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Chen-Carrington A, Leonard D, Goodreau A, Rhodes J, Tye GW. Prenatal diagnosis of meningomyelocele resolves as a mature cystic teratoma in the thoracolumbar region. Childs Nerv Syst 2024:10.1007/s00381-024-06396-7. [PMID: 38684568 DOI: 10.1007/s00381-024-06396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/06/2024] [Indexed: 05/02/2024]
Abstract
A mature cystic teratoma is a mass with heterogeneous appearance, consisting of adult tissue with two or three layers: endoderm, mesoderm, and ectoderm. It is a rare, benign transformation of somatic tissue most commonly found in the sacrococcygeal region and may resemble an uncomplicated spina bifida on prenatal ultrasonography. In this case report, we describe a female newborn with an extremely rare mature cystic teratoma in the thoracolumbar region. She presented prenatally with a preliminary diagnosis of meningomyelocele, diastematomyelia, and Chiari II malformation and a possible teratoma. However, a mass containing solid glandular tissues and bony calcifications approximately 3 × 4 cm in size was observed in the thoracolumbar region upon birth. During surgical resection, no nerve roots were found in the associated meningocele. The patient retained full lower body function postoperatively following surgical excision of the thecal sac and teratoma.
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Affiliation(s)
- Annie Chen-Carrington
- Division of Plastic Surgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA.
| | - Dean Leonard
- Division of Neurosurgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
| | - Adam Goodreau
- Division of Plastic Surgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
| | - Jennifer Rhodes
- Division of Plastic Surgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
| | - Gary W Tye
- Division of Neurosurgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
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Hazneci J, Bastacı F, Börekci A, Öztürk ÖÇ, İş M, Somay A, Ekşi MŞ, Çelikoğlu E. Split cord malformation concomitant with spinal teratoma without open spinal dysraphism. Childs Nerv Syst 2022; 38:1977-1986. [PMID: 35687168 DOI: 10.1007/s00381-022-05578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Split cord malformation (SCM) presenting concomitant with spinal teratoma without any open spinal dysraphism has rarely been reported in the literature. We aimed to make a systematic review and qualitative analysis of the literature about the topic and present the first case of SCM concomitant with spinal teratoma harboring papillary thyroid carcinoma (PTC) component. METHODS Two big search tools (Pubmed/MEDLINE) and Scopus were used. The search strategy was compatible to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An exemplary case of ours was also presented. RESULTS There were 30 patients (15 pediatric and 15 adult). Female and male distribution was even. Median age of the patients was 18 years (range = 0-66 years). The most common presenting symptoms were back pain and lower limb weakness. Spinal teratoma and SCM mostly presented at thoracic/thoracolumbar region in children and lumbar region in adults. Surgical outcome was better in the children compared to the adults. CONCLUSION Thoracolumbar region is the most common location for such entity in children, whereas lumbar region for the adults. Surgical resection should be done as much as possible under neuromonitorization. The resected material should be evaluated thoroughly not to miss any malign pathology. Surgical outcome is better when it is done at an early age.
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Affiliation(s)
- Jülide Hazneci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Feryal Bastacı
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | | | - Merih İş
- Private Practice, Neurosurgery, Istanbul, Turkey
| | - Adnan Somay
- FSM Training and Research Hospital, Pathology Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
- School of Medicine, Neurosurgery Research Laboratory, Yeditepe University, Istanbul, Turkey.
- , Istanbul, Turkey.
| | - Erhan Çelikoğlu
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Berchi Kankam S, Ashrafi M, Tayebi Meybodi K, Sotoudeh Anvari M, Habibi Z, Nejat F. Lumbosacral non-terminal myelocystocele associated with teratoma: case report and review of literature. Childs Nerv Syst 2022; 38:1229-1232. [PMID: 34515813 DOI: 10.1007/s00381-021-05361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Non-terminal myelocystoceles are commonly found in the cervical or thoracic spinal region. Their sac can rarely be associated with tumor. A rare case of an infant with a lumbosacral non-terminal myelocystocele and accompanying mature teratoma is reported in whom the tumor was attached to the placode not as a part of the sac.
