husain S, Grossman ME. Papular acantholytic dyskeratosis of the genitocrural area: A rare unilateral asymptomatic intertrigo. JAAD Case Rep 2016; 2:132-4. [PMID: 27051853 PMCID: PMC4810281 DOI: 10.1016/j.jdcr.2015.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Margaret L Dowd
- Columbia University, College of Physicians and Surgeons, New York
| | - Leah H Ansell
- Columbia University Medical Center, Department of Dermatology, New York
| | - Sameera Husain
- Columbia University Medical Center, Department of Dermatology, New York
| | - Marc E Grossman
- Columbia University Medical Center, Department of Dermatology, New York
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Knopp EA, Saraceni C, Moss J, McNiff JM, Choate KA. Somatic ATP2A2 mutation in a case of papular acantholytic dyskeratosis: mosaic Darier disease. J Cutan Pathol 2015; 42:853-7. [PMID: 26154588 DOI: 10.1111/cup.12551] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/03/2015] [Accepted: 07/04/2015] [Indexed: 11/30/2022]
Abstract
Papular acantholytic dyskeratosis, also known as acantholytic dermatosis of the vulvocrural (or anogenital) area, is an uncommon eruption reported predominantly in women. This entity manifests with pruritic papules in the groin/anogenital area and less commonly on the chest. The pathobiology of papular acantholytic dyskeratosis is uncertain. A 62-year-old woman presented with multiple verrucous-appearing lesions in the groin and on the chest showing acantholytic dyskeratosis on histopathology. Given histological similarity of these papular acantholytic dyskeratosis lesions to Darier disease due to inherited ATP2A2 mutation, we screened affected and normal tissue and peripheral blood in our patient for mutations in ATP2A2. We found an identical ATP2A2 p.706D>N mutation in multiple independent papular acantholytic dyskeratosis lesions that was not present in uninvolved skin or peripheral blood DNA. These findings establish somatic mosaicism of ATP2A2 mutations as a genetic cause for papular acantholytic dyskeratosis.
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Affiliation(s)
- Eleanor A Knopp
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Department of Medicine, Division of Dermatology, University of Washington, Seattle, WA, USA.,Departments of Pathology and Dermatology Group Health Permanente, Seattle, WA, USA
| | - Corey Saraceni
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Florida International University Wertheim College of Medicine, Miami, FL, USA
| | - Jeremy Moss
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
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Goldenberg A, Lee RA, Cohen PR. Acantholytic dyskeratotic acanthoma: case report and review of the literature. Dermatol Pract Concept 2014; 4:25-30. [PMID: 25126453 PMCID: PMC4131993 DOI: 10.5826/dpc.0403a03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/19/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Focal acantholytic dyskeratosis has been described as an incidental finding and as a clinically distinct lesion. In both situations, a dimorphic histologic pattern is observed: acantholysis and dyskeratosis. Solitary, non-genital lesions displaying such pathology have been difficult to classify. Clinical and pathological characteristics of acantholytic dyskeratotic acanthomas are described. METHODS The features of a patient with solitary, non-genital, acantholytic dyskeratotic acanthoma are presented and the literature on acantholytic dyskeratotic acanthomas is reviewed. Using PubMed the following terms were searched and relevant citations assessed: acantholysis, acanthoma, cutaneous, dyskeratosis, nail, warty. RESULTS We identified 30 cutaneous acantholytic dyskeratotic acanthomas, including our patient, most often found on the trunk and mimicking basal cell carcinoma, and three subungual acantholytic dyskeratotic acanthomas of the thumb, which mimicked onychopapilloma. CONCLUSION Acantholytic dyskeratotic acanthomas are clinically and pathologically distinct lesions, which may morphologically present as either truncal plaques or subungual longitudinal erythronychia.
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Affiliation(s)
- Alina Goldenberg
- Medical School, University of California San Diego, California, USA
| | - Robert A Lee
- Division of Dermatology, University of California San Diego, California, USA ; Dermatopathology, University of California San Diego, California, USA
| | - Philip R Cohen
- Division of Dermatology, University of California San Diego, California, USA
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Abstract
The complex and fascinating spectrum of inflammatory skin disease, and the comprehension of it, is ever expanding and evolving. During the first decade of the 21st century, numerous advances in the understanding of inflammatory disease mechanisms have occurred, particularly in psoriasis and atopic dermatitis. Continuation of this trend will assure a future in which molecular tests for biomarkers of immediate clinical relevance are used in routine patient care, not only for diagnosis but also for prognosis and management. This article focuses on selected recent or noteworthy developments that are clinically relevant for the histologic diagnosis of inflammatory skin diseases.
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Affiliation(s)
- Maxwell A Fung
- UC Davis Dermatopathology Service, Department of Dermatology, University of California Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA.
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Catteau X, Heenen M, Lejeune C, Noël JC. [A rare lesion of the vulva]. Ann Pathol 2012; 32:156-9. [PMID: 22520613 DOI: 10.1016/j.annpat.2011.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/27/2011] [Accepted: 09/14/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Xavier Catteau
- Laboratoire d'anatomie pathologique, hôpital Erasme, université Libre de Bruxelles, Belgique.
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Dittmer CJ, Hornemann A, Rose C, Diedrich K, Thill M. Successful laser therapy of a papular acantholytic dyskeratosis of the vulva: case report and review of literature. Arch Gynecol Obstet 2009; 281:723-5. [PMID: 20012979 DOI: 10.1007/s00404-009-1313-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 11/24/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND The papular acantholytic dyskeratosis summarizes a collection of papular skin lesions which occur in intertriginous areas and in the genital area. They show a very characteristic histology without the connection to a syndrome such as the Hailey-Hailey disease or the Darier disease. METHODS We present the case of an affected 45-year-old woman and evaluate the laser therapy as therapeutic option. RESULTS A long lasting reduction of the symptoms was achieved by paying special attention to involving the deep tissue layers while performing the laser therapy. Despite causing a long and painful healing process, this was the only way to achieve a lasting reduction of the symptoms. CONCLUSIONS Laser therapy in afflicted areas can improve the symptoms of the papular acantholytic dyskeratosis. The deep tissue laser therapy showed more success than the superficial laser therapy.
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Affiliation(s)
- C J Dittmer
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck, Germany.
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de Almeida HL, Duquia RP. Effective treatment of papular acantholytic dyskeratosis with oral isotretinoin. J Eur Acad Dermatol Venereol 2007; 21:413-4. [PMID: 17309481 DOI: 10.1111/j.1468-3083.2006.01896.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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