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Dini F, Susini P, Nisi G, Cuomo R, Grimaldi L, Massi D, Innocenti A, Doni L, Mazzini C, Santoro N, De Giorgi V. Periocular sebaceous carcinoma: updates in the diagnosis, treatment, staging, and management. Int J Dermatol 2024; 63:726-736. [PMID: 38351466 DOI: 10.1111/ijd.17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 05/25/2024]
Abstract
Periocular sebaceous carcinoma (PSC) is a rare, aggressive, and potentially metastatic adnexal malignancy. Due to the ability of PSC to resemble several benign and malignant conditions, diagnosis is often delayed or mistaken. In addition, even with a known diagnosis, choosing the right treatment is still an open debate. For this reason, we decided to review the most up-to-date literature on PSC and propose a dedicated procedural protocol to help clinicians when dealing with PSC. A PubMed search was carried out using the terms "Sebaceous Carcinoma", "Adnexal Periocular Cancer", "Sebaceous Carcinoma AND eyelid", "Periocular Sebaceous Carcinoma", and "Ocular Adnexa". Pertinent studies published in English from 1997 up to December 2022 were compared to the selection criteria and if suitable, included in this review. Through the initial search, 84 articles were selected. Of these, 36 were included in the final study. Several papers explored different diagnostic and therapeutic strategies regarding PSC diagnosis and management. In light of the current literature review and the multidisciplinary experience of three clinical centers, a dedicated procedural protocol is proposed. PSC diagnosis may be achieved through accurate clinical evaluation, but it requires histopathologic confirmation, which can be challenging. Dermoscopy, in vivo reflectance confocal microscopy, and optical coherence tomography may facilitate PSC clinical examination, while immunohistochemistry stains may support histological diagnosis. Appropriate disease staging is necessary before choosing the treatment, as local disease requires radically different treatment compared to advanced disease. In addition, recent innovations in nonsurgical treatments, including radio-chemotherapy, immunotherapy, and targeted therapy, may be a viable option in the most challenging cases.
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Affiliation(s)
- Federica Dini
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, Florence, Italy
| | - Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Laura Doni
- Clinical Oncology Unit, University Hospital Careggi, Florence, Italy
| | - Cinzia Mazzini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Nicola Santoro
- Unit of Ocular Oncology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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2
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Utikal J, Nagel P, Müller V, Becker JC, Dippel E, Frisman A, Gschnell M, Griewank K, Hadaschik E, Helbig D, Hillen U, Leiter U, Pföhler C, Krönig L, Ziemer M, Ugurel S. S1-Guideline Sebaceous Carcinoma. J Dtsch Dermatol Ges 2024; 22:730-747. [PMID: 38679790 DOI: 10.1111/ddg.15405] [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: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 05/01/2024]
Abstract
Sebaceous gland carcinomas are rare malignant cutaneous adnexal tumors with sebocytic differentiation. The typical predilection area is the head and neck region, where sebaceous gland carcinomas are the most common malignant adnexal tumors of the skin. According to their localization a distinction is made between periocular and extraocular sebaceous gland carcinomas. Muir-Torre syndrome (MTS) should always be ruled out if it is suspected. In terms of prognosis, sebaceous gland carcinomas are potentially aggressive tumors with a clear tendency to recur and metastasize. Only small extraocular sebaceous gland carcinomas that have been completely resected have a very good prognosis. Sebaceous gland carcinomas most frequently metastasize lymphogenously to regional or distant lymph nodes; organ metastasis occurs less frequently. Periocular sebaceous gland carcinomas have a higher metastasis rate (up to 15%) than extraocular sebaceous gland carcinomas (up to 2%). Complete micrographically controlled surgery (MCS) of the primary tumor is the therapy of first choice, regardless of periocular or extraocular localization. Adjuvant or therapeutic radiotherapy may be considered. There is currently no established standard therapy for advanced, inoperable, or metastatic sebaceous gland carcinomas. Local procedures and systemic therapies such as chemotherapy or immunotherapy can be considered. The procedure should be determined individually by an interdisciplinary tumor board. Close follow-up care is recommended for these potentially aggressive carcinomas.