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Affiliation(s)
- S Berchi Kankam
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Ashrafi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - K Tayebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Sotoudeh Anvari
- Department of Pediatric Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Z Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - F Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran.
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Palacio-Uribe L, Perez-Roman RJ, Bryant JP, Brathwaite C, Pacheco-Jácome E, Niazi T. Cervical intramedullary teratoma: a case report and systematic review of the literature. Childs Nerv Syst 2022; 38:997-1004. [PMID: 34676426 DOI: 10.1007/s00381-021-05385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
Here, we report a case of a 3-year-old female who presented to clinic with an enlarging mass in the posterior cervical midline. The mass was present since birth and demonstrated no cutaneous stigmata. Plain film, CT, and MRI of the cervical spine (C3-C5) revealed enlargement of the spinal canal, soft tissue calcification, spinal dysraphism, and an intramedullary, predominantly fatty, mass. The mass had associated calcifications and a highly proteinaceous cyst. Surgical resection of the spinal lesion was subsequently performed. Histopathological evaluation revealed a mature teratoma. Cervical spinal teratomas in the pediatric population are rare entities with few cases currently reported in the literature. We conducted a systematic review to outline the current evidence detailing cases of intramedullary spinal cord teratomas. Six articles were included for final review. All patients in the included articles underwent maximal surgical resection with one patient also receiving chemotherapy and radiation. With our report, we aim to add to the literature on cervical intramedullary spinal cord teratomas in the pediatric population.
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Affiliation(s)
| | - Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Jean-Paul Bryant
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
| | - Carole Brathwaite
- Department of Pathology, Nicklaus Children's Hospital, Miami, FL, USA
| | | | - Toba Niazi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.,Nicklaus Children's Hospital Division of Pediatric Neurological Surgery, Miami, FL, USA
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Balci M, Yuksel U, Akkaya MA, Akkaya S, Sagsoz N. Mature cystic teratoma mimicking meningomyelocele. Childs Nerv Syst 2021; 37:2245-2249. [PMID: 33404722 DOI: 10.1007/s00381-020-05017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
Teratomas are benign germ cell tumors originating from at least two germ layers, mostly of ectodermal and mesodermal origin. Mature teratomas are the most common subtype and develop from well-differentiated germ cells. Although the location is extragonadal in infants and young children, gonadal involvement occurs in adults. Midline defects can be diagnosed on prenatal imaging. In this case report, a newborn with mature cystic teratoma and a prenatal lumbar midline closure defect was presented. The perinatal preliminary diagnosis was meningomyelocele. However, a cystic sac containing exophytic solid tumoral tissues approximately 5 × 5 × 3 cm in size was seen macroscopically in the lumbar region after the birth, and this tumor was totally resected. After tumor excision, spina bifida aperta and vertebral exophytic bony tissue compatible with diastematomyelia were observed at the bottom of the surgical field and were totally resected. In the short-term follow-up, no additional problem occurred. The histopathological diagnosis was "mature cystic teratoma." In conclusion, extragonadal teratoma accompanying diastematomyelia could easily be mistaken for meningomyelocele or other common malformations. Perinatal diagnosis should be provided using radiodiagnostic methods, and total surgical excision and accurate pathological diagnosis are essential to avoid the risk of recurrence.
