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Absence of driver mutations in persistent polyclonal B-cell lymphocytosis with binucleated lymphocytes. Blood 2017; 130:1267-1269. [PMID: 28679739 DOI: 10.1182/blood-2017-03-776674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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2
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B-cell signaling in persistent polyclonal B lymphocytosis (PPBL). Immunol Cell Biol 2016; 94:830-837. [PMID: 27126628 DOI: 10.1038/icb.2016.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 01/05/2023]
Abstract
Persistent polyclonal B lymphocytosis (PPBL) is a benign hematological disorder characterized by a selective expansion of circulating polyclonal marginal zone (MZ)-like B cells. Previous reports demonstrated that cases of PPBL showed poor activation, proliferation and survival of B cells in vitro, yet the underlying defect remains unknown. Here we report for the first time an attenuated activation of the canonical NF-κB (nuclear factor of kappa light polypeptide gene enhancer in B cells) and mitogen-activated protein kinase/extracellular signal-regulated kinase pathway after CD40 stimulation. This defect was selective, as alternative NF-κB signaling after CD40 stimulation and both B-cell receptor- and Toll-like receptor 9-mediated activation remained unaffected. Reduced canonical NF-κB activation resulted in decreased IκBα and CD40 expression in resting cells. In PPBL patients, expression of Bcl-xL in MZ-like B cells did not increase upon activation, consistent with the high apoptosis rates of PPBL-derived B cells that were observed in vitro. The B-cell phenotype of mice with selective knockouts of early components of the CD40 signaling pathway resembles PPBL, but sequencing corresponding genes in sorted MZ-like B cells of PPBL patients did not reveal relevant genetic alterations. Nevertheless, the frequently observed mutations in early signaling components of the NF-κB pathway in MZ lymphomas underline the relevance of our findings for the pathogenesis of PPBL.
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Lesesve JF, Gressot AL, Troussard X, Mossafa H, Cornet E. Morphologic features of binucleated lymphocytes to assess the diagnosis of persistent B-cell polyclonal lymphocytosis or other mature B-cell neoplasms. Leuk Lymphoma 2013; 55:1551-6. [DOI: 10.3109/10428194.2013.843680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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4
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Sun P, Juskevicius R. Histological and immunohistochemical features of the spleen in persistent polyclonal B-cell lymphocytosis closely mimic splenic B-cell lymphoma. Diagn Pathol 2012; 7:107. [PMID: 22901769 PMCID: PMC3488513 DOI: 10.1186/1746-1596-7-107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/10/2012] [Indexed: 11/25/2022] Open
Abstract
Persistent polyclonal B-cell lymphocytosis (PPBL) is rare and intriguing hematological disorder predominantly reported in young to middle- aged smoking women. It is characterized by persistent moderate polyclonal B-cell lymphocytosis with circulating hallmark binucleated lymphocytes and elevated polyclonal serum IgM. Most patients have benign clinical course on long-term follow-up. Some pathologic features of PPBL may resemble malignant lymphoma, including morphology as well as frequent cytogenetic and molecular abnormalities. Significant symptomatic splenomegaly requiring splenectomy is very unusual for this disorder; therefore there is a lack of descriptions of the morphologic features of the spleen in the literature. We present here one of the first detailed descriptions of the morphologic and immunohistochemical features of the spleen from a young female with PPBL who developed massive splenomegaly during 6-year follow up. Splenectomy was performed for symptomatic relief and suspicion of malignant process. The morphological and immunohistochemical features of the spleen closely mimicked involvement by B-cell lymphoma, however there was no monotypic surface light chain restriction seen by flow cytometry and no clonal rearrangement of IgH gene was detected by molecular analysis. Evaluating a splenectomy sample in cases like this may present a diagnostic challenge to pathologists. Therefore, correlation with B cell clonality studies (by flow cytometry and molecular analysis), clinical findings and peripheral blood morphology searching for characteristic binucleated lymphocytes is essential to avoid misdiagnosing this benign process as B-cell lymphoma. We also present here a literature review on pathogenesis of PPBL.
