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1.
The present study analyzes the anatomical, pathological, and clinical elements in 62 cases of low potential malignancy of the ovary (25 mucinous, 36 serous, and 1 endometrioid) from the Massachusetts General Hospital record room files from 1962 to 1979. Twenty-two serous tumors were stage I, six were stage II, four were stage III, and four were recurrent. Among mucinous tumors twenty-one were stage I, one was stage III, one was stage IV, and two were recurrent. Four patients had ascites; one patient's tumor was ruptured at surgery. The majority of cases were in stage I. The average age was 54.5 years. Thirty-seven percent of the cases were nulligravida. An abdominal mass was the most frequent finding and increased abdominal girth was the most frequent symptom. All of the patients were treated by excision of the tumor with or without hysterectomy. Chemotherapy followed surgery in 16 patients and radiation was used in 10 cases following surgery. Only 1 patient with early disease died of tumor. Five-year survival was 91.4% among serous and 80.7% among mucinous. Ten-year survival was 83.2% for serous and 73.4% mucinous.  相似文献   

2.
年轻妇女子宫颈癌174例临床及预后分析   总被引:42,自引:0,他引:42  
目的 分析 35岁以下年轻妇女子宫颈癌 (以下简称年轻宫颈癌 )的发病趋势、病因、临床表现、卵巢是否保留以及预后。方法 对 174例年轻宫颈癌患者的临床资料进行回顾性分析。结果  1991~ 2 0 0 1年我院年轻宫颈癌患者所占比例 (构成比 ,即年轻宫颈癌例数与同期宫颈癌总数之比 )分别为 1 2 %、1 2 %、4 3%、4 2 %、4 6 %、4 5 %、7 3%、9 0 %、10 7%、9 4 %、10 8% ,各构成比总体比较 ,差异有极显著性 (P <0 0 1)。临床症状以接触性阴道出血为主 ,为 10 1例 (5 8 0 % ) ;4 5例患者(2 5 9% )曾被误诊为宫颈炎 ;5 1例患者 (2 9 3% )有性生活紊乱史。 174例患者中 ,原位癌 2 2例 ,临床分期Ⅰa期 3例 ,Ⅰb期 37例 ,Ⅱa期 6 0例 ,Ⅱb期 34例 ,Ⅲb期 18例 ;宫颈鳞癌 14 3例 ,腺癌 2 7例 ,腺鳞癌 4例。手术患者中 ,2 9例淋巴管有累及 (2 9/ 119,2 4 4 % ) ,宫颈肌层浸润深度≥ 1/ 2者为 6 0例 (6 0 /12 2 ,4 9 2 % ) ,人乳头状瘤病毒 (HPV) 16和HPV18感染率为 34% (19/ 5 6 ) ,卵巢转移率为 0 8% (1/ 12 7)。Ⅰ、Ⅱ、Ⅲ期患者 5年生存率分别为 71 6 %、6 0 4 %、13 3% ,分别比较 ,差异均有极显著性 (P <0 0 1)。多因素分析表明 ,临床分期、淋巴管是否累及和宫颈肌层浸润深度是影响预后的独立因素  相似文献   

3.
OBJECTIVE: To determine significant prognostic factors in patients with mixed mesodermal tumors of the ovary. METHODS: Thirty-one cases of mixed mesodermal tumor of the ovary treated at Memorial Sloan-Kettering Cancer Center between 1977-1990 were reviewed retrospectively. The mean patient age was 61 years. Distribution by stage was as follows: I, seven (23%); II, one (3%); III, 15 (48%); and IV, eight (26%). The median follow-up for survivors was 62 months. Following primary surgery, chemotherapy included cisplatin (four), doxorubicin (seven), or both (ten); six patients received various other treatments. RESULTS: The median survival for the entire group was 10.6 months. In 19 cases (61%), heterologous sarcomatous elements were present in the primary tumor, whereas 12 (39%) contained homologous elements only. There was a trend toward improved survival in patients whose primary tumors had only homologous stromal elements (P = .06). The overall survival was significantly better for the eight patients with early-stage (I, II) disease than for the 23 patients with advanced-stage (III, IV) disease (P = .01). The size of residual disease after cytoreductive surgery was not a significant prognostic factor. There was no difference in survival between the ten women whose metastatic disease contained only epithelial elements and the 16 whose metastases contained mesenchymal elements as well (P = .23). CONCLUSIONS: This study confirms previous observations that mixed mesodermal tumors of the ovary are a highly malignant group of tumors that respond poorly to chemotherapy. In addition, we demonstrated that prognosis is independent of the presence or absence of sarcomatous elements in the metastases.  相似文献   

4.
卵巢子宫内膜异位症恶性变25例临床分析   总被引:13,自引:1,他引:12  
Qian J  Shi Y  Chen X 《中华妇产科杂志》2000,35(11):667-669
目的 探讨卵巢子宫内膜异位症恶性变的临床表现、病理特征、治疗方法和预后。方法 回顾性分析25例卵巢子宫内膜异位症恶性变患者和病量资料。结果 卵巢子宫内膜异位症恶性变患者的主要症状为盆腔包块、腹胀、腹痛、异常阴道流血和流液。病理类型为子宫内膜样癌14例,透明细胞癌2例,腺棘癌2例,浆液性腺癌1例,混合性卵巢上皮性癌6例,镜下均可见良性的异位子宫内膜向恶性移行的证据。临床分期为Ⅰ14例,Ⅱ期7例,Ⅲ期3例,Ⅳ期1例。治疗方法均采用肿瘤细胞减灭术+化学治疗。患者5年生存率达77.7%。结论 卵巢子宫内膜异位症恶性变的确切发生率难以估计,该病的治疗以肿瘤细胞减灭术+化学治疗为主。  相似文献   

