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Uppal DK, Madan R, Peters NJ, Bal A, Ballari N, Goyal S, Khosla D. Mucoepidermoid carcinoma of the trachea in a 9-year-old male child: case report and review of literature. Radiat Oncol J 2022; 40:208-212. [PMID: 36200310 PMCID: PMC9535415 DOI: 10.3857/roj.2021.00500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) is the most common malignancy of minor salivary glands in adults. Pulmonary MEC is extremely uncommon, comprising only 0.1–0.2% of the primary lung malignancies and <1% of primary bronchial tumors. It is even rarer in children, and literature is limited to a few case reports only. Here we present a case report of a 9-year-old boy diagnosed with primary MEC of the trachea along with a review of the literature. A 9-year-old male child presented with complaint of dry cough for two years which was later associated with shortness of breath after one year. Bronchoscopic examination revealed a growth arising from right lateral wall of carina occluding 50% of the lumen and detailed histopathological examination revealed it to be a MEC of the trachea. The patient underwent local excision of the tumor with primary anastomosis. Because of positive margin, adjuvant radiotherapy of 60 Gy in 30 fractions was given to the tumor bed. The patient tolerated the treatment well and is disease free at 6 months follow-up. Experience with MEC of the trachea in children is limited, and optimal treatment protocols have not been defined, with current treatment mainly extrapolated from MEC of the salivary glands.
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Affiliation(s)
- Deepak Kumar Uppal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- Correspondence: Renu Madan Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India. Tel: +91-172-2756390 Fax: +91-172-2744401, 2745078 E-mail:
| | - Nitin J. Peters
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nagarjun Ballari
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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2
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Paraskakis E, Froudarakis M, Tsalkidou EA, Deftereos S, Sarris G, Tsalkidis A. An eight-year-old girl with tracheal mass treated as a difficult asthma case. J Asthma 2020; 58:1689-1693. [PMID: 32991249 DOI: 10.1080/02770903.2020.1825730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Endobronchial masses such as mucoepidermoid carcinomas or carcinoid tumors are extremely rare in children and they usually originate from large bronchi. These lesions may cause wheezing and dyspnea with poor response to bronchodilators and mimic the airway obstruction caused by asthma. CASE STUDY We present the case of an 8-year-old girl with tracheal mucoepidermoid carcinoma who was treated as a difficult asthma case with high dose of inhaled corticosteroids. RESULTS The characteristic stridor, the lack of response to bronchodilators and to inhaled corticosteroid treatment, combined with the characteristic flow loop in spirometry and the hyperinflation seen on the chest radiograph, all raised the clinical suspicion of a tracheal lesion and indicated the need for flexible bronchoscopy. The bronchoscopy revealed a large lesion obstructing totally the trachea lumen. The latter finding was confirmed by chest high resolution CT. The mass was completely excised via sternotomy under cardiopulmonary bypass, and the pathologic examination showed a low-grade mucoepidermoid carcinoma of the trachea. One month after the surgery she was free of symptoms and her spirometry was normal. CONCLUSION Tracheal lesions mimic the symptoms of airway obstruction caused by asthma and should be always be part of the differential diagnosis in young patients with no response to asthma treatment.