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Affiliation(s)
- Ping Sun
- Division of Hematopathology, Diagnostic Services of Manitoba, University of Manitoba, MS559S-820 Sherbrook Street, Winnipeg R3A 1R9MB, Canada
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Fend F, Cabecadas J, Gaulard P, Jaffe ES, Kluin P, Kuzu I, Peterson L, Wotherspoon A, Sundström C. Early lesions in lymphoid neoplasia: Conclusions based on the Workshop of the XV. Meeting of the European Association of Hematopathology and the Society of Hematopathology, in Uppsala, Sweden. J Hematop 2012; 5. [PMID: 24307917 DOI: 10.1007/s12308-012-0148-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The increasing use of immunophenotypic and molecular techniques on lymphoid tissue samples without obvious involvement by malignant lymphoma has resulted in the increased detection of "early" lymphoid proliferations, which show some, but not all the criteria necessary for a diagnosis of malignant lymphoma. In most instances, these are incidental findings in asymptomatic individuals, and their biological behaviour is uncertain. In order to better characterize these premalignant conditions and to establish diagnostic criteria, a joint workshop of the European Association for Haematopathology and the Society of Hematopathology was held in Uppsala, Sweden, in September 2010. The panel reviewed and discussed more than 130 submitted cases and reached consensus diagnoses. Cases representing the nodal equivalent of monoclonal B-cell lymphocytosis (MBL) were discussed, as well as the "in situ" counterparts of follicular lymphoma (FL) and mantle cell lymphoma (MCL), topics that also stimulated discussions concerning the best terminology for these lesions. The workshop also addressed the borderland between reactive hyperplasia, and clonal proliferations such as pediatric marginal zone lymphoma and pediatric FL, which may have very limited capacity for progression. Virus-driven lymphoproliferations in the grey zone between reactive lesions and manifest malignant lymphoma were covered. Finally, early manifestations of T-cell lymphoma, both nodal and extranodal, and their mimics were addressed. This workshop report summarizes the most important conclusions concerning diagnostic features, as well as proposals for terminology and classification of early lymphoproliferations and tries to give some practical guidelines for diagnosis and reporting.
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Affiliation(s)
- Falko Fend
- Institute of Pathology and Comprehensive Cancer Center, Tübingen University Hospital, Tübingen, Germany
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6
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Troussard X, Cornet E, Lesesve JF, Kourel C, Mossafa H. Polyclonal B-cell lymphocytosis with binucleated lymphocytes (PPBL). Onco Targets Ther 2008; 1:59-66. [PMID: 21127753 PMCID: PMC2994211 DOI: 10.2147/ott.s4182] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare and recently described entity. The review of the literature show PPBL is diagnosed predominantly but not exclusively in women, usually smokers. PPBL is recognized by a moderate, chronic and absolute lymphocytosis (>4 × 10(9)/l) in the peripheral blood. In 10% of cases without lymphocytosis, the PPBL diagnosis has to be suggested by peripheral blood examination showing in all cases atypical binucleated lymphocytes. A polyclonal serum IgM is also associated and HLA-DR7 expression is present in most cases. Contrary to B-cell chronic lymphoproliferative disorders (B-CLPD), peripheral B cells are polyclonal with kappa and lambda light-chain expression and no clonal rearrangement of immunoglobulin heavy chain genes is usually demonstrated. The detection of an extra isochromosome for the long arm of chromosome 3 +i(3)(q10) has to be considered as a specific marker of PPBL. We performed conventional cytogenetic analysis (CCA) in 111 patients with typical PPBL we followed-up more than 4 years. +i(3q) was detected in 34% (33/98), PCC in 8% (8/98) and both