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Liu H, Xie W, Gong W. Gastric cancer in pregnancy: a review. Future Oncol 2024; 20:1851-1860. [PMID: 39041597 PMCID: PMC11486268 DOI: 10.1080/14796694.2024.2370236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Malignant tumors including gastric cancer (GC) are the leading cause of deaths among reproductive women. Physiological morning sickness can mask the clinical manifestations of GC, whereas the clinical presence of metastatic tumors in the abdominal cavity may be easily mistaken for abdominal swelling caused by fetal growth. Pregnancy and delivery processes in young females could accelerate the growth of GC, leading to its rapid development and grave prognosis. Therefore, early diagnosis is critical and gastrointestinal endoscopy is recommended for any suspected pregnant woman with long-term morning sickness. Treatment strategies, including chemotherapy, resection surgery and radiotherapy, will be determined based on a comprehensive consideration of the status of both the fetus and the mother. Rational management, especially clinical multidisciplinary collaboration may significantly benefit such patients.
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Affiliation(s)
- Hongming Liu
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou310058, China
| | - Weixun Xie
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou310058, China
| | - Weihua Gong
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou310058, China
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2
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Imaging of Metastatic Disease to the Ovary/Adnexa. Magn Reson Imaging Clin N Am 2022; 31:93-107. [DOI: 10.1016/j.mric.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gaughran JE, Naji O, Al Sabbagh MQ, Sayasneh A. Is Ultrasound a Reliable and Reproducible Method for Assessing Adnexal Masses in Pregnancy? A Systematic Review. Cureus 2021; 13:e19079. [PMID: 34849310 PMCID: PMC8622077 DOI: 10.7759/cureus.19079] [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] [Accepted: 10/26/2021] [Indexed: 11/05/2022] Open
Abstract
In this study, we aimed to systematicallyreview the current evidence regarding the diagnostic accuracy of ultrasound in assessing adnexal masses in pregnancy. The Cochrane Register of Controlled Trials, PubMed, and EMBASE databases were searched for all types of clinical studies that utilised ultrasound for the diagnosis of adnexal masses in pregnancy. Only studies that used outcome measures of either histological diagnosis or significant regression of the adnexal mass on imaging follow-up were included. The quality of each study was assessed for risk of bias. The diagnostic performance of ultrasound in each study type was calculated, along with the pooled diagnostic performance of ultrasound in differentiating benign from malignant masses. The initial search yielded 4,915 articles, of which 2,547 qualified for abstract screening. A total of 83 articles were included in this review, including one prospective cohort study, six retrospective observational studies, seven case series, and 69 case reports. In the included studies, the total number of adnexal masses was 559. The mean patient age was 29.2 years (95% confidence interval [CI]: 28.7-29.7), with a mean gestational age at diagnosis of 13.8 weeks (95% CI: 13.2-14.4). The mean quality assessment score was 75%. The International Ovarian Tumour Analysis Simple Rules were used in two articles, whereas subjective impression was used in the remaining 81 articles. The most frequently diagnosed mass was a simple or physiological cyst (35%). The prevalence of malignancy in the entire sample was 46/559 (8%; 95% CI: 34-61%). The overall pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound in detecting ovarian malignancy were 64% (95% CI: 30-88%), 88% (95% CI: 64-97%), 5.6 (95% CI: 1.2-25.4), and 0.4 (95% CI: 0.15-1), respectively. In conclusion, currently, there is a lack of high-quality prospective studies to guide the management of adnexal masses in pregnancy. Ultrasound appears to have an adequate accuracy in differentiating benign from malignant masses; however, more research is required to assess the role of ultrasound models, rules, and subjective assessment in pregnancy compared to non-pregnant women.