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Affiliation(s)
- Emmanouil Paraskakis
- Department of Paediatrics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marios Froudarakis
- Department of Pulmonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evanthia A Tsalkidou
- Department of Paediatrics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Savvas Deftereos
- Department of Radiology, Democritus University of Thrace, Komotini, Greece
| | - George Sarris
- Department of Pediatric Cardiac Surgery, Athens Heart Surgery Institute, Athens, Greece
| | - Aggelos Tsalkidis
- Department of Paediatrics, Democritus University of Thrace, Alexandroupolis, Greece
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3
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Pio L, Varela P, Eliott MJ, Couloigner V, Guillén Burrieza G, Paraboschi I, Virgone C, Maunsell R, Rachkov V, Rutter MJ, Boglione M, Penchyna Grub J, Bellía Munzón G, Sarnacki S, Irtan S, Schweiger C, Larroquet M, Khen Dunlop N, Ramaswamy M, Pistorio A, Cecchetto G, Ferrari A, Bisogno G, Torre M. Pediatric airway tumors: A report from the International Network of Pediatric Airway Teams (INPAT). Laryngoscope 2019; 130:E243-E251. [PMID: 31090942 DOI: 10.1002/lary.28062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Primary tracheobronchial tumors (PTTs) are rare heterogeneous lesions arising from any part of the tracheobronchial tree. Nonspecific symptoms may lead to delayed diagnosis that requires more aggressive surgical treatment. An analysis of cases collected by the International Network of Pediatric Airway Team was undertaken to ensure proper insight into the behavior and management of PTTs. METHODS Patients <18 years of age with a histological confirmation of PTT diagnosed from 2000 to 2015 were included in this multicenter international retrospective study. Medical records, treatment modalities, and outcomes were analyzed. The patient presentation, tumor management, and clinical course were compared between malignant and benign histotypes. Clinical and surgical variables that might influence event-free survival were considered. RESULTS Among the 78 children identified, PTTs were more likely to be malignant than benign; bronchial carcinoid tumor (n = 31; 40%) was the most common histological subtype, followed by inflammatory myofibroblastic tumor (n = 19; 25%) and mucoepidermoid carcinoma (n = 15; 19%). Regarding symptoms at presentation, wheezing (P = 0.001) and dyspnea (P = 0.03) were more often associated with benign growth, whereas hemoptysis was more frequently associated with malignancy (P = 0.042). Factors that significantly worsened event-free survival were age at diagnosis earlier than 112 months (P = 0.0035) and duration of symptoms lasting more than 2 months (P = 0.0029). CONCLUSION The results of this international study provide important information regarding the clinical presentation, diagnostic workup, and treatment of PTTs in children, casting new light on the biological behavior of PTTs to ensure appropriate treatments. LEVEL OF EVIDENCE NA Laryngoscope, 130:E243-E251, 2020.
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Affiliation(s)
- Luca Pio
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Patricio Varela
- Department of Pediatric Surgery, Clinica Las Condes Medical Center, Hospital de Niños Calvo Mackenna, University of Chile, Santiago, Chile
| | - Martin J Eliott
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Vincent Couloigner
- Pediatric Ear, Nose, and Throat Department, Necker Hospital for Sick Children, Public Assistance-Hospitals of Paris, Paris, France
| | | | | | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Rebecca Maunsell
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Campinas, Campinas, São Paulo, Brazil
| | - Victor Rachkov
- Chair of Pediatric Surgery of N.I. Pirogov Russian Research Medical University, Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology; ZAO European Medical Center, Moscow, Russia
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Mariano Boglione
- Department of General Surgery, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Pichincha, 1850, Ciudad De Buenos Aires
| | - Jaime Penchyna Grub
- Department of Thoracic Surgery and Endoscopy, Hospital Infantil de México, Federico Gómez, Mexico
| | - Gastón Bellía Munzón
- Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sabine Irtan
- Department of Surgery, Hôpital Trousseau-Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Claudia Schweiger
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Michèle Larroquet
- Department of Surgery, Hôpital Trousseau-Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Naziha Khen Dunlop
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Madhavan Ramaswamy
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | | | - Giovanni Cecchetto
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gianni Bisogno
- Pediatric Hematology and Oncology Division, University of Padua, Padua, Italy
| | - Michele Torre
- Airway Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Rehman S, Lovvorn HN, Rickman OB, Wootten CT, Chinnadurai S. Unique application of awake tracheoscopy and endobronchial ultrasound in the management of tracheal mucoepidermoid carcinoma. Head Neck 2018; 40:E58-E61. [PMID: 29575399 DOI: 10.1002/hed.25147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/23/2017] [Accepted: 02/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucoepidermoid carcinoma of the trachea is a rare pediatric malignancy that presents unique challenges in diagnosis, operative management, and surveillance. METHODS AND RESULTS We present a 17-year-old girl with primary tracheal mucoepidermoid carcinoma presenting in acute respiratory distress due to near-total occlusion of the tracheal airway. An algorithmic approach to preoperative planning was developed to evaluate and remove the tumor endoscopically without compromising oxygenation. After initial palliative resection, endobronchial ultrasound was uniquely applied to evaluate depth of tumor invasion, and subsequent tracheal resection with primary anastomosis was performed as curative treatment. CONCLUSION Removal of distal tracheal masses can be performed safely with the implementation of an algorithmic approach to tumor visualization and resection. Endobronchial ultrasound can be used to evaluate the extent of tumor invasion and plan for definitive resection.
