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Yu BR, Choi WK, Cho DH, Lee NR. Aggressive angiomyxoma of the vagina: A case report and literature review. Medicine (Baltimore) 2025; 104:e41287. [PMID: 39854765 PMCID: PMC11771726 DOI: 10.1097/md.0000000000041287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 12/20/2024] [Accepted: 01/03/2025] [Indexed: 01/26/2025] Open
Abstract
RATIONALE Aggressive angiomyxoma (AAM) is an exceptionally rare mesenchymal tumor that predominantly manifests in the female genital organs during the reproductive age. Its rarity alone makes it a fascinating subject for study. The diagnosis of AAM necessitates differentiation from other benign or mesenchymal tumors and can be confirmed through immunohistochemistry (IHC) staining. Surgical resection is the primary treatment, and adjuvant treatment can be used as hormonal therapy with gonadotropin-releasing hormone agonists, selective estrogen receptor modulators, and aromatase inhibitors. PATIENT CONCERNS A 44-year-old premenopausal Korean woman presented with a growing perineal mass and frequent urination. DIAGNOSES Histopathological findings confirmed AAM, with IHC staining showing estrogen receptor, progesterone receptor, actin and desmin positivity, and CD34 and S100 negativity. INTERVENTIONS The mass was excised transvaginally under general anesthesia. OUTCOMES The patient showed no signs of recurrence 6 months postoperatively. LESSONS AAM in the vagina is a rare tumor that requires differential diagnosis using IHC staining. Previously, we reviewed reported cases and confirmed the feasibility and effectiveness of surgery as the main treatment. This might reassure us about the potential successful treatment of AAM. Adjuvant hormonal therapy with gonadotropin-releasing hormone agonists, selective estrogen receptor modulators, and aromatase inhibitors can further reduce the risk of recurrence.
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Affiliation(s)
- Bo Ram Yu
- Department of Obstetrics and Gynecology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Won Ku Choi
- Department of Obstetrics and Gynecology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Dong Hyu Cho
- Department of Obstetrics and Gynecology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Na-Ri Lee
- Department of Internal Medicine, Division of Hematology and Oncology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Keshk EM, Alafghani SO, Tariq MU, Kashif A, Alsulaiman A. An Aggressive Angiomyxoma Presenting as a Vaginal Wall Carbuncle in a 31-Year-Old Female: A Case Report. Cureus 2024; 16:e75512. [PMID: 39803071 PMCID: PMC11718228 DOI: 10.7759/cureus.75512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2024] [Indexed: 01/16/2025] Open
Abstract
An aggressive angiomyxoma (AA) is a rare soft tissue neoplasm of the lower female genital tract. The incidence of vaginal involvement is low, so it is commonly misdiagnosed as a Bartholin cyst, lipoma, and abscess, among others. This is a case of a 31-year-old female patient presenting with anterior vaginal wall swelling measuring 1 x 1 cm, clinically diagnosed as vaginal carbuncle. Histological and immunohistochemical examination of the lesion showed an AA. Some AAs recur locally, while distant metastasis is rare. The tumor is infiltrative with a characteristic histologic picture. The tumor is positive for high mobility group A2 (HMGA2), estrogen receptors (ERs), a cluster of differentiation 34 (CD34), and desmin immunomarkers. Due to the infiltrative nature of the tumor, surgical margins are commonly positive.
