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Billingsley BC, Chaudhary R, Morris MW, Cox JA, Camacho-Gomez SM, Varshney N. Inflammatory Myofibroblastic Tumor of the Esophagus and Stomach Successfully Treated With ALK Inhibitor in a Pediatric Patient: A Case Report and Concise Review of Literature. Int J Surg Pathol 2024:10668969241246470. [PMID: 38656257 DOI: 10.1177/10668969241246470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm of borderline malignant potential. Nearly half of all IMTs have rearrangement of anaplastic lymphoma kinase (ALK) locus on chromosome 2p23 which can be treated with targeted therapy. Herein, we describe an unusual presentation of IMT involving an anatomical region rarely implicated in this disease process. A 15-year-old male patient came to the ER with dysphagia and coffee ground emesis. On esophagogastroscopy, a nodular luminal obstructing 30 × 50 mm mass in the lower esophagus was found, which was continuous with a large, partially circumferential gastric mass extending from the mid-body to the proximal antrum. Biopsies from esophageal and gastric masses revealed submucosal lesions composed of cytologically bland spindle and epithelioid cells, intermingled with inflammatory infiltrate, for which several immunohistochemical (IHC) stains were performed. The molecular study demonstrated ATIC::ALK fusion. Based on morphological, IHC, and molecular study findings, the diagnosis of ALK-positive IMT was rendered. Because surgical excision was deemed infeasible, the patient was started on ALK-inhibiting therapy with crizotinib. The patient responded well with no evidence of residual or recurrent disease on follow-up imaging or surveillance esophagogastroduodenoscopy. Crizotinib was ultimately discontinued after 10 months of therapy, and the patient continues to undergo surveillance imaging for monitoring of disease burden.
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Affiliation(s)
- Benjamin C Billingsley
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ritica Chaudhary
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael W Morris
- Division of Pediatric, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jennifer A Cox
- Division of Hematology and Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandra M Camacho-Gomez
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas at Austin, Austin, TX, USA
| | - Neha Varshney
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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Rich BS, Fishbein J, Lautz T, Rubalcava NS, Kartal T, Newman E, Wok PE, Romao RL, Whitlock R, Naik-Mathuria B, Polites SF, Løfberg K, Lascano D, Kim E, Davidson J, Bütter A, Kastenberg ZJ, Short SS, Meyers RL, Mastropolo R, Malek MM, Weller J, Irfan A, Rhee DS, Utria AF, Rothstein DH, Riehle K, Commander SJ, Tracy E, Becktell K, Hallis B, Lal D, Li O, Dal-Soglio DB, Piché N, Gomez Quevedo O, Murphy AJ, Davidoff AM, Cooke Barber J, Watters E, Dasgupta R, Glick RD. Inflammatory Myofibroblastic Tumor: A Multi-Institutional Study from the Pediatric Surgical Oncology Research Collaborative. Int J Cancer 2022; 151:1059-1067. [PMID: 35604778 DOI: 10.1002/ijc.34132] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate malignancy. We describe the largest cohort of IMT patients to date, aiming to further characterize this rare, poorly understood tumor. This is a multi-institutional review of IMT patients ≤39 years, from 2000-2018, at 18 hospitals in the Pediatric Surgical Oncology Research Collaborative. 182 patients were identified with median age of 11 years. 33% of tumors were thoracic in origin. Presenting signs/symptoms included pain (29%), respiratory symptoms (25%), and constitutional symptoms (20%). Median tumor size was 3.9 cm. Anaplastic lymphoma kinase (ALK) overexpression was identified in 53% of patients. 7% of patients had distant disease at diagnosis. 91% of patients underwent resection: 14% received neoadjuvant treatment and 22% adjuvant treatment. 12% of patients received an ALK inhibitor. 66% of surgical patients had complete resection, with 20% positive microscopic margins, and 14% gross residual disease. Approximately 40% had en bloc resection of involved organs. Median follow-up time was 36 months. Overall 5-year survival (OS) was 95% and 5-year event-free survival (EFS) was 80%. Predictors of recurrence included respiratory symptoms, tumor size, and distant disease. Gross or microscopic margins were not associated with recurrence, suggesting that aggressive attempts at resection may not be warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, NY
| | - Joanna Fishbein
- Biostatistics Unit, The Feinstein Institutes for Medical Research, Manhasset, NY
| | - Timothy Lautz
- Division of Pediatric Surgery, Lurie Children's Hospital, Northwestern University, Chicago, IL
| | - Nathan S Rubalcava
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Tanvi Kartal
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Erika Newman
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Pei En Wok
- Division of Pediatric Surgery, Department of Urology, IWK Health Centre, Halifax, NS
| | - Rodrigo Lp Romao
- Division of Pediatric Surgery, Department of Urology, IWK Health Centre, Halifax, NS
| | - Richard Whitlock
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - Katrine Løfberg
