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Fülber I, Peer K, Maurer E, Bartsch DK, Görlach J, Göbel JN, Roeßler M, Holzer K. Two giant retroperitoneal schwannomas mimicking adrenal malignancy - a case report. Innov Surg Sci 2020; 5:75-79. [PMID: 33506097 PMCID: PMC7798304 DOI: 10.1515/iss-2020-0008] [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: 03/22/2020] [Accepted: 07/07/2020] [Indexed: 12/02/2022] Open
Abstract
Schwannomas are benign tumors in 95% of cases and very rarely occur in the retroperitoneum. We report the cases of a 35-year-old man with abdominal discomfort and a 50-year-old asymptomatic woman with large retroperitoneal masses. Both underwent multivisceral surgery to exclude an adrenal carcinoma, and the pathologic diagnosis showed schwannomas in both cases. Despite morphological imaging, it was not possible to get a clear diagnosis preoperatively.
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Affiliation(s)
- Isabelle Fülber
- Department of General- and Visceral Surgery, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
| | - Katharina Peer
- Department of General- and Visceral Surgery, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
| | - Elisabeth Maurer
- Department of General- and Visceral Surgery, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
| | - Detlef K Bartsch
- Department of General- and Visceral Surgery, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
| | - Jannis Görlach
- Department of Diagnostic and Interventional Radiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
| | - Joachim Nils Göbel
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
| | - Marion Roeßler
- Department of Pathology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
| | - Katharina Holzer
- Department of General- and Visceral Surgery, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
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Juxta-adrenal schwannoma presenting as a giant adrenal tumor: A case report and a literature review. Int J Surg Case Rep 2018; 53:132-136. [PMID: 30391738 PMCID: PMC6216048 DOI: 10.1016/j.ijscr.2018.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/08/2018] [Indexed: 11/24/2022] Open
Abstract
Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath. RS can be misdiagnosed preoperatively, especially when they stick to other structures (the adrenal in our case). Complete surgical resection is the treatment of choice and open surgery is the safest option when we have big tumors. Histology and Immunohistochemistry confirm the diagnosis.
Introduction Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath. Juxta-adrenal schwannomas may be misdiagnosed with giant adrenal tumors. This article reports the case of a RS that presented as an asymptomatic adrenal mass in a 50 Y.O female. Presentation of case An abdominal ultrasound of our asymptomatic patient showed right adrenal lesion of 9 cm of diameter. Endocrinological evaluation was negative. The patient was considered to have a non-secreting right adrenal mass confirmed by adrenal scan. We began a right laparoscopic trans peritoneal adrenalectomy, but when we discovered intra operatively that the wall of the IVC and the renal vein were very adherent to the mass which had a lot of small vessels that were bleeding, we converted to open surgery that allowed us to remove the mass safely. The operative time was 200 min, the blood loss was 850 cc and the patient was discharged uneventfully on the sixth day after surgery. Discussion Although we thought that we removed a huge adrenal tumor from the retroperitoneum of our patient, the pathological exam revealed a RS that comprises the adrenal gland which was normal. Preoperative establishment of diagnosis is difficult in case of RS that can be misdiagnosed, especially when they stick to other structures (the adrenal in our case). Conclusion Complete surgical resection is the treatment of choice for RS and open surgery is the safest option when we have big tumors. Histology and Immunohistochemistry confirms the diagnosis that can be easily missed preoperatively.
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Zhu W, Chen D. Vagus nerve schwannoma in the right upper mediastinum. Thorac Cancer 2017; 8:698-702. [PMID: 28805352 PMCID: PMC5668479 DOI: 10.1111/1759-7714.12485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/02/2017] [Accepted: 07/02/2017] [Indexed: 11/27/2022] Open
Abstract
A 35‐year‐old woman was admitted to our hospital with an abnormal shadow on her chest roentgenogram. Computed tomography showed that a tumor was located in the right upper mediastinum. Resection of the tumor by video‐assisted thoracoscopic surgery was performed. Operative findings determined that the tumor originated from the right vagus nerve and was diagnosed as schwannoma by pathological examination.
