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Wu MM, Fu WJ, Wu J, Zhu LL, Niu T, Yang R, Yao J, Lu Q, Liao XY. Noncirrhotic portal hypertension due to peripheral T-cell lymphoma, not otherwise specified: A case report. World J Clin Cases 2022; 10:9417-9427. [PMID: 36159409 PMCID: PMC9477668 DOI: 10.12998/wjcc.v10.i26.9417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/20/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Peripheral T-cell lymphoma (PTCL), an aggressive and rare disease that belongs to a heterogeneous group of mature T-cell lymphomas, develops rapidly and has a poor prognosis. Early detection and treatment are essential to improve patient cure and survival rates. Here, we report a rare case of PTCL with clinical presentation of noncirrhotic portal hypertension, which provides a basis for early vigilance of lymphomas in the future.
CASE SUMMARY A 65-year-old Chinese woman was admitted to our hospital because of abdominal distension for 3 months and pitting oedema of both lower limbs for 2 months. Physical examinations and associated auxiliary examinations showed the presence of hepatosplenomegaly, and her hepatic venous pressure gradient was 10 mmHg. Immunohistochemical analysis of the liver biopsy confirmed the diagnosis of PTCL. The patient underwent combination therapy with dexamethasone, VP-16, and chidamide. Unfortunately, after 41 days of chemotherapy, the patient died of multiple organ failure.
CONCLUSION PCTL accompanied by noncirrhotic portal hypertension is rarely reported. This case report discusses the diagnosis of a patient according to the literature.
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Affiliation(s)
- Miao-Miao Wu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Jun Fu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia Wu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lin-Lin Zhu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ting Niu
- Department of Haematology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rong Yang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jin Yao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Yang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Pan ST, Wang RC, Su YZ, Hsieh YC, Chuang SS. Lymphomatous effusion of monomorphic epitheliotropic intestinal T-cell lymphoma is characterized by azurophilic granules and is a dismal sign: Report of two new cases with literature review. Diagn Cytopathol 2021; 49:E247-E252. [PMID: 33387400 DOI: 10.1002/dc.24690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/23/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
Lymphoma involving serous effusion is uncommon. The diagnosis of effusion lymphoma may be challenging, particularly when the lymphoid cells are small to medium-sized, which would be difficult for differentiating reactive effusions from low grade lymphomas. Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is an uncommon type of aggressive intestinal T cell lymphoma with a median survival of 7 months. MEITL rarely disseminates to the body cavities. To date, there are only three reported cases of MEITL with malignant effusion. Here we report two additional cases of MEITL with lymphoma cells involving the pleural effusion and the ascites, respectively. Review of the three literature cases and our two new cases of MEITL with malignant effusion, cytoplasmic azurophilic granules were identified in both the two cases with Liu stain. The median survival time was 1.5 months after the occurrence of malignant effusion, even shorter than the median survival in patients with MEITL. Although the case number is small, malignant effusion seems to be a poor prognostic factor of MEITL.
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Affiliation(s)
- Shien-Tung Pan
- Department of Pathology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Ren Ching Wang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Nursing, HungKuang University, Taichung, Taiwan
| | - Ying-Zhen Su
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yen-Chuan Hsieh
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pathology, School of Medicine, National Taiwan University, Taipei, Taiwan
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3
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Savvidou K, Dimitrakopoulou A, Kafasi N, Konstantopoulos K, Vassilakopoulos T, Angelopoulou M, Siakantaris M, Korkolopoulou P, Kanavaros P, Mikou P. Diagnostic role of cytology in serous effusions of patients with hematologic malignancies. Diagn Cytopathol 2018; 47:404-411. [PMID: 30417978 DOI: 10.1002/dc.24110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND We investigated serous effusions occurring during the course of an already known hematologic neoplasia or as a first manifestation of it. We correlated cytology results with flow cytometry results, when available. In the absence of flow cytometry, our correlation was based on clinical follow up information obtained retrospectively. We evaluated our results in relation to the data of the literature and we considered some new suggestions for the improvement of cytology service. METHODS Serous effusions in hematologic patients were retrieved from the files of the Department of Cytology, Laiko Hospital, for a period of 2 years. All patients had enrolled either a previous hematologic history, or a suspicious clinical and imaging status. Seventy-three serous effusions were included. Cytology reports consisting of morphology and immunocytochemistry assessment were correlated to flow cytometry results and, occasionally, to clinical follow-up. RESULTS In the group of patients with previous history, sensitivity was 82.76%, positive predictive value was 100%, specificity 100%, and negative predictive value was 58.33%. In the group of patients without previous history, sensitivity and positive predictive value were both 91%, whereas specificity and negative predictive value could not be estimated. CONCLUSION We provide evidence that the diagnostic accuracy of cytology with the adjunct of immunocytochemistry is high compared to flow cytometry for detecting hematologic malignancies. In order to improve clinical performance, it is suggested that a cytology triage of serous effusions in all patients with hematologic malignancy must be implemented.
