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Li X, Zhu Y, Yu T, Cao L, Sun A, Hu Z. Primary pulmonary extranodal natural killer/T-cell lymphoma of nasal type presenting as pneumonia in the right lower lobe: A case report. Respir Med Case Rep 2024; 52:102114. [PMID: 39345928 PMCID: PMC11439531 DOI: 10.1016/j.rmcr.2024.102114] [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: 06/12/2024] [Accepted: 09/14/2024] [Indexed: 10/01/2024] Open
Abstract
Extranodal Natural Killer/T Cell Lymphoma Nasal Type (EN-NK/T-CL-NT) is a rare type of non-Hodgkin lymphoma in which the lesion is usually located in the upper respiratory tract, such as nasal cavity, palate, and nasopharynx. In addition, the primary lesion of EN-NK/T-CL-NT can rarely originate in extranasal sites such as the skin, gastrointestinal tract, testicles, central nervous system, and lungs. We describe an 82-year-old male smoker was brought to the hospital with 8 months of fever, cough, sputum production, chest pain, and chest tightness. Computed tomography (CT) of the chest showed subpleural high-density shadow in the lower lobe of the right lung with unclear borders and surrounding patchy ground-glass shadow. Initially, the patient's right lower lobe lesion progressed after receiving anti-inflammatory treatment. He subsequently underwent two computerized tomography (CT)-guided percutaneous transthoracic needle aspiration biopsies and a bronchoscopy, but no tumor cells were found. Through multidisciplinary team discussions, the patient was then transferred to the department of cardiothoracic surgery for right lower lobectomy. Finally, extranodal natural killer/T-cell lymphoma (ENKTCL), nasal type, was confirmed by pathology of the surgical specimen. The diagnosis of primary pulmonary ENKTCL was made because no evidence other than extrapulmonary site was found at the time of diagnosis and treatment. Here we report a case of primary pulmonary extranodal natural killer/T-cell lymphoma of nasal type presenting as pneumonia in the right lower lobe and enhance the understanding of the disease.
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Affiliation(s)
- Xuefeng Li
- Department of Thoracic Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, No. 68 Yangqiao Road, Hefei, 230000, China
| | - Yang Zhu
- Department of Respiratory, Fuyang Hospital of Anhui Medical University, No. 99 Huangshan Road, Fuyang, 236000, China
| | - Tao Yu
- Department of Respiratory, Fuyang Hospital of Anhui Medical University, No. 99 Huangshan Road, Fuyang, 236000, China
| | - Liyu Cao
- Department of Pathology, Fuyang Hospital of Anhui Medical University, No. 99 Huangshan Road, Fuyang, 236000, China
| | - Aimin Sun
- Department of Thoracic Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, No. 68 Yangqiao Road, Hefei, 230000, China
| | - Zongtao Hu
- Department of Thoracic Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, No. 68 Yangqiao Road, Hefei, 230000, China
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Li S, Fang X, Liu Y, Yue Q, Yu J. Pulmonary extranodal natural killer/T-cell lymphoma: clinical presentation, CT characteristics, and patient outcomes. Quant Imaging Med Surg 2023; 13:8358-8369. [PMID: 38106312 PMCID: PMC10722052 DOI: 10.21037/qims-23-365] [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: 03/21/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Background Due to the extreme rarity of pulmonary extranodal natural killer/T-cell lymphoma (ENKTCL), studies on this lymphoma type are limited. We aimed to investigate the clinical presentations, computed tomography (CT) findings, CT dynamic changes, and outcomes of patients diagnosed with pulmonary ENKTCL. Methods We conducted a retrospective cohort study on ENKTCL, nasal type, at West China Hospital, from January 2010 to January 2023. Out of 27 initial cases with pulmonary ENKTCL, we excluded 4 due to the lack of chest CT images, resulting in a final cohort of 23 patients. Our evaluation covered clinical features, laboratory findings, CT presentations, treatment strategies, and survival outcomes. Survival analyses were performed using the Kaplan-Meier method, with log-rank tests for survival curve comparisons. Given the small sample size, our interpretation of the data is mainly descriptive. Results The most common CT presentations in our institution was solitary or multiple nodules (7/23, 30.4%). The halo sign (78.3%) and floating vessels sign (83.3%) were commonly observed in pulmonary ENKTCL. Elevated lactate dehydrogenase (LDH) levels were observed in 20 (86.9%) patients. The median overall survival (OS) for pulmonary ENKTCL patients was 1 month; 3 cases displayed a favorable prognosis, maintaining complete remission (CR) status for 1.5-7 years after receiving chemotherapy. Chemotherapy led to improved prognosis, with a median survival of 5 months seen in patients who received chemotherapy. Patients with bilateral lung involvement had worse outcomes compared to those with unilateral lesions. Conclusions Pulmonary ENKTCL is a rare and aggressive disease, often misdiagnosed due to nonspecific clinical and CT features. Laboratory tests, failure of antibiotic treatment, and "floating vessels sign" on enhanced CT scans may aid in diagnosis. Timely chemotherapy may improve survival, emphasizing the importance of early detection and prompt treatment.