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Affiliation(s)
- Mahi Balci
- Department of Pathology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Ulas Yuksel
- Department of Neurosurgery, Faculty of Medicine, Kirikkale University, Yahsihan Yerleskesi, 71450, Kirikkale, Turkey
| | - Merva Aydemir Akkaya
- Department of Pathology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Suleyman Akkaya
- Department of Neurosurgery, Faculty of Medicine, Kirikkale University, Yahsihan Yerleskesi, 71450, Kirikkale, Turkey.
| | - Nevin Sagsoz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Kane A, Kleib AS, Diouf C, Nagi SM, Ada E, Sghair YM, Baba SW. Dorsal teratoma simulating an upper limb associated with a diastematomyelia. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2020.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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D'Agostino EN, Calnan DR, Makler VI, Khan I, Kanter JH, Bauer DF. Type I split cord malformation and tethered cord syndrome in an adult patient: A case report and literature review. Surg Neurol Int 2019; 10:90. [PMID: 31528428 PMCID: PMC6744800 DOI: 10.25259/sni-66-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
Background: In a split cord malformation (SCM), the spinal cord is divided longitudinally into two distinct hemicords that later rejoin. This can result in a tethered cord syndrome (TCS). Rarely, TCS secondary to SCM presents in adulthood. Here, we present an adult female with Type I SCM resulting in TCS and a review of literature. Case Description: A 57-year-old female with a history of spina bifida occulta presented with a 2-year history of worsening back and left leg pain, difficulty with ambulation, and intermittent urinary incontinence; she had not responded to conservative therapy. Magnetic resonance imaging (MRI) revealed a tethered cord secondary to lumbar type I SCM. The patient underwent an L1–S1 laminectomy for resection of the bony septum with cord detethering. At 2-month follow-up, the patient had improvement in her motor symptoms and less pain. In literature, 25 cases of adult-onset surgically managed SCM with TCS were identified (between 1936 and 2018). Patients averaged 37 years of age at the time of diagnosis, and 56% were female. Conclusion: TCS can present secondary to SCM in adulthood and is characterized predominantly by back and leg pain.
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Affiliation(s)
- Erin N D'Agostino
- Department of Neurosurgery, Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - Daniel R Calnan
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - Vyacheslav I Makler
- Section of Neurology, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - Imad Khan
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - John H Kanter
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - David F Bauer
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
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Prasad GL, Divya S. A comprehensive review of adult onset spinal teratomas: analysis of factors related to outcomes and recurrences. Eur Spine J 2019; 29:221-237. [PMID: 31227969 DOI: 10.1007/s00586-019-06037-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Spinal teratomas are rare tumours noted in adults and are commonly located in the thoracolumbar region. Currently, there appears to be a lack of clear consensus regarding the management and prognosis of these lesions. A comprehensive review along with an illustrative case managed at the author's institute has been presented. MATERIALS AND METHODS Online database search was performed for literature review. RESULTS A 26-year-old male presented with acute onset neurological deficits and imaging revealed features of conus teratoma. Subtotal resection was performed and patient achieved fair recovery. Including the present one, a total of 146 cases have been reported and were analysed. Mean age was 39.6 years (range 18-85 years) and males predominated. Limb weakness and backache were the commonest symptoms. Majority of the lesions were intramedullary and located in the thoracolumbar region. Complete resection (CR) was achieved in 45% of cases. All, except one, were mature teratomas. Recurrences were noted in nine (6.1%) cases. Outcome was good/excellent in 86 (60%) and fair/poor in 26 (18%) cases. The presence of pain, absence of limb weakness and CR were significantly associated with good outcomes. Furthermore, subtotal resection (STR) had significantly higher recurrence rates than CR. Four deaths (2.7%) were noted. CONCLUSIONS Total surgical resection is the standard treatment and appears to be beneficial both in terms of outcomes and recurrences. Overall, recurrences are rare and may be managed by re-surgery. In addition, the present report is the eighth case of adult spinal teratoma with an acute onset presentation. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - S Divya
- Department of Orthodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
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Samak EM, Abdel Latif AM, Ghany WA, Hewedi IH, Amer A, Moharram H. Spinal intramedullary hamartoma with acute presentation in a 13-month old infant: case report. J Neurosurg Pediatr 2016; 18:177-82. [PMID: 27127875 DOI: 10.3171/2016.2.peds15561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
True hamartomas of the spinal cord are very rare, and although several have been reported in the literature, there are few detailed radiological and pathological descriptions of the condition. There is also considerable overlap with other entities, the most common being spinal cord teratomas. The authors report the case of a 13-month-old child with a supragluteal sacral dimple who presented with acute neurological deterioration. MRI of the spine revealed a big intramedullary lesion with heterogeneous signal intensity. A near-total resection was performed, and histopathological examination demonstrated findings consistent with a spinal cord hamartoma. The authors believe that careful preoperative evaluation and rigorous pathological examination are mandatory to establish diagnosis and direct further management of cases in which such a lesion is suspected.