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Affiliation(s)
- Eman M Keshk
- Histopathology Department, Ahmed Maher Teaching Hospital, Cairo, EGY
- Histopathology Unit, Laboratory Department, Al Hada Armed Forces Hospital, Taif, SAU
| | - Saud O Alafghani
- Histopathology Unit, Laboratory Department, Al Hada Armed Forces Hospital, Taif, SAU
| | - Muhammad Usman Tariq
- Histopathology Unit, Laboratory Department, Al Hada Armed Forces Hospital, Taif, SAU
| | - Ammara Kashif
- Histopathology Unit, Laboratory Department, Al Hada Armed Forces Hospital, Taif, SAU
| | - Abdullah Alsulaiman
- Genetics Unit, Laboratory Department, Al Hada Armed Forces Hospital, Taif, SAU
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Zhang L, Liu R, Peng J. Misleading clinical and imaging features in atypical aggressive angiomyxoma of the female vulvovaginal or perianal region: report of three cases and review of the literature. Front Oncol 2024; 14:1373607. [PMID: 38590660 PMCID: PMC10999629 DOI: 10.3389/fonc.2024.1373607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
Objectives Aggressive (deep) angiomyxoma (AAM) is a rare mesenchymal tumor that typically originates from the vulvovaginal region, perineum, and pelvis in adult women. The objective of this case report and literature review is to comprehensively analyze the clinical, imaging, and pathological characteristics of atypical AAM in the female lower genital tract and pelvic floor in order to minimize preoperative misdiagnosis or missed diagnosis and ultimately optimize the clinical management strategy. Methods The data of three cases with atypical AAM, which demonstrate similarities with other lesions observed in the female lower genital tract over the past 1.5 years, were retrospectively described. This description included clinical management, images and reports of ultrasonography (US) and magnetic resonance imaging (MRI), clinicopathological features, follow-up, and outcomes. In the Discussion section, a review of the literature on MEDLINE (PubMed) and Web of Science from the past 50 years was conducted. Results The three cases all underwent preoperative ultrasonography, and two of them also underwent preoperative MRI examination. Complete resection of the lesions was performed in all three cases, followed by postoperative pathological examination. The histopathology of these three cases revealed invasive angiomyxoma, as confirmed by immunohistochemical staining, which demonstrated positive expression of desmin, vimentin, estrogen, and progesterone receptors. The patients experienced a smooth postoperative recovery. Ultrasound had a diagnostic accuracy rate of 100% (3/3) for locating and determining the extent of the lesions; however, its specific diagnostic accuracy rate for identifying the pathological type was only 33% (1/3). In contrast, MRI had a diagnostic accuracy rate of 100% (2/2) for locating and determining the extent of lesions but did not show any specific diagnostic accuracy for identifying the pathological types. Conclusions Our findings indicate that even if a vulvovaginal lesion presents with a superficial location, small size, limited scope, and regular shape, suspicion of atypical AAM should arise when palpation reveals toughness, tensility, and deformability under pressure. US reveals a well-defined hypoechoic to anechoic mass with uniformly distributed coarse dot echoes, with or without detectable intratumoral blood flow signal. MRI shows prolonged T1 and T2 signals with inhomogeneous enhancement and evident diffusion restriction on diffusion-weighted imaging (DWI).
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Affiliation(s)
- Ling Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Liu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Peng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Collins K, Warmke LM, Chen S, Ulbright TM. Angiomyofibroblastoma and Potential Mimicking Soft Tissue Tumors That May Occasionally Present in the Retroperitoneum: An Approach to the Differential Diagnosis With Report of an Unusual Index Case Abutting the Kidney. Adv Anat Pathol 2022; 29:141-153. [PMID: 35275847 DOI: 10.1097/pap.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The retroperitoneal soft tissues, extending from the pelvic floor to the level of the diaphragm, are the source of a variety of mesenchymal neoplasms with overlapping features and distinct clinical behaviors, making their distinction of crucial importance. Herein, we report a rare retroperitoneal angiomyofibroblastoma (AMFB) that presented as a right abdominal mass in a 25-year-old woman and that clinically simulated a primary renal carcinoma. The patient underwent complete surgical resection showing a well-circumscribed tumor adjacent to but separate from the right kidney. It was comprised of irregular, often anastomosing islands and cords of plump to spindled cells in a collagenous stroma with numerous thin-walled vessels. The tumor cells clustered around the vessels and admixed with moderate numbers of adipocytes. There was neither significant nuclear atypia nor mitotic activity. Immunohistochemically, the tumor cells showed strong reactivity for desmin, diffuse expression of estrogen and progesterone receptors, retained nuclear expression of retinoblastoma protein, and absent CD34 expression. The immunomorphological features were these of a "lipomatous variant" of AMFB of the retroperitoneum. The occurrence of AMFB in the retroperitoneum is unexpected since it mostly develops in the lower genital tract of young women, making its recognition in this rare location difficult. As a consequence, more common pelvic or retroperitoneal soft tissue neoplasms may represent the primary diagnostic considerations. We, therefore, review a variety of soft tissue tumors occurring in the pelvis/retroperitoneum that, to some degree, may mimic AMFB, and present key findings to assist in accurate diagnosis.