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Affiliation(s)
- Shuang Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Fang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Yue
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Dong N, Jin Y, Li Y, Ye J. Primary pulmonary lymphoma manifesting as diffuse ground glass opacities: a case report and literature review. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2181-2186. [PMID: 32922618 PMCID: PMC7476933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Primary pulmonary lymphoma is a rare clinical neoplasm, and its atypical manifestation frequently leads to misdiagnosis. Here, we have reported a rare case of a 55-year-old man who presented with cough, dizziness, and fatigue. His chest computed tomography (CT) revealed diffuse ground glass pulmonary opacities. Bronchoscope lavage demonstrated lymphocyte predominance, while transbronchial biopsy indicated chronic inflammation. The administration of a broad-spectrum antibiotic regime supplemented with a high dosage of methylprednisolone was ineffective in improving the general condition of the patient, and the diffuse ground glass pulmonary opacities continued to worsen. CT-guided percutaneous lung biopsy confirmed the diagnosis of primary pulmonary lymphoma-diffuse large B-cell (PPL-DLBCL) without extrapulmonary involvement. The patient's general condition improved with the systemic chemotherapy of CHOP. In the context of a systemic review of relevant literature, pulmonary lymphoma should be considered in the differential diagnosis of diffuse ground glass pulmonary opacities, and bronchoscopy is recommended for pathological diagnosis. Moreover, CT-guided percutaneous lung biopsy should also be adopted whenever necessary.
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Affiliation(s)
- Nian Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Yi Jin
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Yuping Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Junru Ye
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
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Hu Q, Xu L, Zhang X, Wang J, Zhou Z. Primary pulmonary extranodal natural killer/T-cell lymphoma (ENKTL), nasal type: Two case reports and literature review. Medicine (Baltimore) 2020; 99:e20822. [PMID: 32590768 PMCID: PMC7328944 DOI: 10.1097/md.0000000000020822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Extranodal natural killer/T-cell lymphoma (ENKTL) - nasal type is an aggressive form of malignant non-Hodgkin lymphoma with a very poor prognosis. Especially primary pulmonary ENKTL is a relatively rare form of non-Hodgkin lymphoma. Until now, the prevalence of primary pulmonary ENKTL is unknown. Since 2001, only 18 cases of primary pulmonary ENKTL have been published, in addition to the 2 cases reported here. PATIENT CONCERNS We describe 2 cases of primary pulmonary ENKTL. Both patients were male non-smokers, aged 61 and 49 years. Their main clinical symptoms included cold-like symptoms and intermittent fever (39.3°C and 38.8°C) for some days (40 days and 3 weeks). Both patients had no relevant personal or family medical history. DIAGNOSIS The patients were initially misdiagnosed with community-acquired pneumonia. Primary pulmonary ENKTL was confirmed by immunohistochemical staining of computed tomography-guided transthoracic needle biopsy specimens. Both cases were positive for CD56, CD3, and in situ hybridization for Epstein-Barr virus-encoded small RNA, but negative for CD20. INTERVENTIONS Initially, both patients were treated inadequately with intravenous moxifloxacin administration (unknown dosage and 400 mg q.d) in their local hospitals. Once diagnosed with primary pulmonary ENKTL in our hospital, they received 3 cycles of chemotherapy with combined regimens of dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE), and in the second patient, bone marrow transplantation was performed following the third chemotherapy cycle. OUTCOMES Clinical follow-up after the chemotherapy showed that the condition of the first patient progressively deteriorated. He died 2 months following the initial diagnosis. However, the presence of the hemophagocytic lymphohistocytosis gradually improved in the second patient during chemotherapy. Ultimately, the second patient died of acute transplant rejection 6 months after the initial diagnosis. CONCLUSION The diagnosis of ENKTL should be considered when patients present with fever and expansile consolidation of the lung not responding to antibiotics. The diagnosis depends on histopathology and immunophenotyping. Percutaneous transthoracic needle biopsy is a safe and effective biopsy method. Chemotherapy may improve the prognosis, but this should be confirmed by prospective multicenter studies.