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Affiliation(s)
| | - Osama Naji
- Gynaecology, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | | | - Ahmad Sayasneh
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, GBR
- Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, London, GBR
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Goidescu IG, Nemeti G, Preda A, Kovacs T, Surcel M, Eniu DT, Cruciat G, Mureșan D. Krukenberg tumor in pregnancy: a rare case and review of the literature. J Matern Fetal Neonatal Med 2021; 35:7290-7295. [PMID: 34470118 DOI: 10.1080/14767058.2021.1946788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Krukenberg's tumor diagnosed in pregnancy is an uncommon situation that raises both diagnosis and medical management issues. We performed a review of the existing literature regarding this pathology, diagnostic means and therapeutic approaches, motivated by a case in our own practice. A 35-year-old primigravida was diagnosed with an adnexal mass during the first trimester prenatal ultrasound. Ultrasound revealed a 10 cm right adnexal mass with multiple septae, richly vascularized, whose presence and characteristics were confirmed by magnetic resonance imaging. Due to the progressively increasing tumor size, laparoscopy was performed with right adnexectomy and peritoneal biopsies. Histopathology diagnosed a metastatic ovarian tumor from a mucinous colorectal adenocarcinoma. After delivery the patient was further investigated and diagnosed with sigmoid cancer. Even though ovarian cancer in pregnancy is rare, adnexal ultrasound is mandatory when scanning during the first trimester to rule out the presence of associated fallopian or ovarian masses.
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Affiliation(s)
- Iulian G Goidescu
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Nemeti
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreia Preda
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tunde Kovacs
- Imogen Clinical Research Centre, Cluj-Napoca, Romania
| | - Mihai Surcel
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan T Eniu
- Department of Surgical Oncology and Oncological Gynecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gheorghe Cruciat
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Mureșan
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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5
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Bozkurt M, Antonoff M, Jaramillo S, Sagebiel T, Murphy MB. Gastroesophageal Cancer During Pregnancy: a Case Report and Review of the Literature. J Gastrointest Cancer 2018; 50:634-640. [PMID: 29577180 DOI: 10.1007/s12029-018-0093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mustafa Bozkurt
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Sylvia Jaramillo
- Department of Hematology-Oncology, Texas Oncology, Austin, TX, 78758, USA
| | - Tara Sagebiel
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mariela B Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA. .,Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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Boussios S, Moschetta M, Tatsi K, Tsiouris AK, Pavlidis N. A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives. J Adv Res 2018; 12:1-9. [PMID: 29988841 PMCID: PMC6032492 DOI: 10.1016/j.jare.2018.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022] Open
Abstract
The management of gestational ovarian cancer can be challenging because of the risk of fetal wastage, and the possibility of treatment-related complications to the fetus; it is based on insufficient data from retrospective studies and case series. Here, a literature review of the diagnostic and surgical approaches to the gestational ovarian cancer has been performed; moreover, data on safety of chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes, have also been reviewed. Up to now, 193 cases of ovarian cancers during pregnancy have been reported in the English literature. Treatment of ovarian malignancies during pregnancy depends on histology, stage, and gestational weeks. When possible, surgical excision is indicated, and fertility-sparing surgery can be offered to stage I epithelial ovarian tumours (EOC), germ cell ovarian, or sex-cord stromal ovarian tumours. Neoadjuvant and/or adjuvant chemotherapy for advanced ovarian tumours is indicated as in non-pregnant women. Administration of chemotherapy after the first trimester, can cause fetal growth restriction, while being seemingly safe. The therapeutic approach of ovarian cancer in pregnancy should be individualized and intended in specialized centers.
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Affiliation(s)
- Stergios Boussios
- Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
- Corresponding author.
| | - Michele Moschetta
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London W1G 6AD, UK
| | - Konstantina Tatsi
- Gynaecology Unit, General Hospital “G. Hatzikosta”, Makrigianni Avenue, 45001 Ioannina, Greece
| | - Alexandros K. Tsiouris
- Department of Biological Applications & Technology, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
| | - Nicholas Pavlidis
- Medical School, University of Cyprus, Old road Lefkosias Lemesou, No. 215/6, 2029 Aglantzia, Nicosia, Cyprus
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Montoro García J, Cabellos Olivares M, Cabana Navia A, López Saña J, Rodríguez Fraile JR. Unexpected obstetric haemorrhage. Krukenberg tumour. ACTA ACUST UNITED AC 2017; 64:479-482. [PMID: 28347550 DOI: 10.1016/j.redar.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
Abstract
Obstetric haemorrhage can endanger the lives of mother and foetus. It often occurs unexpectedly without clear predictors. A high degree of suspicion helps to avoid delaying resuscitation measures. We present the case of a ruptured ovarian metastasis that occurred during labour. It caused a massive bleed forcing a caesarean section due to non-reassuring foetal status. This was an unprecedented and undescribed onset of Krukenberg tumour formation. Malignant tumours in pregnancy are rare and difficult to diagnose due to their clinical manifestations which often overlap with those of pregnancy itself (dyspepsia, nausea and bloating). Despite the available therapeutic measures, a delay in diagnosis is a determining factor for long-term prognosis. We review the causes of obstetric bleeding, and underline how rare Krukenberg tumours concomitant to pregnancy are.