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Affiliation(s)
- WeiPeng Zhu
- Thoracic Surgery Department, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - DongHong Chen
- Thoracic Surgery Department, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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Abstract
Schwannomas are typically slow growing, encapsulated benign neoplasms. Visceral schwannomas are rare, and preoperative diagnosis is challenging, as they are often confused with other neoplasms even with advanced imaging studies. Surgical excision is usually needed to establish a definitive diagnosis, as pathology is the "gold standard." We review the imaging findings of abdominal schwannomas focusing on pancreatic, gastrointestinal, and retroperitoneal/adrenal schwannomas with pathology correlation. We conclude that schwannoma should be included in the broad differential diagnosis of an abdominal mass and that when it is unnecessary radical resection can be avoided.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Galukande M, Khingi A. Chest wall schwannoma presenting as a solitary malignant lesion: a case report. SPRINGERPLUS 2016; 5:1549. [PMID: 27652122 PMCID: PMC5021647 DOI: 10.1186/s40064-016-3270-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 09/08/2016] [Indexed: 11/14/2022]
Abstract
Background Chest wall schwannomas are rare tumors arising from the intercostals nerves. Schwannomas are lobulated, encapsulated spherical masses, different from neurofibromas in that matter. Men and women are equally affected in their third and fourth decades. Case presentation A 42 year old female presented with a 6 month history of progressively worsening pain over the right shoulder and chest wall, aggravated by movement and with associated right arm oedema and paraesthesia. She believed mild symptoms began 2 years prior to presentation. The histopathological examination revealed a benign lesion; a schwannoma with degenerative changes. The section revealed a benign nerve sheath tumor characterized by a proliferation of band spindle cells arranged in fascicles and variable cellularity and associated with dilated and think walled blood vessels. Conclusion Chest wall schwannomas are rare; they mimic chest wall malignant lesions.
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Affiliation(s)
- M Galukande
- International Hospital Kampala, Namuwongo, P.O. Box 8177, Kampala, Uganda ; Surgery Department, College of Health Sciences, Makerere University, Kampala, Uganda
| | - A Khingi
- International Hospital Kampala, Kampala, Uganda
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Bacha S, Chaouch N, Ayadi A, Zidi A, Cheikhrouhou S, Racil H, Chabbou A. [Malignant peripheral sheath nerve tumor: An exceptional mass of the anterior and middle mediastinum]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:364-368. [PMID: 26190334 DOI: 10.1016/j.pneumo.2015.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 03/12/2015] [Accepted: 03/28/2015] [Indexed: 06/04/2023]
Abstract
Malignant peripheral nerve sheath tumors (MPNST) are rare nervous tumors usually located in the posterior mediastinum in the paravertebral gutters. We report the case of a non-smoking 62-year-old man who was admitted with a 4 months history of cough, hoarseness and shortness of breath. Physical examination noted a superior vena cava syndrome. CT scan of the chest revealed a right anterior and middle mediastinal mass compressing the superior vena cava, the ascending aorta, the right pulmonary artery, invading the superior root of the pulmonary vein and the right auricle. Flexible bronchoscopy showed extrinsic compression of the right main bronchus, the right upper lobe bronchus and intermedius bronchus. The patient underwent surgical biopsy of the mass by mediastinoscopy. Histological examination revealed a malignant peripheral nerve sheath tumor. The patient received a single cycle of chemotherapy (ifosfamid-adriamycin). Clinical course was marked by the fast worsening of the dyspnea and the general state. Patient died three weeks after the cure of the chemotherapy. This case is original by the exceptional clinical presentation of MPSNT with a superior vena cava syndrome and the very rare location of this tumor in the anterior and middle mediastinum.
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Affiliation(s)
- S Bacha
- Service de pneumologie, pavillon 2, hôpital Abderrahman-Mami, Ariana, Tunisie.
| | - N Chaouch
- Service de pneumologie, pavillon 2, hôpital Abderrahman-Mami, Ariana, Tunisie
| | - A Ayadi
- Service d'anatomie pathologique, hôpital Abderrahman-Mami, Ariana, Tunisie
| | - A Zidi
- Service de radiologie, hôpital Abderrahman-Mami, Ariana, Tunisie
| | - S Cheikhrouhou
- Service de pneumologie, pavillon 2, hôpital Abderrahman-Mami, Ariana, Tunisie
| | - H Racil
- Service de pneumologie, pavillon 2, hôpital Abderrahman-Mami, Ariana, Tunisie
| | - A Chabbou
- Service de pneumologie, pavillon 2, hôpital Abderrahman-Mami, Ariana, Tunisie
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Fu H, Lu B. Giant retroperitoneal schwannoma: a case report. Int J Clin Exp Med 2015; 8:11598-11601. [PMID: 26379989 PMCID: PMC4565372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/10/2015] [Indexed: 06/05/2023]
Abstract
Schwannomas are rare tumors originating from the Schwann sheath of the peripheral or cranial nerves. They are usually benign tumors and in 95% of the cases they originate from the peripheral nerves. Occurrence in the retroperitoneum is rare. We report a case of giant retroperitoneal schwannoma. The patient was a 71-year old female. She was admitted in with the complaints of finding abdominal mass for 8 years and emaciation for 1 year. CT scan showed a 15 cm × 11 cm mass located between the liver and the upper pole of the right kidney. After adequate preparation, the patient underwent surgery. During the procedure, we found a 15 cm × 11 cm × 6 cm mass located between the right liver, right kidney, adrenal gland and vena cava and adhered to them. The pathologic diagnosis was schwannoma.