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Affiliation(s)
- Kyriaki Savvidou
- Department of Cytopathology, Laiko Hospital of Athens, Athens, Greece
| | | | - Nikolitsa Kafasi
- Flow Cytometry-Immunology Department, Laiko Hospital of Athens, Athens, Greece
| | | | - Theodore Vassilakopoulos
- Hematology Clinic, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Angelopoulou
- Hematology Clinic, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Siakantaris
- 1st Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Penelope Korkolopoulou
- Department of Pathology, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kanavaros
- Department of Anatomy- Histology- Embryology, University of Ioannina, Athens, Greece
| | - Panagiota Mikou
- Department of Cytopathology, Laiko Hospital of Athens, Athens, Greece
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4
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Antoniadou F, Dimitrakopoulou A, Voutsinas PM, Vrettou K, Vlahadami I, Voulgarelis M, Korkolopoulou P, Kafasi N, Mikou P. Monomorphic epitheliotropic intestinal T-cell lymphoma in pleural effusion: A case report. Diagn Cytopathol 2017; 45:1050-1054. [PMID: 28681573 DOI: 10.1002/dc.23772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/29/2017] [Accepted: 06/12/2017] [Indexed: 12/13/2022]
Abstract
Dissemination of lymphomas in serous effusions is quite common. Cytology aims to contribute in the clinical management of haematologic patients, providing an accurate and rapid diagnosis. Ancillary techniques such as immunocytochemistry and flow cytometry are essential to classify the lymphoma entity. Comprehensive awareness of the clinical picture and previous histologic documentation are essential for a lymphomatous effusion diagnosis. We report an unusual case of monomorphic epitheliotropic intestinal T-cell lymphoma, formerly known as enteropathy associated T-cell lymphoma (EATL) type II, spreading in the pleural cavity. Cell morphology and immunohistochemistry of the pleural fluid were consistent with the histology of a jejunal tumor previously excised. Flow cytometry data were consistent, though not pathognomonic for the disease. Serous effusions with evidence of lymphoma involvement should be thoroughly examined with cytology and adjuvant techniques to provide diagnosis for proper therapeutic strategies.
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Affiliation(s)
- F Antoniadou
- Cytopathology Department, Laiko Hospital, Athens, Greece
| | | | - P M Voutsinas
- Pathophysiology Department, Laiko Hospital, Medical School, University of Athens, Greece
| | - K Vrettou
- Cytopathology Department, Laiko Hospital, Athens, Greece
| | - I Vlahadami
- Pathophysiology Department, Laiko Hospital, Medical School, University of Athens, Greece
| | - M Voulgarelis
- Pathophysiology Department, Laiko Hospital, Medical School, University of Athens, Greece
| | - P Korkolopoulou
- Histopathology Department, Laiko Hospital, Medical School, University of Athens, Greece
| | - N Kafasi
- Immunology Department, Laiko Hospital, Athens, Greece
| | - P Mikou
- Cytopathology Department, Laiko Hospital, Athens, Greece
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5
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Ameri MD, Parekh TM, Qian YW, Elghetany MT, Schnadig V, Nawgiri R. A case of peripheral T-cell lymphoma, not otherwise specified in a HCV and HTLV-II-positive patient, diagnosed by abdominal fluid cytology. J Gastrointest Oncol 2016; 7:S96-9. [PMID: 27034820 DOI: 10.3978/j.issn.2078-6891.2015.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is a rare neoplasm that typically presents as generalized lymphadenopathy. PTCL, NOS presenting as malignant ascites is rare. METHODS A 61-year-old African-American man with past medical history of HCV, cryoglobulinemia, and cryptococcal pneumonia was admitted for dyspnea on exertion over a period of 1 month and new onset of abdominal distension. RESULTS Ascites, splenomegaly, hepatomegaly and extensive lymphadenopathy were found by imaging. Paracentesis obtained 1.3 liter of abdominal fluid, the cytologic evaluation showed a monomorphic population of intermediate-sized lymphoid cells with irregular to convoluted nuclear contours. Fluid sent for flow cytometry showed an abnormal T-lymphocyte population expressing CD4, weak surface CD3 and absence of CD7. PCR studies of ascitic fluid detected a clonal T-lymphocyte population with T-cell receptor gamma gene rearrangement. Serologic testing for human T lymphotropic virus (HTLV) was positive for HTLV-II. Subsequent bone marrow biopsy revealed lymphomatous involvement. CD30 and ALK-1 immunostaining were negative. This case was classified as PTCL, NOS. CONCLUSIONS PTCL, NOS can have unusual clinical presentation such as ascites and pleural effusion, and may also occur as a complication of immunodeficiency state. Further studies are needed to determine if HCV or HTLV-II viral infection is associated with PTCL.