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Affiliation(s)
- Katrina Collins
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN
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Ambrose NP, Coelho VV, Roopavathana B, Chase S. Recurrent perineal aggressive angiomyxoma: dilemma in diagnosis and outcome of this rare disease. BMJ Case Rep 2021; 14:14/2/e238722. [PMID: 33619134 PMCID: PMC7903107 DOI: 10.1136/bcr-2020-238722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aggressive angiomyxoma (AAM) is a very rare, benign, locally infiltrative mesenchymal tumour with a high chance of recurrence following surgical excision. In the male population, it is so rare that less than only 50 cases have been reported so far. We present a case of a large recurrent perineal AAM in a man who presented with swelling in the perineal region following surgical excision 3 years ago. After evaluation, the diagnostic dilemma of a possible perineal hernia or recurrence remained. Surgical exploration ruled out hernia and the tumour was excised with difficulty. Immunohistochemical examination showed tumour cells with diffuse nuclear positivity for oestrogen receptor and patchy cytoplasmic positivity for desmin (A2). Histological and immunohistochemical features confirmed the diagnosis. Being very rare, AAMs need to be considered as a differential diagnosis of pelvic/perineal tumours among males. With no standardised therapy for AAM, complete resection would be the goal of therapy.
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Affiliation(s)
- Nitin Paul Ambrose
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Victor Vijay Coelho
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Beulah Roopavathana
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suchita Chase
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Kafka M, Rehder P, Maier H, Horninger W. Incidental resection of a scrotal aggressive angiomyxoma mimicking a spermatocele: a case report. Eur Surg 2018. [DOI: 10.1007/s10353-018-0564-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Aydin AM, Katipoglu K, Baydar DE, Bilen CY. Long-standing aggressive angiomyxoma as a paratesticular mass: A case report and review of literature. SAGE Open Med Case Rep 2017; 5:2050313X17712090. [PMID: 28616233 PMCID: PMC5459349 DOI: 10.1177/2050313x17712090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives: Aggressive angiomyxoma is known as a mesenchymal tumor of premenopausal women and it is extremely rare in men. Methods: Herein, we report a 66-year-old male with a firm scrotal mass that had gradually enlarged over 20 years. Results: Radiological studies revealed 10 x 15 cm mass lesion confined to right scrotum with neither local invasion nor distant metastasis. Inguinal orchiectomy was performed and histopathology showed characteristic features of an aggressive angiomyxoma occupying paratesticular region, which was a challenging diagnosis due to its unexpected occurrence in the male gender. Conclusion: Aggressive angiomyxoma is mostly considered as a benign tumor in females despite its propensity for local recurrence. Whether it may show a divergent biological behavior in men is unknown as the reported cases are too few.
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Affiliation(s)
- Ahmet M Aydin
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kubra Katipoglu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilek E Baydar
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cenk Y Bilen
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Yuan CT, Huang WC, Lee CH, Lin MC, Lee CH, Kao YC, Huang HY, Kuo KT, Lee JC. Comprehensive screening forMED12mutations in gynaecological mesenchymal tumours identified morphologically distinctive mixed epithelial and stromal tumours. Histopathology 2017; 70:954-965. [DOI: 10.1111/his.13156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/19/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Chang-Tsu Yuan
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
| | - Wen-Chih Huang
- Department of Pathology; Far-Eastern Memorial Hospital; New Taipei City Taiwan
| | - Cheng-Han Lee
- Department of Pathology; British Columbia Cancer Agency; Vancouver British Columbia
- University of Alberta; Edmonton Alberta Canada
| | - Ming-Chieh Lin
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
| | - Chen-Hui Lee
- Department of Pathology and Laboratory Medicine; Taichung Veterans General Hospital; Taichung Taiwan
| | - Yu-Chien Kao
- Department of Pathology; Shuang Ho Hospital; Taipei Medical University; Taipei Taiwan
| | - Hsuan-Ying Huang
- Department of Pathology; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Kuan-Ting Kuo
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
| | - Jen-Chieh Lee
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
