Malignant lung carcnimoma
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Risk Factors/Epidemiology
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Pleuripotent cell
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Topography
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Histology
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Gross
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Immunohistochemistry
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Imaging
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Mets
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Squamous cell carcinoma
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Papillary
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- Cigarette smokers
- Arsenic
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- Centrally in the mainstem
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- Exophytic
- Intra-epithelial
- Without invasion
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- White or grey and, depending on the severity of fibrosis
- Firm with focal carbon pigment deposits in the centre and star-like retractions on the periphery.
- Cavitations.
- Intraluminal polypoid masses and / or infiltrate through the bronchial wall into the surrounding tissues
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- High molecular weight keratin (34ßE12
- Cytokeratins (5/6)
- Carcinoembryonic antigen (CEA)
- Low molecular weight keratin (35ßH11)
- Thyroid transcription factor-1 (TTF-1)
- Cytokeratin 7 (CK7)
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- lobar or entire lung collapse
- In central SCC,
- Shift of the mediastinum to the ipsilateral side.
- Extension into regional lymph nodes
- Hilar, perihilar or mediastinal masses
- Peripheral tumours
- Presents as solitary pulmonary nodules (< 3 cm) or masses (> 3 cm).
- Cavitations
- Hilar opacities, atelectasis or peripheral masses
- Mediastinal enlargement
- Hemidiaphragmatic elevation
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Clear cell
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- Cells with clear cytoplasm
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Small cell
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- Poorly differentiated cells
- Focal squamous
- No characteristic nuclear features of SCC.
- Intercellular bridges or keratinization.
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Basaloid
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- Peripheral palisading of nuclei.
- Poor differentiation
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Small cell carcinoma
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Combined small cell carcinoma
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- Sheet-like growth
- Nesting,
- Trabeculae
- Peripheral palisading
- Rosette formation
- Tumor cells are usually less than the size of lymphocytes.
- Nuclear chromatin is finely granular
- Nucleoli are absent or inconspicuous.
- Cell borders are rarely seen and nuclear moulding is common.
- High mitotic rate
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- White-tan, soft, friable perihilar masses.
- Extensive necrosis.
- 5% peripheral coin lesions
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- CD56
- Chromogranin
- Synaptophysin
- TTF-1
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- Hilar or perihilar masses
- Mediastinal lymphadenopathy
- Lobar collapse
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- Bone marrow
- Liver metastases
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Adeno carcinoma
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Adenocarcinoma, mixed sub type
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- Single or multiple lesions
- Different in size
- Peripheral distribution.
- Gray-white central fibrosis
- Pleural puckering
- Anthracotic pigmentation.
- Necrosis,
- Cavitation
- Hemorrhage.
- Lobulated or ill defined edges.
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- Epithelial markers (AE1/AE3, CAM 5.2)
- Carcinoembryonic antigen
- CK7
- TTF-1
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- Peripheral nodules under 4.0 cm in size
- Central location as a hilar or perihilar mass
- Rarely show cavitations.
- Hilar adenopathy
- Adenocarcinomas account for the majority of small peripheral cancers identified radiologically.
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- Brain
- Bone
- Adrenal glands
- Liver
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Acinar adenocarcinoma
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Papillary adenocarcinoma
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- Characterized by
- Papillae (secondary and tertiary papillary structures)
- Necrosis
- Surrounding invasion
- Cuboidal to columnar epithemlial linning
- Mucinous or non-mucinous
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Bronchio-alveolar carcinoma
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Non-mucinous
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Consists of
- Clara cells
- Columnar cells with cytoplasmic snouts and pale eosinophilic cytoplasm.
- Nuclei may be apical in location.
- Type II cells
- Cuboidal or dome-shaped cells
- Fine cytoplasmic vacuoles or clear to foamy cytoplasm.
