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Lee J, Kim DW, Song JY, Yoon SK. Multilocular Cystic Renal Neoplasm of Low Malignant Potential: A Case Report and Literature Review. TAEHAN YONGSANG UIHAKHOE CHI 2022; 83:173-177. [PMID: 36237353 PMCID: PMC9238200 DOI: 10.3348/jksr.2021.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/11/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a rare subtype of renal cell carcinoma that has a favorable outcome. Most cases of MCRNLMP usually present as distinct multilocular cystic lesions; however, they may appear as small complicated cysts with hemorrhagic components. Herein, we present a case of MCRNLMP and provide a review of the literature.
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Palmeiro MM, Niza JL, Loureiro AL, Conceição e Silva JP. Unusual renal tumour: multilocular cystic renal cell carcinoma. BMJ Case Rep 2016; 2016:bcr-2016-214386. [PMID: 26957035 DOI: 10.1136/bcr-2016-214386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multilocular cystic renal cell carcinoma (MCRCC) is a rare presentation of renal cell carcinoma. Most patients are asymptomatic and frequently MCRCCs are detected incidentally. MCRCCs have good prognosis because of their low malignant potential. We report a case of a 39-year-old woman who presented with mild right flank pain and normal laboratory data. On imaging examinations, a Bosniak III cystic lesion was detected in the lower third of the right kidney. She underwent right partial nephrectomy and histopathology showed a multilocular cystic renal cell carcinoma Fuhrman grade 1. In this article, we also present a review of the literature on MCRCC, highlight the correlation of the pathological and imaging characteristics of these low aggressive renal lesions, and underscore the importance of their recognition to prevent unnecessary radical surgery.
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Affiliation(s)
- Marta Morna Palmeiro
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - João Luz Niza
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Ana Luisa Loureiro
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Curran-Melendez SM, Hartman MS, Heller MT, Okechukwu N. Sorting the Alphabet Soup of Renal Pathology: A Review. Curr Probl Diagn Radiol 2016; 47:417-427. [PMID: 26928791 DOI: 10.1067/j.cpradiol.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/25/2016] [Indexed: 02/01/2023]
Abstract
Diseases of the kidney often have their names shortened, creating an arcane set of acronyms which can be confusing to both radiologists and clinicians. This review of renal pathology aims to explain some of the most commonly used acronyms within the field. For each entity, a summary of the clinical features, pathophysiology, and radiological findings is included to aid in the understanding and differentiation of these entities. Discussed topics include acute cortical necrosis, autosomal dominant polycystic kidney disease, angiomyolipoma, autosomal recessive polycystic kidney disease, acute tubular necrosis, localized cystic renal disease, multicystic dysplastic kidney, multilocular cystic nephroma, multilocular cystic renal cell carcinoma, medullary sponge kidney, paroxysmal nocturnal hemoglobinuria, renal papillary necrosis, transitional cell carcinoma, and xanthogranulomatous pyelonephritis.
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Affiliation(s)
| | - Matthew S Hartman
- Department of Radiology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Matthew T Heller
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA
| | - Nancy Okechukwu
- Department of Radiology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA
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Abstract
There are many imaging modalities used in the diagnosis of renal cell carcinoma, the most common cancer of the kidney, which accounts for approximately 2-3% of adult malignancies. Early detection of this tumor with the correct diagnostic approach using various cross-sectional imaging is very important, as are the clinical and laboratory findings. Familiarity with the spectrum of imaging findings of renal cell carcinoma will enable clinicians to consider appropriate treatment for patients and eliminate unnecessary further imaging studies.
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Affiliation(s)
- Jongchul Kim
- Department of Diagnostic Radiology, Chungnam National University Hospital, 640 Daesa-Dong, Jung-Gu, Daejeon, 301-721, Korea.