abnormalities in 31% (30/98). CCA showed neither +i(3q) nor PCC in 28% (27/98). Fluorescence in situ hybridization (FISH) was also performed in 84 cases and +i(3q) was detected in 71% (60/84). When combining both procedures in 84 patients, +i(3q) was detected in 17 patients with negative CCA and was confirmed in 43 patients with positive CCA. CCA and FISH were both negative in 24 cases. Whether patients with PPBL are at increased risk of hematological malignancy remains unclear. After a median follow-up of 4.4 years, most PPBL patients presented a stable clinical and biological course. Six patients died from pulmonary cancer, myocardial infarction, cerebral aneurysm rupture or diffuse large B-cell lymphoma. Two patients had IgM monoclonal gammopathy of undetermined significance (MGUS) at the time of PPBL diagnosis and two other patients developed IgM MGUS respectively 12 and 22 years after PPBL diagnosis. A malignant non Hodgkin's lymphoma (NHL) appeared in 3 additional patients: two patients presented diffuse large B cell lymphoma and 1 patient a splenic marginal zone lymphoma. In conclusion, the possibility of PPBL to evolve toward a clonal proliferation, malignant lymphoma or secondary solid cancer lead us to consider PPBL not as a benign pathology. We recommend a careful and continued clinical and biological long-term follow-up in all PPBL patients.
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Affiliation(s)
- Xavier Troussard
- Laboratoire d’Hématologie Côte de Nacre, Université Caen Basse Normandie Caen, Registre Régional des Hémopathies Malignes de Basse Normandie, France
| | - Edouard Cornet
- Laboratoire d’Hématologie Côte de Nacre, Université Caen Basse Normandie Caen, Registre Régional des Hémopathies Malignes de Basse Normandie, France
| | | | - Carine Kourel
- Département de Génétique Humaine, Laboratoire pasteur-Cerba, Cergy-Pontoise, France For the Groupe Français d’Hématologie cellulaire (GFHC)
| | - Hossein Mossafa
- Département de Génétique Humaine, Laboratoire pasteur-Cerba, Cergy-Pontoise, France For the Groupe Français d’Hématologie cellulaire (GFHC)
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7
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Wolowiec D, Nowak J, Majewski M, Haus O, Duszenko E, Stella-Holowiecka B, Mika-Witkowska R, Makuch-Lasica H, Nowak G, Krawcewicz A, Kuliczkowski K, Warzocha K. High incidence of ancestral HLA haplotype 8.1 and monoclonal incomplete DH–JH immunoglobulin heavy chain gene rearrangement in persistent polyclonal B-cell lymphocytosis. Ann Hematol 2008; 87:597-8. [DOI: 10.1007/s00277-007-0434-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 12/14/2007] [Indexed: 11/24/2022]
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Chapuy B, Wulf G, Tessen HW, Griesinger F, Trümper L, Schroers R. [Asymptomatic 32 year old female smoker with persistent polyclonal lymphocytosis]. Internist (Berl) 2007; 48:314-8. [PMID: 17287965 DOI: 10.1007/s00108-007-1800-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 32 year old female smoker (20 pack years) presented with an asymptomatic lymphocytosis of 13,000/nl and splenomegaly. The patient's blood smear showed an absolute lymphocytosis with 65% atypical lymphocytes. A total of 1% of the lymphocytes were bilobulated. Bone marrow histology and immunphenotyping of blood and bone marrow excluded leukemia and non-Hodgkin's lymphoma. IgH-CDR-3 PCR analysis revealed a polyclonal pattern. In summary, a persistent polyclonal B-cell-lymphocytosis (PPBL) was diagnosed. The exact etiology of PPBL is still unclear, however, it is associated with a polyclonal raise in the lymphocyte count of CD27+IgD+-memory-B-lymphocytes due to a defect in apoptosis signaling and leukocyte homing to secondary lymphoid tissues. An association with cigarette smoking is obvious since all patients are smokers. From all published cases, only two developed a malignancy with an uncertain association with PPBL. We have been monitoring our patient for 6.5 years without any evidence of the development of a lymphoma.