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Affiliation(s)
- Hong Fu
- Department of General Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University Shaoxing 312000, Zhejiang, China
| | - Baochun Lu
- Department of General Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University Shaoxing 312000, Zhejiang, China
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Roncon A, Davoli F, Casadio C, Baietto G, Rena O, Turello D. Mediastinal vagus nerve scwhannoma succesfully treated by a biportal VATS approach. Arch Bronconeumol 2015; 51:102-103. [PMID: 25572343 DOI: 10.1016/j.arbres.2014.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Alberto Roncon
- Unidad de Cirugía Torácica, Universidad de Piamonte Orientale, Azienda Ospedaliero-Universitaria «Maggiore della Carità», Novara, Italia
| | - Fabio Davoli
- Unidad de Cirugía Torácica, Universidad de Piamonte Orientale, Azienda Ospedaliero-Universitaria «Maggiore della Carità», Novara, Italia.
| | - Caterina Casadio
- Unidad de Cirugía Torácica, Universidad de Piamonte Orientale, Azienda Ospedaliero-Universitaria «Maggiore della Carità», Novara, Italia
| | - Guido Baietto
- Unidad de Cirugía Torácica, Universidad de Piamonte Orientale, Azienda Ospedaliero-Universitaria «Maggiore della Carità», Novara, Italia
| | - Ottavio Rena
- Unidad de Cirugía Torácica, Universidad de Piamonte Orientale, Azienda Ospedaliero-Universitaria «Maggiore della Carità», Novara, Italia
| | - Davide Turello
- Unidad de Cirugía Torácica, Universidad de Piamonte Orientale, Azienda Ospedaliero-Universitaria «Maggiore della Carità», Novara, Italia
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Quartey B, Lenert J, Deb SJ, Henry LR. Giant Posterior Mediastinal Ancient Schwannoma Requiring Thoracoabdominal Resection: A Case Report and Literature Review. World J Oncol 2011; 2:191-194. [PMID: 29147246 PMCID: PMC5649657 DOI: 10.4021/wjon348w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2011] [Indexed: 12/03/2022] Open
Abstract
Posterior mediastinal schwannomas are benign, slow growing nerve sheath tumors and rarely cause symptoms. We present a case of a 47-year-old man who presents with severe mid-back pain and dyspnea on exertion. Chest radiograph and computed topography revealed a large posterior mediastinum mass. Surgical resection required en bloc resection of a portion of the diaphragm, and wedge resection of the left lower lobe of the lung via left thoracoabdominal approach. Pathology was consistent with ancient schwannoma. This case is unique due to the location and size of the mass and the surgical approach required for complete resection.
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Affiliation(s)
- Benjamin Quartey
- National Capital Consortium, National Naval Medical Center, Department of General Surgery, Bethesda, Maryland, 20889, USA
| | - Jeffrey Lenert
- National Capital Consortium, National Naval Medical Center, Department of Surgical Oncology, Bethesda, Maryland, 20889, USA
| | - Subrato J Deb
- National Naval Medical Center, Department of Cardiothoracic Surgery, Bethesda, Maryland, 20889, USA.,Western Maryland Regional Medical Center, Thoracic Surgery Oncology, Cumberland, Maryland, 21502, USA
| | - Leonard R Henry
- Indiana University Health, Goshen Center for Cancer, Goshen, IN 46526, USA
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Imperatori A, Dionigi G, De Monte L, Conti V, Rotolo N. Cervico-mediastinal schwannoma of the vagus nerve: resection with intraoperative nerve monitoring. Updates Surg 2011; 63:59-61. [DOI: 10.1007/s13304-010-0040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/16/2010] [Indexed: 10/18/2022]
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11
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Rammos KS, Rammos SK, Foroulis CN, Zaramboukas TK. Schwannoma of the vagus nerve, a rare middle mediastinal neurogenic tumor: case report. J Cardiothorac Surg 2009; 4:68. [PMID: 19941638 PMCID: PMC2788545 DOI: 10.1186/1749-8090-4-68] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 11/26/2009] [Indexed: 11/10/2022] Open
Abstract
Schwannoma originating from the vagus nerve within the mediastinum is a rare, usually benign tumor. A 44-year old male was presented with chest pain. Chest radiography, CT scan and MRI showed a well circumscribed mass, 5 × 4 cm located in the aortopulmonary window. The mass was found at surgery to be in close proximity with the aortic arch and the left pulmonary hilum, alongside the left vagus nerve. The encapsulated tumor was completely resected through a left thoracotomy incision and it was found to be a benign schwannoma in pathology. The patient is free of recurrence 6 years after surgery.