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Affiliation(s)
- Jochen Utikal
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Pia Nagel
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Verena Müller
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research, Department of Dermatology, University Medical Center Essen, and German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Edgar Dippel
- Department of Dermatology and Venereology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Alexander Frisman
- Department of Radiation Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Martin Gschnell
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Klaus Griewank
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Eva Hadaschik
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Doris Helbig
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Ulrike Leiter
- Center for Dermato-Oncology, Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Claudia Pföhler
- Department of Dermatology, Venereology and Allergology and Skin Tumor Center, Saarland University Medical School, Homburg, Homburg/Saar, Germany
| | - Lisa Krönig
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
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3
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Utikal J, Nagel P, Müller V, Becker JC, Dippel E, Frisman A, Gschnell M, Griewank K, Hadaschik E, Helbig D, Hillen U, Leiter U, Pföhler C, Krönig L, Ziemer M, Ugurel S. S1‐Leitlinie Talgdrüsenkarzinom. J Dtsch Dermatol Ges 2024; 22:730-749. [PMID: 38730519 DOI: 10.1111/ddg.15405_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 05/13/2024]
Abstract
Sebaceous gland carcinomas are rare malignant cutaneous adnexal tumors with sebocytic differentiation. The typical predilection area is the head and neck region, where sebaceous gland carcinomas are the most common malignant adnexal tumors of the skin. According to their localization a distinction is made between periocular and extraocular sebaceous gland carcinomas. Muir-Torre syndrome (MTS) should always be ruled out if it is suspected. In terms of prognosis, sebaceous gland carcinomas are potentially aggressive tumors with a clear tendency to recur and metastasize. Only small extraocular sebaceous gland carcinomas that have been completely resected have a very good prognosis. Sebaceous gland carcinomas most frequently metastasize lymphogenously to regional or distant lymph nodes; organ metastasis occurs less frequently. Periocular sebaceous gland carcinomas have a higher metastasis rate (up to 15%) than extraocular sebaceous gland carcinomas (up to 2%). Complete micrographically controlled surgery (MCS) of the primary tumor is the therapy of first choice, regardless of periocular or extraocular localization. Adjuvant or therapeutic radiotherapy may be considered. There is currently no established standard therapy for advanced, inoperable or metastatic sebaceous gland carcinomas. Local procedures and system therapies such as chemotherapy or immunotherapy can be considered. The procedure should be determined individually in an interdisciplinary tumor board. Close follow-up care is recommended for these potentially aggressive carcinomas.
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Affiliation(s)
- Jochen Utikal
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrums (DKFZ) Heidelberg und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Krebsinstitut an der Universitätsmedizin Mannheim
| | - Pia Nagel
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrums (DKFZ) Heidelberg und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Krebsinstitut an der Universitätsmedizin Mannheim
| | - Verena Müller
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrums (DKFZ) Heidelberg und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Krebsinstitut an der Universitätsmedizin Mannheim
| | - Jürgen C Becker
- Translationale Hautkrebsforschung, Klinik für Dermatologie, Universitätsmedizin Essen, und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - Edgar Dippel
- Klinik für Dermatologie und Venerologie, Klinikum der Stadt Ludwigshafen
| | - Alexander Frisman
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Leipzig
| | - Martin Gschnell
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg
| | - Klaus Griewank
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Eva Hadaschik
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Doris Helbig
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinikum Köln
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik Tübingen, Universitätsklinikum Tübingen
| | - Claudia Pföhler
- Universitätsklinikum des Saarlandes, Klinik für Dermatologie, Venerologie und Allergologie und Hauttumorzentrum am UKS, Homburg/Saar
| | - Lisa Krönig
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg
| | - Mirjana Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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Polanowski P, Nasiek A, Grządziel A, Chmielik E, Pietruszka A, Składowski K, Polanowska K. Stereotactic Radiotherapy Boost in Treatment of Persistent Periocular Sebaceous Carcinoma after Surgery. Biomedicines 2023; 11:1538. [PMID: 37371633 DOI: 10.3390/biomedicines11061538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Sebaceous carcinoma is a rare malignancy that should be treated with surgical resection. Nonetheless, a dynamic and aggressive course of the disease may disqualify a patient from this treatment. Applying radiotherapy with the escalation dose using a stereotactic boost is worthy of consideration as a radical treatment. In this paper, we present the case study of a young patient with a tumor localized in the periocular area. The patient was treated with operation two times without a satisfactory effect. Conventional radiotherapy, 60 Gy in 30 fractions, combined with chemotherapy based on cisplatin 40 mg/m2 and the addition of a stereotactic radiosurgery boost were administered. The tolerance of this treatment was acceptable. During the 2-year follow-up, local and distant recurrences were not diagnosed. The presented case shows the usefulness of an individualized approach in the radical treatment of sebaceous carcinoma with the use of the stereotactic radiotherapy boost. This is a subsequent example of the implementation of the boost in head and neck carcinoma, which yields a positive result.