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Affiliation(s)
- J Montoro García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - M Cabellos Olivares
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España
| | - A Cabana Navia
- Servicio de Ginecología y Obstetricia, Hospital Universitario de Guadalajara, Guadalajara, España
| | - J López Saña
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España
| | - J R Rodríguez Fraile
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España
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Spinelli C, Liloia C, Piscioneri J, Ugolini C, Strambi S. An Unusual Evolution of Krukenberg Tumour: A Case Report. J Clin Diagn Res 2016; 10:PD07-PD11. [PMID: 27891398 PMCID: PMC5121736 DOI: 10.7860/jcdr/2016/20299.8747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
Krukenberg tumours are rare metastatic tumours of the ovaries characterized by the presence of mucin-producing neoplastic Signet Ring Cell Carcinoma (SRCC). At first glance, this tumour may be confused with a primary ovarian tumour. Surgery and chemotherapy combination have led to improvement in prognosis, but it still remains severe. We report the case of a 60-year-old woman with a Krukenberg tumour rising from a low differentiated gastric adenocarcinoma. The patient was clinically stable for 26 months after surgery until she experienced a prompt decline and died of cerebral haemorrhage within two weeks. The aim of this article was to give an overview of the Krukenberg tumour starting from our case report and comparing it with clinicopathological characteristics of this pathology derived from a review of recent literature.
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Affiliation(s)
- Claudio Spinelli
- Professor, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Chair of Pediatric Surgery, University of Pisa, Italy
| | - Concetta Liloia
- Assistant Professor, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Italy
| | - Jessica Piscioneri
- Assistant Professor, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Italy
| | - Clara Ugolini
- Assistant Professor, Department of Laboratory Medicine and Integrated Diagnostics, Section of Experimental Pathology, University of Pisa, Italy
| | - Silvia Strambi
- Assistant Professor, Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Italy
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9
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Feto-maternal outcomes of pregnancy complicated by Krukenberg tumor: a systematic review of literature. Arch Gynecol Obstet 2016; 294:589-98. [PMID: 26897498 DOI: 10.1007/s00404-016-4048-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Krukenberg tumor is a rare type of ovarian cancer with a poor prognosis, and little is known about its behavior during pregnancy. METHODS A systematic review was conducted to identify pregnancies complicated by Krukenberg tumor, correlated to oncologic and neonatal outcomes (n = 35). RESULTS Mean age of cases was 30.4 years, and the most common origin of primary cancer was the stomach (68.6 %) followed by the colon (14.3 %). The two most common presenting symptoms were abdominal/pelvic pain (51.4 %) and nausea/vomiting (48.6 %). Two-thirds of tumors were bilateral (65.7 %) and the average size was 16.7 cm. Ascites (45.7 %), carcinomatosis (25.7 %) and non-ovarian distant metastases (14.3 %) were found at the time of surgery. Chemotherapy was administered in 20 cases, with fetal exposure in two of these. The ovarian tumor was identified prior to the primary cancer diagnosis in all 28 cases. The overall number of live births was 27 (81.8 %). The median survival was 6 months after Krukenberg tumor diagnosis. In univariate analysis, decreased overall survival was associated with dyspnea, ascites, carcinomatosis, non-radical surgery for the primary cancer, and residual disease at surgery (all, p < 0.05). On multivariate analysis, dyspnea and carcinomatosis remained independent prognostic factors for decreased overall survival after Krukenberg tumor diagnosis (2-year overall survival rates, dyspnea 0 vs. 56.6 %, adjusted-hazard ratio [HR] 9.74, 95 % confidence interval [CI] 2.04-46.2, p < 0.01; and carcinomatosis, 0 vs. 58.1 %, adjusted-HR 7.95, 95 % CI 1.76-36.0, p < 0.01). CONCLUSIONS Our results showed that prognosis of Krukenberg tumor complicated pregnancies is extremely poor, however it may be improved if radical surgery is achievable.