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Abstract
PURPOSE A personal series of 131 patients with split cord malformation (SCM) operated on is presented. METHODS Age, gender, symptoms and signs, radiological and operative findings, complications, associated anomalies, outcome, and pathological specimens were analyzed. RESULTS There were 88 girls (73 %) and 43 boys (27 %). The female predominance was slightly more remarkable in type I SCMs than in type II SCMs. The presenting symptoms can be summarized as skin lesions, spina bifida aperta, scoliosis or kyphoscoliosis, sphincter disturbance, foot deformities and weakness, and/or atrophy in the lower extremities. The ages of patients with neurological deficits and orthopedic deformities were significantly older than those without deficits (P = 0.030). The duration of symptoms was longer in the patients with neurological deficits and orthopedic deformities than that in those without deficits (P = 0.00095). In six patients, composite SCMs were present. Only one patient with a type II SCM did not have an associated spinal cord lesion. A type I SCM was more frequently encountered in patients with spina bifida (P < 0.0005). Transient postoperative complications were seen in 29 patients (22 %). There was no permanent complication. Retethered cord syndrome developed in five patients with a type I SCM. CONCLUSIONS The risk of neurological and orthopedic deficits increases with the age of the patient. The risk of permanent deficit after surgery is very low. The whole spine must be examined for additional lesions. All patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations, and all associated lesions should also be treated at the same session.
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Affiliation(s)
- Yusuf Erşahin
- Department of Neurosurgery, Faculty of Medicine, Ege University, 1394 Sokak, No. 14 Baysak 2 Is Merkezi, D. 5, Alsancak, Izmir 35220, Turkey.
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Abstract
INTRODUCTION Spinal dysraphisms are a heterogeneous group of congenital malformations involving the bony component of vertebrae or spinal cord or both. Simple forms include the contiguous, solitary malformations such as myelomeningocele and diastematomyelia, and can be either aperta or occulta type. MATERIAL Complex forms include various types of spinal malformations occurring in combination, one type of malformations occurring at multiple levels in noncontiguous manner or spinal dysraphisms with other organ anomalies. Anomalous development in gastrulation, primary neurulation, and secondary neurulation stage in variable proportions give rise to these types of complex malformations. These cases can be diagnosed postnatally in early infancy by the strong clinical suspicion, supplemented by whole spinal axis and cranial magnetic resonance imaging (MRI) screening, to detect any occult spinal dysraphisms like split cord malformations, neurenteric cyst, lipoma, or cranial anomalies like Chiari malformations and hydrocephalus. Computed tomography and MRI are the gold standard to detect bony anomalies and cord malformations, respectively. Complex spinal dysraphisms, to our mind, should always be tried to be corrected in single operative stage, however, in case of ruptured defects, correction through multiple operations can be considered. DISCUSSION Overall, prognosis of complex forms of spinal dysraphism is poor in comparison to their simple forms and depends on preoperative neurological status and the nature of complex dyraphism. We discuss the classification, embryogenesis, investigation, and treatment protocol with review of literature of such complex anomalies.
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Affiliation(s)
- Ashis Patnaik
- Department of Trauma & Emergency, All India Institute of Medical Sciences, Sijua, Dumuduma, Bhubaneswar, 751019 Odisha, India
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Affiliation(s)
- N Khursheed
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
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