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Efficacy of Imaging-Guided Percutaneous Radiofrequency Ablation for the Treatment of Biopsy-Proven Malignant Cystic Renal Masses. AJR Am J Roentgenol 2013; 201:1029-35. [DOI: 10.2214/ajr.12.10210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Huber J, Winkler A, Jakobi H, Bruckner T, Roth W, Hallscheidt P, Daneshvar K, Hohenfellner M, Pahernik S. Preoperative decision making for renal cell carcinoma: cystic morphology in cross-sectional imaging might predict lower malignant potential. Urol Oncol 2013; 32:37.e1-6. [PMID: 23587431 DOI: 10.1016/j.urolonc.2013.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/25/2013] [Accepted: 02/28/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Several histologic studies showed more favorable oncologic outcome for renal cell carcinoma (RCC) with cystic change. However, there is no prognostic tool to judge on cystic RCC preoperatively. We hypothesized, that cystic morphology in cross-sectional imaging predicts lower malignant potential. MATERIALS AND METHODS From our prospectively conducted oncologic database, we identified 825 patients who underwent surgery for malignant renal tumors between 2001 and 2010. In 348 cases (42%), adequate imaging was available for an independent review by 2 radiologists. We excluded recurrent and synchronous bilateral RCC, familial syndromes, collecting duct carcinoma, and metastases of other origin. For the resulting 319 patients, we compared clinical, pathologic, and survival outcomes. RESULTS Median age was 63 (19-88) years and 220 (69%) patients were male. Median follow-up was 1.7 (0-9.8) years. Of 319 renal masses, 277 (86.8%) were solid and 42 (13.2%) were cystic. In cystic RCC, median tumor diameter was lower (3 cm vs. 4 cm, P = 0.002) and nephron-sparing surgery was more frequent (69% vs. 41.5%, P = 0.002). None of the patients with cystic RCC and 56 (20.2%) with solid RCC had synchronous systemic disease (P = 0.001). The nuclear grade of cystic RCC was more favorable (P = 0.002). Patients with cystic RCC showed better overall (P = 0.049) and cancer-specific survival (P = 0.027). In a multivariate model, only synchronous metastases, positive R status, and greater tumor diameter were independent risk factors (P ≤ 0.03). CONCLUSIONS We report the first study to show that cystic morphology in cross-sectional imaging might predict RCC with a lower malignant potential. This insight could allow less invasive treatment strategies in selected patients.
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Affiliation(s)
- Johannes Huber
- Department of Urology, University of Heidelberg, Heidelberg, Germany.
| | - Alexandra Winkler
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Hildegard Jakobi
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometrics and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Wilfried Roth
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Peter Hallscheidt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Keivan Daneshvar
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | | | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
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Singhai A, Babu S, Verma N, Singh V. Multilocular cystic renal cell carcinoma: a rare entity. BMJ Case Rep 2013; 2013:bcr-2012-008457. [PMID: 23559650 DOI: 10.1136/bcr-2012-008457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multilocular cystic renal cell carcinoma (MCRCC) is an uncommon subtype of clear cell renal cell carcinoma that appears to have a favourable prognosis. Literature reports a very low incidence of 1-2% of MCRCC among the renal neoplasms. The first such reported case was in 1957 by Robinson. In 1998, Eble et al suggested following diagnostic criterion for MCRCC: (1) an expansile mass surrounded by a fibrous capsule; (2) interior of tumour entirely composed of cysts and septa with no expansile nodule or solid component confined to more than 10% of entire tumour and (3) septa containing aggregates of clear epithelial cells. We report a case of MCRCC in a 60-year-old male patient who presented with abdominal lump and after suspicion of renal malignancy underwent nephrectomy. The patient was perfectly well till last follow-up of 3 months postoperatively.
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Affiliation(s)
- Atin Singhai
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.
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Tsukada J, Jinzaki M, Yao M, Nagashima Y, Mikami S, Yashiro H, Nozaki M, Mizuno R, Oya M, Kuribayashi S. Epithelioid angiomyolipoma of the kidney: radiological imaging. Int J Urol 2013; 20:1105-11. [PMID: 23551572 DOI: 10.1111/iju.12117] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/17/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To review the imaging findings of renal epithelioid angiomyolipomas. METHODS Eight patients treated at two institutions were pathologically diagnosed as having epithelioid angiomyolipoma. All of them underwent computed tomography, and four underwent magnetic resonance imaging. The tumor size, existence of fat, heterogeneity, computed tomography attenuation, degree of enhancement, enhancement pattern and magnetic resonance imaging signal intensity were evaluated. RESULTS Intratumoral fat was not detected in any of the cases. On unenhanced computed tomography, the intratumoral attenuation was hyperattenuating in six of the seven patients who were examined using this modality. On T2-weighted images, the signal intensity of the solid component, cyst wall or septum was low in three of the four cases. Four of the eight cases were heterogeneous solid-type accompanied by hemorrhage, necrosis or hyalinization. One homogeneous solid-type lesion was large in size and was pathologically accompanied by neither hemorrhage nor necrosis. All three multilocular cystic types were pathologically accompanied by massive hemorrhage in the cystic component. One was accompanied by spontaneous perirenal hematoma. CONCLUSIONS The radiological appearance of most epithelioid angiomyolipomas has a tendency to be hyperattenuating on unenhanced computed tomography images, with low intensities on T2-weighted images. They can be heterogeneously solid, homogeneously solid or a multilocular cystic lesion with massive hemorrhage.