- Division of Pediatric Surgery, OHSU Doernbecher Children's Hospital, Portland, OR
| | - Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Eugene Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jacob Davidson
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Andreana Bütter
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | | | - Marcus M Malek
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh
| | - Jennine Weller
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ahmer Irfan
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Daniel S Rhee
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Alan F Utria
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David H Rothstein
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Kimberly Riehle
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Elisabeth Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Kerri Becktell
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Brian Hallis
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Dave Lal
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Orville Li
- Faculty of Medicine, Université de Montréal
| | | | - Nelson Piché
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine
| | | | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Jo Cooke Barber
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Erin Watters
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, NY
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Meng X, Zhang L, Wang Q, Chen J, Zhang C, Tao R, Wang Y. Genetic Testing and Immunotherapy for Intracranial Inflammatory Myofibroblastic Tumor: A Case Report. Onco Targets Ther 2022; 15:313-321. [PMID: 35401006 PMCID: PMC8985701 DOI: 10.2147/ott.s343562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/15/2022] [Indexed: 12/25/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor that can develop in numerous organs, most commonly in the lungs and rarely in the brain. Here, we reported a 55-year-old patient with nasopharyngeal IMT and the recurrence in the skull base, slope and pterygoid sinus who underwent cranial base and slope tumor resection. Postoperative magnetic resonance imaging (MRI) and multiplex immunohistochemistry (mIHC) showed tumor recurrence and metastasis to the intracalvarium. While genetic testing revealed no significant related gene mutations, tertiary mutations in NSD1 and SOX9 genes were identified in the tumor tissues. The patient achieved partial remission after receiving 7 cycles of immunotherapy (toripalimab 240 mg for 1 cycle followed by 6 cycles of sintilimab 200 mg), and MRI examination indicated an almost complete remission of intracranial IMT after 16 cycles of immunotherapy. In summary, the novel class of immune-targeted agents may be effective in clinical management of rare intracranial IMT.
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Affiliation(s)
- Xiangji Meng
- Department of Neurosurgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China
| | - Lei Zhang
- Department of Translational Medicine, Genecast Biotechnology Co., Ltd, Wuxi, Jiangsu, 214104, People’s Republic of China
| | - Qi Wang
- Department of Paediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Jimin Chen
- Department of Translational Medicine, Genecast Biotechnology Co., Ltd, Wuxi, Jiangsu, 214104, People’s Republic of China
| | - Chunmei Zhang
- Department of Translational Medicine, Genecast Biotechnology Co., Ltd, Wuxi, Jiangsu, 214104, People’s Republic of China
| | - Rongjie Tao
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China
- Rongjie Tao, Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China, Email
| | - Yong Wang
- Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250117, People's Republic of China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, Peoples' Republic of China
- Correspondence: Yong Wang, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, Shandong, 250117, People’s Republic of China, Email
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Therapeutic options in inoperable ROS1-rearranged inflammatory myofibroblastic tumor of the tongue in a child: a case report and literature review. Anticancer Drugs 2021; 32:1111-1115. [PMID: 34145176 DOI: 10.1097/cad.0000000000001099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare borderline malignancy, usually treated with surgery only. Exceedingly rare cases of inoperable, recurrent, or metastatic IMTs pose a therapeutic challenge. We report successful treatment of a 7-year-old girl with an inoperable anaplastic lymphoma kinase (ALK)-negative IMT of the tongue. The patient underwent various anti-inflammatory (steroids, nonsteroidal anti-inflammatory drugs, clarithromycin) and antiproliferative (chemotherapy) therapies to enable tumor regression and complete resection. Ultimately, next-generation sequencing of the tumor revealed a TFG-ROS-1 translocation, allowing for an off-label targeted therapy with crizotinib. Crizotinib treatment caused slight tumor regression but evident change of its structure, allowing for complete non-mutilating resection. Two histopathology examinations revealed complete disappearance of neoplastic cells following therapy. The patient remains disease-free 22 months after the delayed surgery. In children with inoperable ALK-negative IMTs, molecular testing must be performed to identify other targetable oncogenic fusions, including TFG-ROS1.