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Affiliation(s)
- Saad Rehman
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harold N Lovvorn
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Otis B Rickman
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher T Wootten
- Children's Ear, Nose, and Throat, and Facial Plastic Surgery, Minneapolis, Minnesota
| | - Sivakumar Chinnadurai
- Children's Ear, Nose, and Throat, and Facial Plastic Surgery, Minneapolis, Minnesota
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5
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Lin CH, Chao YH, Wu KH, Lin WC. Primary mucoepidermoid carcinoma at the carina of trachea presenting with wheezing in an asthmatic child mimicking an attack of asthma: A case report. Medicine (Baltimore) 2016; 95:e5292. [PMID: 27858901 PMCID: PMC5591149 DOI: 10.1097/md.0000000000005292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Asthma is a very common disease, but primary tracheal tumors are extremely rare in children. Wheezing is not pathognomonic, but is the typical presentation of asthma and could also be found in patients with tracheal tumors. CLINICAL FINDINGS This report describes a 12-year-old boy with a previous history of frequent asthma attacks and experienced responses to antiasthma treatment. He was admitted to the hospital due to persistent wheezing and progressive dyspnea. Hyperinflation in the bilateral lungs was detected on chest x-ray, but without other significant findings. Chest computed tomography revealed a mass at the carina. Tracheal mucoepidermoid carcinoma was diagnosed by histopathological assessment. CONCLUSION Despite the rarity of tracheal tumors, chest computed tomography scans should be performed in the first place for children presenting persistent wheezing and having poor response to antiasthma treatment to rule out the other alternative diagnosis. Coexistence of other diseases such as tracheal tumor in asthmatic patients should be considered.
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Affiliation(s)
- Chien-Heng Lin
- Division of Pediatric Pulmonology, China Medical University Children's Hospital
- Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University
| | - Yu-Hua Chao
- Department of Pediatrics, Chung Shan Medical University Hospital
- School of Medicine, Chung Shan Medical University
| | - Kang-Hsi Wu
- School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University
- Division of Pediatric Hematology-Oncology, China Medical University Children's Hospital
| | - Wei-Ching Lin
- Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University
- Department of Radiology, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
- Correspondence: Wei-Ching Lin, Department of Radiology, China Medical University Hospital, Taichung, Taiwan, Address: No 2, Yuh-Der Road, Taichung 404, Taiwan (e-mail: )
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6
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Jaramillo S, Rojas Y, Slater BJ, Baker ML, Hicks MJ, Muscal JA, Vece TJ, Wesson DE, Nuchtern JG. Childhood and adolescent tracheobronchial mucoepidermoid carcinoma (MEC): a case-series and review of the literature. Pediatr Surg Int 2016; 32:417-24. [PMID: 26790674 DOI: 10.1007/s00383-015-3849-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 01/30/2023]
Abstract
Tracheobronchial mucoepidermoid carcinomas (MEC) are rare in the pediatric population with literature limited primarily to case reports. Here we present our institutional experience treating MEC in three patients and review the literature of 142 pediatric cases previously published from 1968 to 2013. Although rare, tracheobronchial MEC should be included in the differential diagnosis in a child with recurrent respiratory symptoms. Conservative surgical management is often sufficient to achieve complete resection and good outcomes.