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Affiliation(s)
- B Chapuy
- Abteilung für Hämatologie und Onkologie, Universitätsklinikum Göttingen, Göttingen, Deutschland.
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Mitterer M, Lanthaler AJ, Irschick EU, Engelmann H, Larcher C, Huemer HP. Functional T-cell anergy in a case of persistent polyclonal B-cell lymphocytosis. Leuk Res 2005; 29:1479-88. [PMID: 15979703 DOI: 10.1016/j.leukres.2005.05.007] [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] [Received: 01/20/2005] [Revised: 05/04/2005] [Accepted: 05/14/2005] [Indexed: 11/29/2022]
Abstract
The T-cell population of a patient with persistent polyclonal B-cell lymphocytosis (PPBL) presenting with an intermittent Epstein-Barr virus (EBV)-associated disease was studied. Unstimulated T-cells did not express CD40 ligand (CD40L), whereas activation with IL-2 led to expression of this costimulatory molecule. CD40L expression was inhibited upon incubation with the supernatant of an EBV-positive B-cell line (SM) which had been grown spontaneously from the patient's peripheral blood cells. The supernatant of SM cells effectively inhibited cytotoxic T-cells. Elevated levels of IL-10, TNF-alpha and soluble CD40 were found in the supernatant of SM cells. Additionally, enhanced levels of LMP-1 protein were detected.
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Affiliation(s)
- Manfred Mitterer
- Department of Transfusion Medicine, Meran Hospital, Meran, Italy.
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Walker M, Weiss MD, Distad BJ, Samii A. Multiple Myeloma and Peripheral Neuropathy in Myotonic Dystrophy Type 2 (DM2). J Clin Neuromuscul Dis 2005; 6:132-135. [PMID: 19078762 DOI: 10.1097/01.cnd.0000157324.10564.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Myotonic dystrophy type 2 (DM2) is a phenotypically heterogeneous multisystem disorder, most dramatically involving the nervous system. Although multisystem involvement is common in this disease, we present a genetically proven DM2 patient with both peripheral neuropathy and blood dyscrasia, previously unreported in the literature, suggesting a distinct phenotype in this population. Routine electrophoresis in DM2 patients with neuropathy is recommended, and implications surrounding the etiology of peripheral neuropathy and paraproteinemia in DM2 are discussed.
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Affiliation(s)
- Melanie Walker
- From the Department of Neurology, University of Washington School of Medicine, Seattle, WA
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Kelaidi C, Rollot F, Park S, Tulliez M, Christoforov B, Calmus Y, Podevin P, Bouscary D, Sogni P, Blanche P, Dreyfus F. Response to antiviral treatment in hepatitis C virus-associated marginal zone lymphomas. Leukemia 2004; 18:1711-6. [PMID: 15284859 DOI: 10.1038/sj.leu.2403443] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A link between chronic hepatitis C virus (HCV) infection and low-grade B-cell lymphomas has been suggested by epidemiological studies. Marginal zone lymphomas (MZLs) including splenic lymphomas with villous lymphocytes are among the most frequently reported subgroups in the setting of chronic HCV infection. In this study, we examined the effect of antiviral treatment in eight patients with HCV-associated MZL. We found that five out of eight patients have responded to interferon alpha and ribavirin. In some cases, hematologic responses were correlated to virologic responses. In addition, we report a case of large granular lymphocyte leukemia occurring in association with MZL and HCV, and responding to interferon and ribavirin. We suggest that there is an etiologic link between HCV and antigen-driven lymphoproliferative disorders.