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Affiliation(s)
- Jitsuro Tsukada
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
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Multilocular Cystic Renal Cell Carcinoma: Comparison of Imaging and Pathologic Findings. AJR Am J Roentgenol 2012; 198:W20-6. [DOI: 10.2214/ajr.11.6762] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Radopoulos D, Dimitriadis G, Gologinas P, Tahmatzopoulos A, Kotakidou R. Solitary multilocular cystic renal cell carcinoma in adults: Diagnostic problems, pathological features and treatment. ACTA ACUST UNITED AC 2009; 43:84-7. [DOI: 10.1080/00365590802475896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Demetrios Radopoulos
- 1st Department of Urology, Aristotle University of Thessaloniki, Makedonia, Greece
| | - Georgios Dimitriadis
- 1st Department of Urology, Aristotle University of Thessaloniki, Makedonia, Greece
| | - Peter Gologinas
- 1st Department of Urology, Aristotle University of Thessaloniki, Makedonia, Greece
| | | | - Rodoula Kotakidou
- Department of Pathology, “G. Gennimatas” Hospital, Thessaloniki, Makedonia, Greece
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Gulani V, Adusumilli S, Hussain HK, Vazquez AL, Francis IR, Noll DC. Apparent wall thickening of cystic renal lesions on MRI. J Magn Reson Imaging 2008; 28:103-10. [PMID: 18581399 DOI: 10.1002/jmri.21376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To show that cystic renal lesions that would otherwise meet criteria for simple cysts can demonstrate perceptible walls or increased wall thickness on MRI, sometimes causing these lesions to be "upgraded." It was hypothesized that thickening of cyst walls on MRI can be artifactual, due to data truncation, applied filtering, and low signal-to-noise ratio (SNR). MATERIALS AND METHODS k-Space data for a 4-cm cyst were created in a 40-cm field of view (FOV) (512 x 512 matrix). Additional data sets were created using the central 512 x 256 and 512 x 128 points. Noise was simulated so that the cyst SNR was approximately 7, 14, and 20, respectively. Actual wall thickness was set at 0.25 mm, and cyst:wall signal at 1:4. An inverse two-dimensional (2D) fast Fourier transform (FFT) yielded simulated images. A Fermi filter was applied to reduce ringing. Images/projections were examined for wall thickening. Seven patients with initially thick-walled cysts on fat-saturated spoiled gradient-echo (FS-SPGR) images were scanned with increasing resolution (256 x 128 and 256 x 256; four patients were also scanned with 512 x 512). Average wall thickness at each resolution was compared using a two-tailed paired Student's t-test. RESULTS Simulations showed apparent wall thickening at low resolution, improving with higher resolutions. Low SNR and application of the Fermi filter made it difficult to identify ringing as the cause of this thickening. The simulation results were confirmed on seven patients, whose cyst walls proved to be artifactually thickened (P < 0.01). CONCLUSION Thickening of cyst walls on MRI can be artifactual. Upon encountering thick-walled cystic renal lesions, high-resolution images can be acquired to exclude apparent thickening.
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Affiliation(s)
- Vikas Gulani
- Department of Radiology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Weibl P. Editorial Comment. Urology 2007. [DOI: 10.1016/j.urology.2007.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Ultrasonography and CT have allowed improved detection of renal mass lesions. Though ultrasonography is less sensitive in the characterization of the renal mass lesions, it is often the first imaging modality for evacuation of the kidneys. This article gives an overview of the benign and malignant renal mass lesions and the role of ultrasonography in their characterization.