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Affiliation(s)
- Sergio Jaramillo
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Yesenia Rojas
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin, Suite 1210, Houston, 77030, TX, USA
| | - Bethany J Slater
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin, Suite 1210, Houston, 77030, TX, USA
| | - Michael L Baker
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - M John Hicks
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Jodi A Muscal
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Timothy J Vece
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - David E Wesson
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin, Suite 1210, Houston, 77030, TX, USA
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin, Suite 1210, Houston, 77030, TX, USA.
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7
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Abdennadher M, Rivera C, Gibault L, Fabre E, Pricopi C, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Mucoepidermoid tracheo-bronchial tumors in adulthood. A series of 22 cases]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:27-36. [PMID: 25687822 DOI: 10.1016/j.pneumo.2014.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Mucoepidermoid tumours (TME) are rare tumours arising from the submucosal glands of the tracheobronchial tree. The majority of these tumours develop in a benign fashion but some of them are malignant. The latter can be easily mistaken for adenosquamous carcinomas. PATIENTS AND METHOD We have reviewed 22 patients suffering from TME observed over a period of 25 years. Two arose from the trachea and 20 from the cartilaginous bronchi; 12 of these tumours had macroscopic and histological criteria of low-grade malignancy, 4 had macroscopic and 6 macroscopic and microscopic criteria of high grade malignancy. RESULTS Prognosis of the latter was very poor and no survival observed after 6 years follow-up, a behavior similar to that observed in non-small cell lung carcinomas and adenosquamous carcinomas. CONCLUSION The best treatment of these orphan tumours remains surgery.
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Affiliation(s)
- M Abdennadher
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - L Gibault
- Service d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - E Fabre
- Service d'oncologie, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France.
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8
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Kose M, Bilgin M, Kontas O, Ozturk S, Doganay S, Ozdemir MA. A case of mucoepidermoid carcinoma of the bronchus presented with hydropneumothorax in a child. Pediatr Pulmonol 2014; 49:E86-9. [PMID: 24167037 DOI: 10.1002/ppul.22938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/17/2013] [Indexed: 11/11/2022]
Abstract
Mucoepidermoid carcinoma is a rare pulmonary neoplasm seen in the pediatric population. We report a low grade mucoepidermoid carcinoma in a 12-year-old boy who presented with spontaneous pneumothorax.
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Affiliation(s)
- Mehmet Kose
- Department of Pediatrics, Division of Pediatric Pulmonology Unit, Erciyes University, Kayseri, Turkey
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9
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Serraj M, Lakranbi M, Ghalimi J, Ouadnouni Y, Tizniti S, Smahi M. About a submucosal tracheal tumor. World J Surg Oncol 2013; 11:229. [PMID: 24034840 PMCID: PMC3847585 DOI: 10.1186/1477-7819-11-229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 09/03/2013] [Indexed: 11/16/2022] Open
Abstract
The authors report the case of 46-year-old man with recurrent hemoptysis. Bronchoscopy revealed a submucosal tumor protruding into the tracheal lumen. Transbronchial biopsy failed to obtain a conclusive diagnosis; only surgery allowed complete resection of the tumor and confirmed the diagnosis of tracheal mucoepidermoid carcinoma. We discuss the unusual submucosal presentation of this tumor, and the contribution of surgery for diagnosis and therapy.
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Affiliation(s)
- Mounia Serraj
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, BP 1893, Km 2,200, Route Sidi Harazem, Fez 30000, Morocco.