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Affiliation(s)
- Maryam Dadfarnia Ameri
- 1 Department of Pathology, City of Hope National Medical Center, Duarte, USA ; 2 Department of Internal medicine, 3 Department of Pathology, University of Texas Medical Branch, Galveston, USA ; 4 Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - Trisha M Parekh
- 1 Department of Pathology, City of Hope National Medical Center, Duarte, USA ; 2 Department of Internal medicine, 3 Department of Pathology, University of Texas Medical Branch, Galveston, USA ; 4 Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - You-Wen Qian
- 1 Department of Pathology, City of Hope National Medical Center, Duarte, USA ; 2 Department of Internal medicine, 3 Department of Pathology, University of Texas Medical Branch, Galveston, USA ; 4 Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - M Tarek Elghetany
- 1 Department of Pathology, City of Hope National Medical Center, Duarte, USA ; 2 Department of Internal medicine, 3 Department of Pathology, University of Texas Medical Branch, Galveston, USA ; 4 Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - Vicki Schnadig
- 1 Department of Pathology, City of Hope National Medical Center, Duarte, USA ; 2 Department of Internal medicine, 3 Department of Pathology, University of Texas Medical Branch, Galveston, USA ; 4 Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - Ranjina Nawgiri
- 1 Department of Pathology, City of Hope National Medical Center, Duarte, USA ; 2 Department of Internal medicine, 3 Department of Pathology, University of Texas Medical Branch, Galveston, USA ; 4 Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
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Bihari C, Bhatia V, Rastogi A, Bhardwaj V, Jain D, Thapar S. T-cell lymphoma with raised serum glycoprotein-125(CA-125) and raised ascitic fluid adenosinedeaminase levels initially presenting as ascites: a case report and review of literature. Diagn Cytopathol 2010; 39:770-4. [PMID: 20890997 DOI: 10.1002/dc.21551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/19/2010] [Indexed: 12/13/2022]
Abstract
We report a case of T-cell lymphoma presenting as ascites, omental thickening, and raised serum glycoprotein-125 (CA-125) and high-ascitic fluid adenosinedeaminase levels. This case was clinically suspected to be peritoneal carcinomatosis or peritoneal tuberculosis based on clinical, biochemical, and radiological features. However, effusion cytology, cell block, and immunohistochemistry confirmed this case as T-cell lymphoma. This revealed the role of effusion cytology and cell-block preparation with imunohistochemistry in the diagnosis.