- Intranuclear eosinophilic inclusions
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Mucinous
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- Low grade differentiation
- Composed of
- Tall columnar cells
- Basal nuclei
- Pale cytoplasm resembling goblet cells
- Varying amounts of cytoplasmic mucin
- Cytologic atypia
- Aerogenous spread is characteristic
- Extensive consolidation
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Mixed non-mucinous and mucinous or indeterminate
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Solid adenocarcinoma with mucin production
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Fetal adenocarcinoma
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- Consists glandular elements
- Tubules of glycogen-rich
- Non-ciliated cells
- Subnuclear and supranuclear glycogen vacuoles
- Rounded morules of polygonal cells with abundant eosinophilic and finely granular cytoplasm.
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Mucinous (“colloid”) carcinoma
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- Dissecting pools of mucin containing neoplastic cells.
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Mucinous cystadenocarcinoma
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- Circumscribed tumor with
- Partial fibrous tissue capsule.
- Central cystic change with mucin pooling
- Neoplastic mucinous epithelium grows along alveolar walls.
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Signet ring adenocarcinoma
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Clear cell adenocarcinoma
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Large cell carcinoma
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Giant-cell carcinoma of the lung
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Basaloid large cell carcinoma of the lung
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Clear cell carcinoma of the lung
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Lymphoepithelioma-like carcinoma of the lung
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Large-cell lung carcinoma with rhabdoid phenotype
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Large cell neuroendocrine carcinoma of the lung
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Sarcomatoid carcinoma
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Pleomorphic carcinoma
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Carcinosarcoma
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Spindle cell carcinoma
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Giant cell carcinoma
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Pulmonary blastoma
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Carcinoid tumour
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Typical carcinoid
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Atypical carcinoid
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Salivary gland tumours
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Mucoepidermoid carcinoma
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Adenoid cystic carcinoma
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Epithelial-myoepithelial carcinoma
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Preinvasive lesions
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Squamous carcinoma in situ
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- Basal cells of squamous epithelium
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- Angiogenic squamous dysplasia
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- EGFR
- HER2/neu
- p53
- MCM2
- Ki-67
- Cytokeratin 5/6
- bcl-2
- VEGF
- Folate binding protein
- p16
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Atypical adenomatous hyperplasia
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- Surfactant apoprotein
- Clara cell specific 10kDd protein
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- Intranuclear inclusions
- Clara cells and type II pneumocytes.
- Thickened alveolar walls
- Discontinuous lining of cells
- Moderate atypia.
- Pseudopapillae
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- Multiple grey to yellow foci
- 1mm to 10mm in size.
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- CEA
- MMPs
- E-cadherin,
- ß-catenin,
- CD44v6
- TTF-1
- TP53
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- Typically not visualized on radiographs.
- Small non-solid nodules
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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
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- Most commonly seen in fifth or sixth decades
- Mostly seen in women
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- Pulmonary neuroendocrine cells
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- Nodular aggregates
- Fibrosis due to proliferation
- Invade locally
- Fibrous stroma aggregates to form ‘tumorlets’.
- Carcinoids are tumorlets >5cm.
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- Early lesions
- Small, gray-white nodules
- Resembling ‘miliary bodies’
- Larger carcinoid tumours are
- Firm
- Homogeneous
- Well-defined
- Grey or yellow-white masses.
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- Mosaic pattern of air trapping
- Sometimes with nodules
- Thickened bronchial and bronchiolar walls
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Mesenchymal tumors
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Epithelioid haemangioendothelioma / Angiosarcoma
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- Round to oval-shaped nodules
- Central sclerosis
- Hypocellular zone
- Peripheral cellular zone
- Calcifications
- Intranuclear cytoplasmic inclusions
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- 0.3-2.0 cm circumscribed mass
- Gray-white or gray-tan firm tissue
- Yellow flecks
- Central calcifications
- Cut surface has a cartilaginous consistency.
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- CD31
- CD34
- factor VIII (von Willebrand factor)
- Fli1
- FKBP12
- Cytokeratin
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- Multiple
- Bilateral
- Small nodules
- 1-2 cm in size.
- Can mimic pulmonary Langerhans’ cell histiocytosis.