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10
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Mucoepidermoid carcinoma in a minor salivary gland in a child. Case Rep Dent 2013; 2013:615948. [PMID: 23970980 PMCID: PMC3736535 DOI: 10.1155/2013/615948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/07/2013] [Indexed: 11/18/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC), one of the most common salivary gland malignancies, is rare in children. MEC mainly occurs in the parotid gland, along with minor glands being the second common site, particularly in palate. Clinical, histological, and radiological findings of palatal MEC in a 12-year-old girl are presented with three-year follow-up. Pathologic lesions must be considered in differential diagnoses of intraoral asymptomatic lesions, and their detailed inspection should be taken into consideration.
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11
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Papiashvilli M, Ater D, Mandelberg A, Sasson L. Primary mucoepidermoid carcinoma of the trachea in a child. Interact Cardiovasc Thorac Surg 2012; 15:311-2. [PMID: 22611186 DOI: 10.1093/icvts/ivs199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mucoepidermoid carcinoma of the trachea is a rare tumour, especially in the paediatric population. We report the case of a 9-year-old boy with mucoepidermoid carcinoma of the trachea that was preoperatively diagnosed as an intraluminal polypoid mass arising from the trachea and extending into the right main bronchus. A complete resection of the tumour with reconstruction and end-to-end anastomosis of the trachea was performed. The patient is now, 24 months after surgery, free of disease.
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Affiliation(s)
- Michael Papiashvilli
- Department of Cardiothoracic Surgery, Edith Wolfson Medical Center, Holon, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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12
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Mussi RK, Toro IFC, Pereira MC. Mucoepidermoid carcinoma of the trachea mimicking asthma. J Bras Pneumol 2009; 35:280-4. [PMID: 19390728 DOI: 10.1590/s1806-37132009000300014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 06/26/2008] [Indexed: 11/22/2022] Open
Abstract
In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.
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13
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Romão RLP, de Barros F, Maksoud Filho JG, Gonçalves MEP, Cardoso S, Tannuri ACA, Tannuri U. Malignant tumor of the trachea in children: diagnostic pitfalls and surgical management. J Pediatr Surg 2009; 44:e1-4. [PMID: 19944203 DOI: 10.1016/j.jpedsurg.2009.07.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 07/25/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
Abstract
Primary tracheal malignant neoplasms are very rare. Histologically, squamous cell and adenoid cystic carcinomas are the most common types of malignant primary tracheal tumors when all age groups are studied. In the past 5 years, we treated 2 children with tracheal mucoepidermoid carcinoma. Herein we report both cases and review the literature on the subject with particular emphasis on diagnosis and surgical management.
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Affiliation(s)
- Rodrigo Luiz Pinto Romão
- Division of Pediatric Surgery, Instituto Da Criança, Laboratory of Investigation in Pediatric Surgery, Faculty of Medicine, University of São Paulo Medical School, São Paulo, Brazil.
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Tao H, Sano Y, Yamane M, Toyooka S, Oto T, Date H. Bronchial mucoepidermoid carcinoma with recurrent hemoptysis in a pregnant woman: report of a case. Surg Today 2008; 38:850-2. [PMID: 18751953 DOI: 10.1007/s00595-007-3722-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 12/04/2007] [Indexed: 11/26/2022]
Abstract
Mucoepidermoid carcinoma of the tracheobronchial tree, which is thought to arise from the minor salivary gland tissue of the proximal airway, is an extremely rare neoplasm. We herein report a case of a 31-year-old pregnant woman in her 36th week, who complained of recurrent hemoptysis from bronchial mucoepidermoid carcinoma. As massive bleeding from the tumor was seen during a caesarean section, it was necessary to add bronchial artery embolization. The tumor was successfully removed by a sleeve resection of the left main bronchus after the embolization. The patient is doing well without any signs of recurrence at 3 years after undergoing the operation.