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Affiliation(s)
- Paweł Polanowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Aleksandra Nasiek
- 3rd Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Aleksandra Grządziel
- Radiotherapy Planning Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Agnieszka Pietruszka
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115 Cracow, Poland
| | - Krzysztof Składowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Katarzyna Polanowska
- Ophthalmology Department, St. Barbara Provincial Hospital No 5, Plac Medyków 1, 41-200 Sosnowiec, Poland
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Xu W, Le Y, Zhang J. Prognostic risk factors and nomogram construction for sebaceous carcinoma: A population-based analysis. Front Oncol 2023; 13:981111. [PMID: 36923421 PMCID: PMC10009225 DOI: 10.3389/fonc.2023.981111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
Background Sebaceous gland carcinoma (SGC) is a rare tumor for which there are currently no effective tools to predict patient outcomes. We analyzed the clinical and pathological prognostic risk factors of sebaceous carcinoma based on population data and created a nomogram of related risk factors, which can more accurately predict the 3-, 5-, and 10-year overall survival (OS) rates of patients. Methods SGC patients between 2004 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to training and validation cohorts. Relevant risk factors were identified by univariate and multivariate COX hazards regression methods and combined to produce a correlation nomogram. The concordance index (C-index), the area under the receiver operating characteristic (AUC) curve, and calibration plots have demonstrated the predictive power of the nomogram. Decision curve analysis (DCA) was used to measure nomograms in clinical practice. Results A total of 2844 eligible patients were randomly assigned to 70% of the training group (n=1990) and 30% of the validation group (n=854) in this study. The derived meaningful prognostic factors were applied to the establishment of the nomogram. The C-index for OS was 0.725 (95% CI: 0.706-0.741) in the training cohort and 0.710 (95% CI: 0.683-0.737) in the validation cohort. The AUC and calibration plots of 3-, 5-, and 10-year OS rates showed that the nomogram had good predictive power. DCA demonstrated that the nomogram constructed in this study could provide a clinical net benefit. Conclusion We created a novel nomogram of prognostic factors for SGC, which more accurately and comprehensively predicted 3-, 5-, and 10-year OS in SGC patients. This can help clinicians identify high-risk patients as early as possible, carry out personalized treatment, follow-up, and monitoring, and improve the survival rate of SGC patients.
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Affiliation(s)
- Wen Xu
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Yijun Le
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
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Adachi A, Oike T, Tamura M, Ota N, Ohno T. Radiotherapy With Hydrogen Peroxide-Soaked Gauze for Preauricular Sebaceous Carcinoma. Cureus 2022; 14:e27464. [PMID: 35923494 PMCID: PMC9339371 DOI: 10.7759/cureus.27464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Sebaceous carcinoma is a rare and aggressive malignant tumor deriving from the adnexal epithelium of the sebaceous glands. The case of inoperable preauricular sebaceous carcinoma treated with definitive radiotherapy is first reported herein. Radiotherapy of 60 Gy in 30 fractions was combined with a hydrogen peroxide-soaked gauze bolus aiming at potential radiosensitization. Macroscopic complete remission was achieved eight months after radiotherapy with tolerable adverse effects. Although further clinical studies are needed, radiotherapy with a hydrogen peroxide-soaked gauze bolus can be an effective and tolerable treatment for inoperable patients with extraocular sebaceous carcinoma.
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An Immunohistochemical Study of Epidermal Growth Factor Receptor in Sebaceous Carcinoma of the Eyelid: A Potential Therapeutic Target. Ophthalmic Plast Reconstr Surg 2022; 38:377-380. [DOI: 10.1097/iop.0000000000002126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wu A, Rajak SN, Huilgol SC, James C, Selva D. Cutaneous sebaceous carcinoma. Australas J Dermatol 2020; 61:e283-e292. [PMID: 31956994 DOI: 10.1111/ajd.13234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/03/2019] [Accepted: 12/14/2019] [Indexed: 12/19/2022]
Abstract
Cutaneous sebaceous carcinoma occurs almost exclusively on the head and neck and has a significant propensity for recurrence and metastasis. It is easily mistaken for benign conditions, resulting in inappropriate management. Thus, it is important to maintain a high index of suspicion. Despite previous reports, sebaceous carcinoma may occur with similar frequency in Asians and whites. Recent genetic data suggest there are multiple mutational groups of sebaceous carcinoma, paving the way for targeted treatment. After a diagnosis, investigations for staging and for Muir-Torre syndrome should be considered. The available evidence on the treatment options for sebaceous carcinoma is discussed, and specific recommendations for management are made.
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Affiliation(s)
- Albert Wu
- Department of Dermatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Saul N Rajak
- Sussex Eye Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Shyamala C Huilgol
- Department of Dermatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Skin and Eye Centre, Adelaide, South Australia, Australia
| | - Craig James
- Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Adelaide Skin and Eye Centre, Adelaide, South Australia, Australia.,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
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