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Affiliation(s)
- Qun Hu
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang’an Hospital, Xiamen University, Xiamen
| | - Liyu Xu
- Department of Pulmonary and Critical Care Medicine, Fuzhou First Hospital, Fujian Medical University, Fuzhou
| | - Xiaoming Zhang
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital
| | - Jie Wang
- College of Pharmacy, Shenzhen University, Shenzhen, China
| | - Zizi Zhou
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital
- Department of Plastic and Reconstructive Surgery, BG Unfallklinik Ludwigshafen, University of Heidelberg, Heidelberg, Germany
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Abe Y, Suzuki M, Tsuji K, Sato M, Kimura H, Kimura H, Nagaoka K, Takakuwa E, Matsuno Y, Konno S. Lung metastasis from gastric cancer presenting as diffuse ground-glass opacities. Respir Med Case Rep 2020; 30:101104. [PMID: 32489852 PMCID: PMC7260585 DOI: 10.1016/j.rmcr.2020.101104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022] Open
Abstract
Most metastatic lung tumors display well-defined, round, multiple nodular shadows, whereas the presence of diffuse ground-glass opacities on chest computed tomography generally suggests non-malignant conditions. Here, we report an unusual case of pulmonary metastasis from gastric cancer in which diffuse ground-glass opacities were observed in all lung segments. A 59-year-old man with a 3-month history of worsening chest pain and shortness of breath was referred to the pulmonary clinic. Chest computed tomography revealed low attenuation areas, suggesting emphysema, along with diffuse ground-glass opacities and interlobular septal thickening in both lungs. A transbronchial lung biopsy specimen revealed signet-ring cell carcinoma infiltrating the alveolar septa. Immunohistochemical staining of the cancer cells was positive for CDX-2, cytokeratin 7, and cytokeratin 20, and negative for surfactant apoprotein-A, TTF-1, and Napsin A. Gastrointestinal endoscopy revealed an ulcerative tumor in the stomach, and a biopsy from the tumor demonstrated malignant cells with similar morphology and immunophenotypes as those in the lungs. The final diagnosis was diffuse lung metastasis from gastric cancer. Our case shows that although multiple, well-defined nodules are typically considered to be the classic presentation of pulmonary metastasis, clinicians should also be aware of the possibility of pulmonary metastasis presenting as diffuse ground-glass opacities.
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Affiliation(s)
- Yuki Abe
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kosuke Tsuji
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mineyoshi Sato
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokazu Kimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Kimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Nagaoka
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Pan Z, Xu ML. T-cell and NK-cell lymphomas in the lung. Semin Diagn Pathol 2020; 37:273-282. [PMID: 32448591 DOI: 10.1053/j.semdp.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/11/2022]
Abstract
While the lung is frequently involved by systemic lymphoma, primary pulmonary lymphoma accounts for less than 1% of all extranodal ymphomas. In particular, T-cell lymphoma is very rare in the lung, as a primary or secondary lesion. Patients with pulmonary T-cell lymphoma usually present with cough, dyspnea, pain, fever, recurrent infections, and hemoptysis. Typical radiologic features include pulmonary nodules, consolidation, solid pulmonary opacities, cystic changes, hilar adenopathy, and pleural effusions. Patients with these clinical and radiologic findings are frequently presumed to have pneumonia and initially treated with empirical antibiotics. Therefore, CT-guided needle biopsy, bronchoscopic examination, or even wedge biopsy should be considered when clinical symptoms show deterioration despite adequate antibiotic therapy. Precise pathologic diagnosis and molecular characterization are recommended in all cases, following the World Health Organization (WHO) classification. Principles of treatment typically vary with the different histologic types of T-cell lymphoma.