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Affiliation(s)
- Hiroyuki Tao
- Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
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15
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Baghai-Wadji M, Sianati M, Nikpour H, Koochekpour S. Pleomorphic adenoma of the trachea in an 8-year-old boy: a case report. J Pediatr Surg 2006; 41:e23-6. [PMID: 16863832 DOI: 10.1016/j.jpedsurg.2006.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We report a case of pleomorphic adenoma of the trachea in an 8-year-old boy who required emergency surgery for severe respiratory distress. Chest computed tomographic scan and bronchoscopy showed a relatively large mass in distal trachea and right main bronchus and destruction of the lung parenchyma. The patient was subjected to right carinal resection, pneumonectomy, and pericardial patch tracheoplasty for reconstruction of the trachea. Histopathological examination and immunohistochemical staining of tumor specimens were compatible with pleomorphic adenoma. Postoperative follow-up of this patient for a period of 6 months showed satisfactory results with no complications or tumor recurrence. We present not only a very rare benign tracheal tumor in children but also demonstrate successful usage of a free pericardial patch for tracheal reconstruction, although direct anastomosis failed to provide an adequate anastomotic lumen.
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Affiliation(s)
- Massoud Baghai-Wadji
- Department of Thoracic Surgery, Afzalipour Medical Education Centre, P.O. Box 76135-1713, 49850 Kerman, Iran.
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16
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Triantafillidou K, Dimitrakopoulos J, Iordanidis F, Koufogiannis D. Mucoepidermoid carcinoma of minor salivary glands: a clinical study of 16 cases and review of the literature. Oral Dis 2006; 12:364-70. [PMID: 16792720 DOI: 10.1111/j.1601-0825.2005.01166.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of salivary glands with a widely diverse biologic behavior that is correlated with the histological grade of the tumor. The purpose of this study was to evaluate the clinical outcomes of MEC of minor salivary glands in a group of 16 patients, who were treated in our clinic, and to discuss the management of this carcinoma. MATERIALS AND METHODS Between 1985 and 2000, 16 patients with MEC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the 'G. Papanikolaou' General Hospital, in Thessaloniki. The age range was 16-65 years. The distribution of the primary sites was: hard plate (one), soft palate (two), hard and soft palate (three), hard and soft palate with spread in paranasal sinus and nasal cavity (one), buccal mucosa (three), hard palate, alveolar process and buccal mucosa (two), and retromolar triangle (our). The tumors were clinically staged according to the tumor nodes metastase (TNM) system (Seifert, 1991). All patients were treated radically with surgery. The surgery was combined with radiotherapy in nine patients. Radiotherapy was delivered using Co-60. Doses ranged from 50 to 60 Gy and the duration of the therapy ranged from 25 to 35 days. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. RESULTS The mean follow-up range was 4-14 years. From the 16 patients with MECs 10 (62.5%) were alive and five (35.6%) had died from the disease. Four patients were free of the disease for more than 5 years (range 8-14), five patients were free of the disease for 5 years and one patient was free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence developed in one patient 10 years after the initial treatment. Lymph node metastases occurred in one patient within the first year after the initial surgical treatment. Distant metastases (two in bones and one in lungs) occurred in three patients within 2 years after completing the treatment. The Pearson chi-square statistical analysis was used for comparing the Ki-67 values in correlation with histological grade of the tumors. The Ki-67 expression was only 1% in low-grade MECs, while in intermediate-grade tumors it was estimated between 3 and 4%. The high-grade tumors had increased expression (10%) of tumor cells. CONCLUSION Complete surgical excision is the treatment of choice for MECs. Adequate excision is important in all grades of tumors. Prognosis of MECs is a function of the histological grade, adequacy of excision and clinical staging. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.