- Calcifications
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Pleuropulmonary blastoma
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- Most common in children
- Median age of diagnosis is 2 years.
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- Thoracic splanchnopleural mesenchyme.
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- Type I
- Purely cystic
- Lined by respiratory type epithelium
- Underneath malignant cells
- Type II
- Partial or complete overgrowth of the septal stroma
- Type III
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- Purely cystic
- Thin-walled
- Rarely solid
- Firm to gelatinous
- Upto 15 cm
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- Unilateral
- Localized airfilled cysts
- Septal thickening or an intracystic mass
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- Brain
- Spinal cord
- Skeletal system
- Eyes
- Pancreas
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Chondroma
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- Chondrocytes,
- Cartilaginous cells
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- Peripheral lesions in lung
- 1o seen in
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- Capsulated lobules
- Hypocellular
- Features of malignancy are absent
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- Peripheral
- Solid lesions
- Calcified
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- Multiple
- Well circumscribed lesions
- “Pop-corn” calcifications
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Congenital peribronchial myofibroblastic tumor
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- Rare
- Sporadic
- Complicated by
- Polydramnios
- Non-immune hydrops fetalis
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- Fascicles of spindle cells.
- Bronchial invasion
- Peribronchial distribution
- Cystic foci of haemorrhage
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- 5-10 cm
- Well-circumscribed
- Non-encapsulated
- Smooth or multinodular surface
- The cut surface has a tann-grey to yellow-tan fleshy appearance.
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- Well circumscribed
- Opacifying the hemithorax
- Heterogeneous mass
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Diffuse pulmonary lymphangiomatosis
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- Children
- Young adults of both sexes
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- Smooth muscles cells of lymphatic vessels.
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- Along the lymphatic distribution.
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- Anastomosing endothelial-lined cells along lymphatic routes.
- Spindle cells
- Intra alveolar siderophages
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- Prominence of the bronchovascular bundles along
- Pleura
- Interlobular pulmonary septa
- Mediastinum
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- Increased interstitial markings
- Thickening of the
- Interlobular septa
- Fissures
- Central airways
- Pleura
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Inflammatory myofibroblastic tumor
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- Previous viral infections
- HHV8
- Children
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- Mixture of spindle cells
- Fibroblastic
- Myofibroblastic
- Arranged in fascicles
- Cytologic atypia
- Touton type giant cells.
- Plasma cells
- Lymphoid follicles
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- Yellowish-gray discoloration
- Average size of 3.0 cm
- Non encapculated
- Calcifications
- No local invasion
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- Solitary mass
- Regular borders
- Spiculated appearance
- Accompanied by
- Post-obstructive pneumonia
- Atelectasis
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Pulmonary artery sarcoma
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- Mean age of diagnosis is 49.3 years
- Commonly misdiagnosed as PE
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- Mesenchymal cells of the intima
- Primitive cells of the bulbus cordi in the trunk of pulmonary artery.
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- Pulmonary trunk most commonly
- Right pulmonary artery
- Left pulmonary artery
- Pulmonary valve,
- Right ventricular outflow tract
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- Spindle cells in
- A myxoid background
- Collagenized stroma
- Recanalized thrombi
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- Mucoid or gelatinous clots filling vascular lumens
- The cut surface may show
- Firm fibrotic areas
- Bony/gritty or chondromyxoid foci
- Haemorrhage and necrosis are common in high-grade tumors
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- Vimentin
- Osteopontin
- Factor VIII
- CD31
- CD34
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- Findings overlap with those of chronic thromboembolic disease
- Decreased vascularity
- Heterogeneous soft tissue density
- Smooth vascular tapering
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Pulmonary vein sarcoma
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- Most common in women.
- Mean age of diagnosis is 49.
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- Smooth muscle differentiation
- Moderate to highly cellular spindle cell neoplasms
- Epithelioid morphology
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- Fleshy-tan tumor
- Can occlude the lumen of the involved vessel.
- 3.0- 20.0 cm
- Invasion of wall of the vein.
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- Vimentin
- Desmin and actin
- Keratin
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