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Affiliation(s)
- Zenggang Pan
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, New Haven, CT, 06510, United States.
| | - Mina L Xu
- Director of Hematopathology, Department of Pathology & Laboratory Medicine, Yale University School of Medicine, 310 Cedar Street, New Haven, CT, 06510, United States.
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Lookzadeh S, Pourabdollah Toutkaboni M, Jamaati H, Rezaei M, Marashian M. Primary Gastrointestinal Involvement in a Case of Extranodal-Extranasal Natural Killer T Cell Lymphoma. TANAFFOS 2020; 19:74-78. [PMID: 33101435 PMCID: PMC7569497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/26/2019] [Indexed: 06/11/2023]
Abstract
Extra-nasal types of Extra-nodal natural killer cell lymphoma (ENKL) have been known with poorer prognoses than nasal type with the worst responses to treatment. The current work introduces a case of ENKL with GI involvement with no nasal manifestations. We report a 56-year male farmer with fever, productive cough, dyspnea, anorexia, vomiting and chill in addition to malaise and cachexia of three months duration referred to a hospital with acute abdominal pain, and was diagnosed as peritonitis due to perforated terminal ileum ulcer before experiencing surgery as a case of acute abdomen. The pathologic study of the relevant biopsy showed "ulceration and necrosis with dense fibrinoleukocytic exudation and granulation tissue formation. CT scan determined a bilateral mass like haziness which was more likely to be metastatic. The review of the previous pathologic specimens raised Natural Killer/T cell Lymphoma (NKTL), the reason for which we focused on the patient's sinuses and nasal area as well as nasopharynx. There was no finding in examination and endoscopy of sinuses. Pathology also found malignant high grade non-Hodgkin T cell lymphoma in specimens obtained from debridement of ulcer at terminal ileum. It also showed that most of the tumor cells were positive for CD3, CD56, CD8, and LCA but negative for CD19, CD20 and AE1/AE3. Positive reactions for CD30 were shown by some cells. CD56, CD3, and CD8 were expressed by neoplastic cells and CD30 were positive in few cells. Proliferative activity (Ki67 index) was high (60-70%). This was the main base to diagnose an extra-nodal extra-nasal NK/T cell lymphoma. In conclusion, Intestinal changes at middle age, especially in men with nonspecific clinical manifestations is highly advised to be studied pathologically and genetically for T cell types like CD30 positive T cells which are usually engaged in ENKTL.
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Affiliation(s)
- Somayeh Lookzadeh
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihan Pourabdollah Toutkaboni
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Rezaei
- Virology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Mehran Marashian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Primary pulmonary extranodal NK/T cell lymphoma of an elderly adult: a case report and literature review. J Hematop 2019. [DOI: 10.1007/s12308-019-00380-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Vázquez-Armenta G, Gómez-Garnica MF, Mondragón-Cervantes MI, González-Lucano LR. Angiocentric Centrofacial Lymphoma as a Challenging Diagnosis in an Elderly Man. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:412-418. [PMID: 30926768 PMCID: PMC6454582 DOI: 10.12659/ajcr.913856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/18/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Angiocentric centrofacial lymphomas, now known as nasal-type extranodal natural killer T-cell lymphomas, are neoplasms of highly destructive characteristics that mainly affect the nasal cavity and palate. The most frequent clinical presentation includes fever, weight loss, nasal obstruction, epistaxis, nasal or facial edema, as well as necrotic ulcers in the nasal cavity, gums, and palate. It has been found to have an important association with the Epstein-Barr virus. Diagnostic pathology could be difficult due to the typical widespread tissue necrosis. CASE REPORT A 72-year-old Caucasian male sought medical attention with a chief complaint of nasal obstruction for the past 3 years, which only responded partially to unspecific treatment. He also presented with intermittent fever and nocturnal hyperhidrosis. Physical examination with rhinoscopy demonstrated a deviated septum, congestive turbines, and fragile and pale mucous membrane with yellowish, thick mucus. The pathology report described an angiocentric centrofacial lymphoma and a positive serology for Epstein-Barr virus. CONCLUSIONS The objective of this case report was to show that this illness represents a diagnostic challenge for the treating physician. It may be concluded that despite the poor prognosis of the disease, this particular case showed slower evolution and the patient remained stable despite multiple consecutive complications.
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