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Affiliation(s)
- Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary sciences (ILBS), New Delhi, India
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Abstract
Serous effusions are a common complication of lymphomas. Although the frequency of pleural effusion is 20-30% in non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), the involvement of peritoneal and pericardial cavities is uncommon. Among lymphoma subtypes, T-cell neoplasms, especially the lymphoblastic lymphomas, more frequently involve the serous fluids. The thoracic duct obstruction and impaired lymphatic drainage appear to be the primary mechanism for pathogenesis of pleural effusion in HD and direct pleural infiltration is the predominant cause in NHL. There is wide variation in rate of positive cytologic findings of NHL in pleural effusion (22.2-94.1%). Cytologic features of specific lymphoma subtypes such as lymphoblastic lymphoma, follicular center cell lymphoma, including Burkitt-type lymphoma, marginal zone lymphoma, MALT lymphoma, and anaplastic large-cell lymphoma, etc., have been described in the literature. The differential diagnostic problems of lymphomas in serous effusions include reactive lymphocytoses, early involvement by lymphomatous process, small round-cell tumors (SRCT), and presence of look-alike of Reed-Sternberg cells. To overcome these difficulties, various ancillary studies, including immunocytochemistry (ICC), morphometry, flow cytometry (FCM), and cytogenetics/molecular genetics (PCR, in-situ hybridization, and Southern blotting), have been performed on effusion specimens. ICC not only distinguishes lymphomas from reactive lymphocytoses and SRCTs, it significantly modifies the morphologic diagnosis to achieve a better classification of lymphomas. Combined morphology and immunophenotyping by FCM, has a sensitivity as well as specificity of 100%. Morphometry also distinguishes reactive lymphocytoses from malignant lymphoma with a high degree of sensitivity (>85%) and specificity (>95%). Limitations of individual ancillary techniques can be overcome by using multiple parameters. Although lymphomas rarely present as serous effusions without the involvement of other thoracic and extrathoracic sites, a small group of lymphomas called primary effusion lymphomas (PEL) exhibit exclusive or dominant involvement of serous cavities, without a detectable solid tumor mass. This body cavity based lymphoma (BCBL) is a distinct clinicopathologic entity and is found predominantly in AIDS patients with preexisting Kaposi sarcoma. In the absence of obstructive or infiltrative tumor mass, its pathogenesis has been attributed to stimulation by vascular endothelial growth factor (VEGF)/vascular permeability factor (VPF), leading to vascular leakage. Cytomorphologically, PEL is usually a large-cell lymphoma, which appears to bridge features of large-cell immunoblastic and anaplastic large-cell lymphoma (ALCL). Most of these cases comprise a unique subgroup of B-cell lymphoma, with features of both high-grade anaplastic and B-immunoblastic lymphoma, but T-cell and/or natural killer cell immunophenotypes are described. Its association with various viral DNAs has been studied in detail by molecular techniques. Pleural effusion due to lymphomas, either primary or otherwise, is considered as one of the factors adversely influencing overall survival. The presence of pleural effusion at the time of presentation is not only associated with extremely poor outcome of lymphomas, it is also a predictor of disease relapse after chemotherapy and decreased survival. When the patients of lymphomatous pleural effusions with and without mediastinal mass present in respiratory distress, thoracocentesis is the initial diagnostic and therapeutic choice in these patients. In such situations, cytology along with ancillary studies not only gives a quick diagnosis of lymphoma, but also offers prognostically significant information such as classification of lymphomas, its grade and immunophenotype, and presence/absence of viral DNAs and tumor lysis syndrome.
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Affiliation(s)
- Dilip K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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Nodit L, McGrath K, Peel R. An 86-year-old woman with gastric outlet obstruction. Arch Pathol Lab Med 2005; 129:1349-51. [PMID: 16196532 DOI: 10.5858/2005-129-1349-aywwgo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Laurentia Nodit
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Zimmerman RL. Effusion cytology: Keeping researchers and journals in business for the past 20 years—and it is not over yet. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cdip.2005.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tsuruta S, Ohyama S, Arai H, Kojima M, Johshita T, Suzuki Y. Atypical lymphocytosis resembling non-Hodgkin’s lymphoma in peritoneal effusion of infectious mononucleosis: a case report. Pathol Res Pract 2004; 200:47-51. [PMID: 15157050 DOI: 10.1016/j.prp.2003.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Peritoneal effusion appears to be an unusual complication of infectious mononucleosis (IM). The cytological features of peritoneal effusion from a patient affected by IM are presented. The patient was a 21-year-old Japanese woman, with typical and physical findings of IM. Ascites disappeared with resolution of acute IM. The cytospin smears of the ascitic fluid were highly cellular, consisting exclusively of lymphoid cells. Lymphoid cells were composed of large cells with broad basophilic cytoplasm, as well as of small to medium-sized cells having scant cytoplasm and irregularly shaped nuclei. The overall cytomorphological pictures posed serious difficulties in differentiating this condition from those of peripheral T-cell lymphomas manifesting ascites. The majority of atypical lymphocytes, including large cells, expressed CD3 and CD8. The present case indicates that IM should be added to the list of lesions considered for the differential diagnosis of non-Hodgkin's lymphoma of the peritoneal fluid, particularly regarding young adults.
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Affiliation(s)
- Seiji Tsuruta
- Department of Clinical Laboratories, Isesaki Municipal Hospital, 12-1, Tsunatorihonmachi 372-0817, Isesaki, Japan.
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