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Affiliation(s)
- K Triantafillidou
- Department of Oral and Maxillofacial Surgery, Dentistry School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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17
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Fauroux B, Aynie V, Larroquet M, Boccon-Gibod L, Ducou le Pointe H, Tamalet A, Clément A. Carcinoid and mucoepidermoid bronchial tumours in children. Eur J Pediatr 2005; 164:748-52. [PMID: 16133240 DOI: 10.1007/s00431-005-1740-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 06/14/2005] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of the study was to determine the characteristic features and outcome of carcinoid or mucoepidermoid tumours in children. A retrospective analysis of all patients treated for a carcinoid or mucoepidermoid tumour in France between 1984 and 2001 was performed. There were 11 cases of carcinoid tumour and 6 cases of mucoepidermoid tumour. The mean age of the patients was 10.5+/-3.0 years, with a range of 5 to 15 years. Twelve and 6 patients presented with evidence of bronchial obstruction and haemoptysis, respectively. Fibre optic bronchoscopy confirmed the presence of a bronchial tumour in all cases and endobronchial biopsies were diagnostic in 11 of 12 cases. A chest CT scan revealed the presence of a hypervascular tumour in 8 of 12 patients. The distribution of the location of the tumours was equal between the right and the left lung, and, in 9 cases, the airways were totally occluded by the tumour. Complete surgical resection (lobectomy in 15 patients and pneumonectomy in 2 patients) was performed in all cases without pre-operative chemotherapy or radiotherapy. The mean duration of follow-up was 4.0+/-3.0 years. In 2 patients, auscultation assymetry and an episode of haemoptysis revealed the recurrence of a mucoepidermoid tumour, successfully cured by removal of the tumour and chemotherapy and radiotherapy in one child. No death was observed. CONCLUSION Pulmonary carcinoid and mucoepidermoid tumours are rare in children. Bronchoscopic removal should not be performed. With aggressive surgical therapy, the prognosis is excellent. Fibre optic bronchoscopy confirms the presence of an endobronchial mass. A biopsy is needed for diagnosis and complete surgical removal is the treatment of choice. Long-term results are excellent but a clinical follow-up is recommended.
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Affiliation(s)
- Brigitte Fauroux
- Paediatric Pulmonary Department, Research Unit INSERM U 719, Armand Trousseau Hospital, Paris, France.
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18
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Vogelberg C, Mohr B, Fitze G, Friedrich K, Hahn G, Roesner D, Leupold W, Suttorp M. Mucoepidermoid carcinoma as an unusual cause for recurrent respiratory infections in a child. J Pediatr Hematol Oncol 2005; 27:162-5. [PMID: 15750450 DOI: 10.1097/01.mph.0000155120.50936.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recurrent respiratory infections in a 9-year-old girl prompted a chest radiograph and a CT scan, which showed a right middle lobe consolidation. Bronchoscopy revealed a tumor that totally obstructed the middle lobe. Open lung biopsy revealed a low-grade mucoepidermoid carcinoma. Middle and lower right lung lobectomy was performed, followed by an uneventful recovery. Cytogenetic investigation of tumor cells exhibited the translocation t(11;19). This case shows that further diagnostic modalities such as CT scanning should be performed early in children with recurrent lower respiratory tract infections who have suspicious radiographic findings such as persistent atelectasis or recurrent unifocal infiltration. Bronchial mucoepidermoid carcinoma is infrequent, and molecular investigations might shed additional light on the prognosis.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
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19
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Giusti RJ, Flores RM. Mucoepidermoid carcinoma of the bronchus presenting with a negative chest X-ray and normal pulmonary function in two teenagers: two case reports and review of the literature. Pediatr Pulmonol 2004; 37:81-4. [PMID: 14679495 DOI: 10.1002/ppul.10390] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Two adolescents presented with a history of dyspnea upon exertion and cough. In both cases, the chest X-ray and pulmonary function testing, including flow-volume loop, were normal. A bronchial tumor was diagnosed by CT scan, which was ordered after each patient had an episode of hemoptysis. The sedimentation rate was the only abnormal laboratory test in both cases. Mucoepidermoid carcinoma of the bronchus, a rare tumor in childhood, was found at pathology in both cases. There was no evidence of metastases to local lymph nodes or distal sites. There were 47 previously reported cases in children. Recurrent pneumonia and persistent cough were the most common presenting findings. These tumors are of low-grade malignant potential but they can become locally invasive, extending into cartilage and surrounding soft tissue. Prognosis is good with complete resection.