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Berthé A, Diop MM, Bentefouet L, Ba PA, Faye FA, Touré PS, Thiam M, Gueye L, Diop BM, Ka MM. [Ascites and fever in women: do not rule out Krukenberg tumor]. Pan Afr Med J 2015; 21:269. [PMID: 26587120 PMCID: PMC4633835 DOI: 10.11604/pamj.2015.21.269.7108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/07/2015] [Indexed: 12/29/2022] Open
Abstract
Les tumeurs de Krukenberg (TK) se définissent comme des métastases ovariennes d'un cancer, le plus souvent digestif. Elles représentent 5 à 15% des tumeurs malignes ovariennes. Notre objectif était de décrire les caractéristiques épidémiologiques, diagnostiques, thérapeutiques et évolutives. Nous rapportons deux observations de tumeur de Krukenberg découvertes à l'occasion de l'exploration d'une ascite fébrile.Il s'agit de deux patientes multipares âgées respectivement de 32 ans et 50 ans. Les signes d'appel étaient essentiellement digestifs. La découverte de ces métastases ovariennes était survenue à distance des foyers primitifs. L'atteinte des ovaires était bilatérale dans le premier cas et unilatérale droite dans le second cas. Le diagnostic est apporté par la tomodensitométrie abdominopelvienne dans les deux cas. La fibroscopie œsogastroduodénale avait permis de retrouver le foyer primitif respectivement sous forme d'un processus bourgeonnant et d'un ulcère en position antrale avec des stigmates d'hémorragies. L'examen anatomopathologique des biopsies réalisées mettait en évidence un adénocarcinome tubuleux moyennement différencié de l'estomac avec composante mucineuse dans la première observation et un adénocarcinome de type intestinal moyennement différencié dans la seconde. Le traitement chirurgical confirme le diagnostic histologique. Dans notre série, le traitement n'a pu être que symptomatique en raison de l'existence constante d'une carcinose péritonéale et de l'altération profonde de l’état général. Les deux patientes ont été confiées à l'institut de cancérologie pour une chimiothérapie palliative. La première est décédée 1 mois après. La tumeur de Krukenberg est une maladie rare. Le diagnostic est facilité par la radiologie et confirmé par l'histologie. Son pronostic demeure encore très sombre. Le seul espoir réside dans les mesures préventives.
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Affiliation(s)
- Adama Berthé
- Université de Thiès - UFR des Sciences de la Santé Ex l0 Thiès, Sénégal ; Service de Médecine Interne Centre Hospitalier Régional de Thiès, 1 Avenue Malick SY Prolongée, Thiès Sénégal
| | - Madoky Magatte Diop
- Université de Thiès - UFR des Sciences de la Santé Ex l0 Thiès, Sénégal ; Service de Médecine Interne Centre Hospitalier Régional de Thiès, 1 Avenue Malick SY Prolongée, Thiès Sénégal
| | - Linda Bentefouet
- Université de Thiès - UFR des Sciences de la Santé Ex l0 Thiès, Sénégal
| | - Papa Abdoulaye Ba
- Université de Thiès - UFR des Sciences de la Santé Ex l0 Thiès, Sénégal ; Service de Chirurgie Générale Centre Hospitalier Régional de Thiès, 1 Avenue Malick SY Prolongée, Thiès,Sénégal
| | - Fulgence Abdou Faye
- Service de Médecine Interne Centre Hospitalier Régional de Thiès, 1 Avenue Malick SY Prolongée, Thiès Sénégal
| | | | - Marietou Thiam
- Université de Thiès - UFR des Sciences de la Santé Ex l0 Thiès, Sénégal ; Service de Gynécologie-Obstétrique Centre Hospitalier Régional de Thiès, 1 Avenue Malick SY Prolongée, Thiès, Sénégal
| | - Lamine Gueye
- Service de Gynécologie-Obstétrique Centre Hospitalier Régional de Thiès, 1 Avenue Malick SY Prolongée, Thiès, Sénégal
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