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Aggressive angiomyxomas: a comprehensive imaging review with clinical and histopathologic correlation. AJR Am J Roentgenol 2014; 202:1171-8. [PMID: 24848813 DOI: 10.2214/ajr.13.11668] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Aggressive angiomyxomas are rare infiltrative mesenchymal neoplasms that commonly recur locally. The purpose of this study was to conduct a retrospective review of imaging findings of aggressive angiomyxomas with clinicopathologic correlation in 16 patients. MATERIALS AND METHODS CT and MRI studies and clinical data of 16 patients with histopathologic evidence of aggressive angiomyxoma who had been referred to our institutions from January 2002 through January 2012 were retrospectively reviewed. The tumors were evaluated with respect to location, morphology, attenuation or signal intensity, and enhancement characteristics. RESULTS The most common location was the pelvis and perineum with the mass on either side of the pelvic diaphragm (12/16, 75%). The characteristic "laminated" appearance was seen in 10 of 12 patients on MRI. Aggressive angiomyxomas showed only mild diffusion restriction and mild (18)F-FDG avidity in both of the two patients who underwent DWI and PET/CT, in keeping with histologic low-mitotic activity. Imaging features, such as collateral vessels and fingerlike growth pattern, were seen in seven of 16 (44%) aggressive angiomyxomas. Internal cystic degeneration was seen in three of 16 (19%) aggressive angiomyxomas. CONCLUSION The finding of a large multicompartmental tumor with a characteristic internal laminated morphology or extension on either side of the pelvic diaphragm should alert the radiologist to the possible diagnosis of aggressive angiomyxoma. Imaging features, such as large peripheral vessels and cystic degeneration are less common, but presence of these features in the background of laminated morphology should not deter the radiologist from suggesting a diagnosis of aggressive angiomyxoma.
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Bai HM, Yang JX, Huang HF, Cao DY, Chen J, Yang N, Lang JH, Shen K. Individualized managing strategies of aggressive angiomyxoma of female genital tract and pelvis. Eur J Surg Oncol 2013; 39:1101-8. [PMID: 23899874 DOI: 10.1016/j.ejso.2013.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/17/2013] [Indexed: 12/17/2022] Open
Abstract
AIMS To investigate and evaluate the clinical management strategies of aggressive angiomyxoma (AA) in female genital tract and pelvis. METHODS A cohort of 13 patients with AA diagnosed and treated in Peking Union Medical College Hospital in the last 12 years was reported focusing on the results of the managements and prognosis. RESULTS The mean age at initial presentation was 36.9 years. The commonest site of tumor was perineum. Only two cases were accurately diagnosed as AA preoperatively by biopsy and fine needle aspiration of the tumors respectively. MRI helpfully reveals the location, relationship and degree of infiltration between tumors and pelvic organs. Surgery is the mainstay treatment. 11 of 12 patients had complete resection and majority of the operations were finished successfully through trans-perineum and trans-vagina approaches. Three cases with positive expression of ERs and PRs in the tumors received GnRHa injections which were useful preoperatively but not postoperatively. One repeatedly-recurrent case was treated with radiotherapy effectively. The recurrence rate in our study was 41.7% (5/12), with a median recurrence interval of 20.9 months. No patient developed distant metastases and died of the disease. CONCLUSIONS AA preferentially involves the pelvic and perineal regions of women in reproductive age. Tumor biopsy and fine-needle aspiration cytology are conducive to the preoperative diagnosis. The individualized operative strategy and awareness to protect and rebuild structure and function of the organs should be emphasized during the management of AA. Long-term follow-up is mandatory because of the high rate of recurrence.
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Affiliation(s)
- H M Bai
- Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan Wangfujing, Beijing 100730, People's Republic of China
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Angiomyxome agressif du pelvis et du périnée : à propos d’un cas. IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vulvovaginal aggressive angiomyxoma mimicking lymphedema complicated with Behcet’s disease: a case report and review of the literature. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-012-0066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Aggressive Angiomyxoma of the Female Genital Tract and Pelvis—Clinicopathologic Features With Immunohistochemical Analysis. Int J Gynecol Pathol 2011. [DOI: 10.1097/pgp.0b013e31823a4166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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