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Affiliation(s)
- Robert J Giusti
- Department of Pediatrics, Long Island College Hospital, Brooklyn, New York 11201, USA.
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20
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Brandwein MS, Ivanov K, Wallace DI, Hille JJ, Wang B, Fahmy A, Bodian C, Urken ML, Gnepp DR, Huvos A, Lumerman H, Mills SE. Mucoepidermoid carcinoma: a clinicopathologic study of 80 patients with special reference to histological grading. Am J Surg Pathol 2001; 25:835-45. [PMID: 11420454 DOI: 10.1097/00000478-200107000-00001] [Citation(s) in RCA: 308] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We sought to review our experience with salivary mucoepidermoid carcinoma (MEC) over two decades to confirm the validity and reproducibility of histologic grading and to investigate MIB-1 index as a prognosticator. Diagnosis was confirmed on 80 cases, and chart review or patient contact was achieved for 48 patients, with follow-up from 5 to 240 months (median 36 months). Immunohistochemistry with citrate antigen retrieval for MIB-1 was performed on a subset of cases. Kaplan-Meier survival curves were generated for each stage, site, and grade according to our proposed grading system. To address the issue of grading reproducibility, 20 slides were circulated among five observers, without prior discussion; slides were categorized as low-, intermediate-, or high-grade according to one's "own" criteria, and then according to the AFIP criteria proposed by Goode et al.10 Weighted kappa (kappa) estimates were obtained to describe the extent of agreement between pairs of rating. The Wilcoxon signed rank test or the Friedman test as appropriate tested variation across ratings. There was no gender predominance and a wide age range (15-86 years, median 49 years). The two most common sites were parotid and palate. All grade 1 MECs presented as Stage I tumors, and no failures were seen for this category. The local disease failure rates at 75 months for grades 2 and 3 MEC were 30% and 70%, respectively. Tumor grade, stage, and negative margin status all correlated with disease-free survival (DFS) (p = 0.0091, 0.0002, and 0.048, respectively). The MIB index was not found to be predictive of grade. Regarding the reproducibility of grading, the interobserver variation for pathologists using their "own" grading, as expressed by the kappa value, ranged from good agreement (kappa = 0.79) to poor (kappa = 0.27) (average kappa = 0.49). A somewhat better interobserver reproducibility was achieved when the pathologists utilized the standardized AFIP criteria (average kappa = 0.61, range 0.38-0.77). This greater agreement was also reflected in the Friedman test (statistical testing of intraobserver equality), which indicated significant differences in using one's own grading systems (p = 0.0001) but not in applying the AFIP "standardized" grading (p = 0.33). When one's own grading was compared with the AFIP grading, there were 100 pairs of grading "events," with 46 disagreements/100 pairs. For 98% of disagreements, the AFIP grading "downgraded" tumors. This led us to reanalyze a subset of 31 patients for DFS versus grade, for our grading schema compared with the AFIP grading. Although statistical significance was not achieved for this subset, the log rank value revealed a trend for our grading (p = 0.0993) compared with the Goode schema (p = 0.2493). This clinicopathologic analysis confirms the predictive value of tumor staging and three-tiered histologic grading. Our grading exercise confirms that there is significant grading disparity for MEC, even among experienced ENT/oral pathologists. The improved reproducibility obtained when the weighted AFIP criteria were used speaks to the need for an accepted and easily reproducible system. However, these proposed criteria have a tendency to downgrade MEC. Therefore, the addition of other criteria (such as vascular invasion, pattern of tumor infiltration [i.e., small islands and individual cells vs cohesive islands]) is necessary. We propose a modified grading schema, which enhances predictability and provides much needed reproducibility.
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Affiliation(s)
- M S Brandwein
- Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY 11021, USA.
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