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Affiliation(s)
- Kyriakos St Rammos
- Department of Thoracic and Cardiovascular Surgery, Aristotle University Medical School, Thessaloniki, Greece.
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12
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Khorgami Z, Nasiri S, Rezakhanlu F, Sodagari N. Malignant schwannoma of anterior abdominal wall: report of a case. J Clin Med Res 2009; 1:233-6. [PMID: 22461875 PMCID: PMC3299187 DOI: 10.4021/jocmr2009.09.1264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2009] [Indexed: 11/14/2022] Open
Abstract
Malignant schwannoma of the anterior abdominal wall nerves is extremely rare. Malignant peripheral nerve sheath tumors (MPNST) represent approximately 10% of all soft tissue sarcomas and it is found in 4% of patients with neurofibromatosis 1. We present a case of malignant schwannoma in a 28-year-old female patient with neurofibromatosis 1. She presented with a painful mass in the right upper quadrant of her abdomen. The tumor location was in the abdominal wall in explorative laparatomy and malignant schwannoma was diagnosed in pathologic assessment. The tumor recurred in 3 months and computed tomography showed two masses in the right side of abdominopelvic cavity. Thereafter, second complete surgical resection was performed and pathologic finding was the same. In spite of administering chemotherapy after second surgery,the tumor recurred and magnetic resonance imaging finding showed a huge heterogeneously enhancing mass with adhesion to the inner side of the abdominal wall. The patient died because of acute respiratory failure due to multiple bilateral pulmonary metastases. Tumor location and rapid recurrence was unique in our patient.
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Affiliation(s)
- Zhamak Khorgami
- General surgery, Tehran University of Medical Science, Tehran, Iran
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Shimoyama T, Yoshiya K, Yamato Y, Koike T, Honma K. Long-term survival after removal of a malignant peripheral nerve sheath tumor originating in the anterior mediastinum. Gen Thorac Cardiovasc Surg 2009; 57:310-4. [PMID: 19533278 DOI: 10.1007/s11748-008-0358-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 10/15/2008] [Indexed: 11/29/2022]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs; malignant schwannomas) rarely occur in the anterior mediastinum, and their prognosis is poor. A 75-year-old man was referred to our hospital for examination of an anterior mediastinal tumor. A computed tomography-guided percutaneous needle biopsy revealed only fibrosis. The tumor was completely excised via a median sternotomy with partial resection of the pericardium and right upper lobe of the lung. Thereafter, the tumor was diagnosed as a storiform-pleomorphic type of malignant fibrous histiocytoma. At 1 year after the surgery, a distant metastasis was found in the interlobular space between the right middle and lower lobes. The tumor was completely excised via a right posterolateral thoracotomy. Reexamination of the primary and secondary tumors revealed an MPNST. No recurrence was found up to 5 years after the second surgery without adjuvant chemotherapy or radiation therapy. However, he died from multiple lung metastases after 6 years.
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Affiliation(s)
- Takehiko Shimoyama
- Division of Chest Surgery, Cancer Center of Niigata Hospital, Niigata, Japan.
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Abstract
This discussion reviews the common causes of Horner's syndrome, with emphasis on case reports from the past several years. Much of the recent literature concerns the use of apraclonidine as a diagnostic test for Horner's syndrome, possibly as an alternative for the current gold standard of cocaine eye drops. This new literature is discussed in the context of the current standards for clinical diagnosis.
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Affiliation(s)
- Timothy J Martin
- Wake Forest University Eye Center, Medical Center Boulevard, Winston-Salem, NC 27157-1033, USA.
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