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Affiliation(s)
- Raj Mohan Paspulati
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Benjaminov O, Atri M, O'Malley M, Lobo K, Tomlinson G. Enhancing component on CT to predict malignancy in cystic renal masses and interobserver agreement of different CT features. AJR Am J Roentgenol 2006; 186:665-72. [PMID: 16498093 DOI: 10.2214/ajr.04.0372] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of our study was to determine the CT features of complex cystic renal masses that are the most predictive of malignancy and to assess interobserver variability when interpreting these features. MATERIALS AND METHODS Two radiologists blinded to pathology results retrospectively reviewed CT scans of 36 consecutive cystic renal masses in 30 patients (19 men and 11 women; age range, 28-76 years; mean age, 59 +/- 13 years) who had undergone surgery. The study population included only masses with a cystic component on gross pathology and imaging. All patients underwent contrast-enhanced CT. The reviewers recorded the CT features of each cystic mass, including the presence of enhancing components. Accuracy values and odds ratio to predict malignancy were calculated for each CT feature. Weighted kappa was used to measure interobserver agreement. RESULTS There were 21 cystic renal cell cancers and 11 benign cystic lesions. All cystic renal cell carcinomas showed an enhancing septal or nodular component. The mean sensitivity and specificity of the two reviewers in predicting malignancy for the presence of septal enhancement were 83% (95% confidence interval [CI], 65-93%) and 82% (95% CI, 56-94%); for nodular enhancement, 67% (95% CI, 49-81%) and 96% (95% CI, 75-99%); and for either septal or nodular enhancement, 100% (95% CI, 86-100%) and 86% (95% CI, 67-95%), respectively. The interobserver agreements for septal and nodular enhancement were good (kappa = 0.67) and moderate (kappa = 0.57), respectively. CONCLUSION The presence of either nodular or septal enhancement shows the highest sensitivity for predicting malignancy with moderate to good interobserver agreement.
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Affiliation(s)
- Ofer Benjaminov
- Present address: Department of Medical Imaging, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, University of Tel-Aviv, Jabutinsky St., Petach Tikva, Israel, 49100
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Abstract
This review aims to assist in the categorization of inherited, developmental, and acquired cystic disease of the kidney as well as to provide a pertinent, up-to-date bibliography. The conditions included are autosomal-dominant polycystic kidney disease, autosomal-recessive polycystic kidney disease, unilateral renal cystic disease (localized cystic disease), renal simple cysts, multicystic dysplastic kidney, pluricystic kidney of the multiple malformation syndromes, juvenile nephronophthisis and medullary cystic disease, medullary sponge kidney, primary glomerulocystic kidney disease, and glomerulocystic kidney associated with several systemic disorders mainly of genetic or chromosomal etiology, cystic kidney in tuberous sclerosis, and in von Hippel-Lindau syndrome, cystic nephroma, cystic variant of congenital mesoblastic nephroma, mixed epithelial stromal tumor of the kidney, renal lymphangioma, pyelocalyceal cyst, peripylic cyst and perinephric pseudocyst, acquired renal cystic disease of long-term dialysis, and cystic renal cell carcinoma and sarcoma. Whereas the gross and histologic appearance of some of these conditions may be diagnostic, clinical and sometimes molecular studies may be necessary to define other types.
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Affiliation(s)
- Michele Bisceglia
- Division of Anatomic Pathology, IRCCS Casa Sollievo della Sofferenza Hospital, I-71013 San Giovanni Rotondo (FG), Italy.
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Kim KA, Choi JW, Park CM, Lee CH, Lee JH, Yoon DK, Seol HY. Unusual renal cell carcinomas: a pictorial essay. ACTA ACUST UNITED AC 2005; 31:154-63. [PMID: 16333698 DOI: 10.1007/s00261-005-0382-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Renal cell carcinoma (RCC) is the most common solid renal neoplasm. Clear cell (conventional) carcinoma is the most common pathologic subtype of RCC. Usually RCC is a hypervascular, solid, solitary mass with contour bulging. However, RCC can manifest different features according to the pathologic tumor subtypes. Preoperative diagnosis of cyst-associated RCC is very difficult, especially in cases of RCC originating in a cyst. Multiple or bilateral presentation of RCC occurs in fewer than 5% of cases. In addition, RCCs may demonstrate unusual findings such as infiltrative growth mimicking transitional cell carcinoma, fatty component mimicking angiomyolipoma, severe perinephric infiltration, and extensive calcifications mimicking inflammation or other tumor. RCCs can be associated with hereditary diseases such as von Hippel-Lindau disease. Familiarity with these radiologic features of unusual RCCs can help ensure correct diagnosis and proper management.
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Affiliation(s)
- K A Kim
- Department of Radiology, Korea University Guro Hospital, 97 Gurodong-Gil, Guro-Ku, Seoul 152-703, Korea
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