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Song W, Zhu Y. Clinical characteristics and outcomes of 17 cases of inflammatory myofibroblastic tumor at a University Hospital in China. Oncol Lett 2021; 21:51. [PMID: 33281962 PMCID: PMC7709559 DOI: 10.3892/ol.2020.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
The aim of the present study was to explore the clinical and pathological characteristics, diagnosis, and treatment of inflammatory myofibroblastic tumor (IMT). A total of 17 patients with IMT diagnosed between July 2010 and February 2020 were included in the present study, and the clinical characteristics, pathological features, treatment and prognosis were analyzed retrospectively. The cohort consisted of 17 participants, including 12 men and 5 women, with a mean age of 34.76 years. The most common locations of tumors were the bronchi and the lungs (9 cases, including 1 case involving the mediastinum), followed by the colon and bladder (2 cases each), and the omentum majus, mesocolon, stomach and peritoneal cavity (1 case each). Immunohistochemical staining demonstrated that the tumor cells exhibited positive staining for anaplastic lymphoma kinase p80 (13/17), smooth muscle actin (12/17), cytokeratin pan (6/17), vimentin (5/17) and desmin (4/17). The follow-up time was 18-114 months. A patient with epithelial inflammatory myofibroblast sarcoma (EIMS) succumbed to the disease, 1 case was lost to follow-up, 2 cases relapsed and the other 13 cases were considered cured. IMTs may be malignant or low-grade. EIMS is a rare and invasive variant of IMT. The clinical and imaging manifestations are often unique and vary among individuals. Once confirmed by pathology, radical surgery should be the first choice of treatment.
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Affiliation(s)
- Wei Song
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yan Zhu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
- Correspondence to: Dr Yan Zhu, Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, P.R. China, E-mail:
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Anaplastic lymphoma receptor tyrosine kinase-negative inflammatory myofibroblastic tumor of triceps brachii: Case report. Jt Dis Relat Surg 2020; 31:605-609. [PMID: 32962596 PMCID: PMC7607928 DOI: 10.5606/ehc.2020.74662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a non-neoplastic benign lesion comprising various inflammatory cells, including myofibroblasts and vascular tissues. It is a rare tumor that sometimes shows similar signs and progression as malignant tumors. The anatomical sites of IMTs include the lungs, liver, orbit, skin, mesentery, and maxillary sinus, but they rarely occur in the limb musculoskeletal system. To our knowledge, no case of neurological symptoms caused by the tumor in the triceps brachii muscle has been reported. In this article, we report the case of a 42-year-old male patient with an IMT that grew rapidly in the triceps brachii muscle and consequently caused symptoms of ulnar nerve lesion owing to its increasing size. The patient showed no ulnar nerve lesion symptoms after undergoing wide excision and was diagnosed with anaplastic lymphoma receptor tyrosine kinase- negative IMT.
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Lee YJ, Jeong JS, Kim SR, Lee YC. Inflammatory Myofibroblastic Tumor of the Lung With Multifocal Metastases. JTO Clin Res Rep 2020; 1:100007. [PMID: 34589921 PMCID: PMC8474268 DOI: 10.1016/j.jtocrr.2020.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Young J. Lee
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea
| | - Jae S. Jeong
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Chonbuk, National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - So R. Kim
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Chonbuk, National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Yong C. Lee
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Chonbuk, National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
- Corresponding author. Address for correspondence: Yong C. Lee, MD, PhD, Department of Internal Medicine, Chonbuk National University Medical School, san 2-20, Geumam-dong, Deokjin-gu, Jeonju 54907, South Korea
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Mir MH, Dar W, Aejaz Aziz S, Mohamad G, Wani B. Clinico-radiological and Pathological Characteristics of Inflammatory Myofibroblastic Tumors in Children: A Retrospective Study. Indian J Med Paediatr Oncol 2017; 38:261-265. [PMID: 29200670 PMCID: PMC5686963 DOI: 10.4103/ijmpo.ijmpo_178_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Inflammatory myofibroblastic tumors (IMTs) are rare, benign lesions most often seen in the lung of young adults but can occur in children, in various sites. They mimic, clinically and radiologically, malignant tumors - especially sarcomas and lymphomas. The aim was to review the clinical, radiological, and pathological data of children with a diagnosis of IMT referred to our department. Materials and Methods This retrospective study was conducted at the Department of Medical and Paediatric Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India from January 2014 to December 2015. Results Among 288 pediatric tumors registered during the study, 5 (1.73%) had the diagnosis of IMTs. The main symptoms were abdominal distension and pain in 60% (three cases), breathlessness and cough in 20% (one case), and right axillary area swelling in 20% (one case). In three patients, complete surgical excision was done, whereas another patient with retroperitoneal mass had the residual disease and received chemotherapy followed by complete second surgery. In the case of mediastinal IMT, surgery was followed by local radiotherapy. At present, four patients are disease-free and one patient with mediastinal IMT has the residual progressive disease. Conclusion On presentation, IMT can constitute a formidable challenge, from diagnosis through to treatment.
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Affiliation(s)
- Mohamad Hussain Mir
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Waseem Dar
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sheikh Aejaz Aziz
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Gul Mohamad
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Burhan Wani
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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