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Affiliation(s)
- C Kelaidi
- 1Department of Hematology, Hôpital Cochin, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France
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12
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Wong KF, So CC, Chan JCW, Kho BCS, Chan JKC. Gain of chromosome 3/3q in B-cell chronic lymphoproliferative disorder is associated with plasmacytoid differentiation with or without IgM overproduction. CANCER GENETICS AND CYTOGENETICS 2002; 136:82-5. [PMID: 12165458 DOI: 10.1016/s0165-4608(02)00526-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Trisomy 3 has been reported to be associated with marginal zone B-cell lymphoma. However, its occurrence and significance in other B-cell chronic lymphoproliferative disorders has not been fully defined. We report five cases of B-cell chronic lymphoproliferative disorders showing gain of chromosome 3 or 3q. The patients were elderly males who presented with splenomegaly with or without hepatomegaly and lymphadenopathy. The diagnoses included chronic lymphocytic leukemia (3 cases), prolymphocytic leukemia (1 case), and Waldenstrom macroglobulinemia (1 case). Distinctive feature in this group of patients was the plasmacytoid appearance of the leukemic lymphocytes, with an associated IgM hypergammaglobulinemia in three patients. The relationship between the gain of chromosome 3 and plasmacytoid differentiation in B-cell chronic lymphoproliferative disorders is discussed.
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Affiliation(s)
- K F Wong
- Department of Pathology, Queen Elizabeth Hospital, SAR, Hong Kong, China.
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Casato M, Mecucci C, Agnello V, Fiorilli M, Knight GB, Matteucci C, Gao L, Kay J. Regression of lymphoproliferative disorder after treatment for hepatitis C virus infection in a patient with partial trisomy 3, Bcl-2 overexpression, and type II cryoglobulinemia. Blood 2002; 99:2259-61. [PMID: 11877309 DOI: 10.1182/blood.v99.6.2259] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A patient with type II cryoglobulinemic vasculitis and hepatitis C virus (HCV) infection presented with a leukemiclike proliferation of B cells bearing marginal zone B-cell phenotypic markers. A partial trisomy 3 (bands 3q11-29) and overexpression of Bcl-2 without t(14;18) translocation was detected in the monoclonal B cells that were classic rheumatoid factor-producing B cells bearing the WA cross-idiotype. Treatment with interferon-alpha produced a complete clinical remission and synchronous marked decreases in viremia and monoclonal B-cell prevalence. This is the first report of partial trisomy 3 and Bcl-2 overexpression in type II cryoglobulinemic vasculitis associated with HCV infection. Further studies of HCV-infected patients with and without type II cryoglobulinemia are required to determine the prevalence and possible physiologic and/or pathophysiologic significance of these findings.
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Affiliation(s)
- Milvia Casato
- Department of Clinical Medicine, University of Rome La Sapienza, Rome, Italy
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Abstract
Cytogenetic analysis has contributed greatly to our understanding of the nature of leukaemia and lymphoma. Study of these two groups of diseases has revealed general truths about the nature of the neoplastic process. Cytogenetic analysis has demonstrated that haematological neoplasms result from a somatic mutation occurring in a haemopoietic, lymphoid or multipotent stem cell. Complete remission has been related to disappearance of the clone of cells bearing the mutation whereas the occurrence of clonal evolution has often been found to be indicative of increasingly aggressive disease. Cytogenetic analysis of leukaemias and lymphomas has led to the discovery of numerous proto-oncogenes; these generally play a crucial role in proliferation and differentiation of normal cells with a perturbation of their function leading to neoplasia. In addition, cytogenetic evidence has suggested a role for loss of function of cancer-suppressing genes in haematological neoplasms. Cytogenetic analysis has also made major contributions to precise diagnosis and to the assigning of prognosis and, furthermore, by identifying good and poor prognostic groups has improved the management of patients. Good-prognosis patients have been spared unnecessary treatment and, conversely, more intensive treatment for some diseases associated with a cytogenetic abnormality that was previously indicative of a poor prognosis has improved the outcome for these patients.
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Affiliation(s)
- B J Bain
- Department of Haematology, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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