5.
H F Huang 《中华妇产科杂志》1990,25(3):152-5, 188
Preservation of fertility was practiced in 28 young patients with malignant germ cell tumors from 1962 through 1987. The pathologic diagnosis was immature teratoma in 16, endodermal sinus tumor in 7, dysgerminoma in 2 and germ cell tumor of mixed type in 3. At laparotomy, 16 patients proved to have stage I disease, one stage II, 9 stage III and 2 stage IV disease. The tumor was confined to one ovary in all the 22 cases operated on for the first time and the preserved ovary and uterus were normal in all 6 referred cases for recurrent diseases. Postoperative chemotherapy was given to all patients except two with stage I immature teratoma. A persistent remission was achieved in 22 patients, while 5 patients died and one was out of contact. The duration of survival was more than one year for all patients, more than 3 years in 16 cases (72.7%) and more than 5 years in 13 cases (59.1%). The menstrual periods were normal in all cases except 3, of which 2 were below the age of 12 and one failed to menstruate at the age of 19 with a hypoplastic uterus and underdeveloped secondary sex characteristics. Among 12 married patients, 7 of 10 desirous of childbirth became pregnant during follow-ups. Of these, 6 had normal term-deliveries and one is currently pregnant. The preliminary conclusion is that preservation of fertility for young patients with malignant ovarian germ cell tumor is a safe and practicable procedure in the absence of involvement of the contralateral ovary and uterus.  相似文献   

6.
Prognostic factors of patients with yolk sac tumors of the ovary   总被引:4,自引:0,他引:4  
OBJECTIVE: Our purpose was to evaluate the prognostic factors in yolk sac tumors of the ovary. STUDY DESIGN: We performed a retrospective review of 47 patients with yolk sac tumors of the ovary from 1979 to 1997. RESULTS: Twenty-two patients had pure yolk sac tumors and 25 had germ cell tumors with yolk sac tissue as a component of the disease. The 5-year survival rate in stages I, II, III, and IV was 95%, 75%, 30%, and 25%, respectively. Patients with stage I disease had a more favorable prognosis than those with stage III and IV disease (P <.001). All patients who did not respond to chemotherapy died of this disease within 36 months of the first treatment. Chemotherapy regimens that included cisplatin gave better results than those without cisplatin (P <.05). The difference in prognosis was significant in cases in which the size of residual tumor was <2 cm in diameter (P <.01) and in cases in which ascites was either absent or <100 mL in volume (P <.05). Coexistence of other components of ovarian germ cell tumors in histologic specimens, preoperative serum alpha-fetoprotein level, fertility-sparing surgery, dissection of intrapelvic nodes, and p53 status had no significant correlation with the prognosis in this study. CONCLUSIONS: Staging and tumor-reductive surgery strongly affected the prognosis of this disease. Tumor-reductive surgery is advisable when ascites is minimal. Cisplatin-based chemotherapy after surgery was superior to chemotherapy without cisplatin; however, p53 status seemed to have no impact on chemosensitivity in yolk sac tumors of the ovary.  相似文献   

7.
MATERIAL AND METHODS: Retrospective multi-center analysis of women diagnosed with borderline ovarian tumor and treated between January 1990 and December 1997. A national survey was conducted, in which 457 patients from 27 centers corresponding to ten of Spain's autonomous communities were analyzed. RESULTS: Four hundred fifty-seven women with borderline ovarian tumor were analyzed. The mean age of patients was 45.5+/-16.9 years. Of these, 390 patients (85.3%) were at stage I, 8 (1.8%) were at stage II and 36 (7.9%) at stage III. A bilateral tumor was observed in 63 women (13.8%). The mean tumor size was 14.2 cm and in 88 cases (19.3%) the tumor was on the surface of the ovary. Microinvasion was observed in 25 (5.5%) cases, and 29 women (6.3%) showed a micropapillary pattern. Study of the factors related to the appearance of peritoneal implants revealed positive tumor markers (OR 15.02: 1.9-32.9) and a tumor on the ovarian surface (OR 8.0: 1.8-127) to be independent risk factors. With respect to recurrence, the presence of peritoneal implants at the time of initial surgery (OR 3.4: 1.1-10.4) and signs of microinvasion in the anatomicopathological study (OR 5.5: 1.5-17.8) were found to be independent risk factors. The overall survival rate in our series was 97% with a mean follow-up of 88.3 months. The survival rate by stage was 97% for stage I, 100% for stage II and 97% for stage III. CONCLUSIONS: Although borderline ovarian tumors have an excellent prognosis, they are not exempt from a risk of recurrence. Characterization of patients with borderline ovarian tumor is essential in order to prevent their evolution. Likewise, the taking on board of risk factors will enable more selective treatments to be offered in each case.  相似文献   

8.
Ninety-five cases of mesonephroma of the ovary from the Emil Novak Ovarian Tumor Registry were examined in order to better delineate the clinicopathologic features of this tumor. The majority of patients were in the perimenopausal age group and 51% were nulliparous. Of the 95 patients 68% had tumor confined to the ovary (F.I.G.O. Stage I), in 19% tumor was limited to the pelvis (Stage II), 11.6% had widespread abdominal metastases (Stage III), and only one patient had extra-abdominal extension at the time of initial evaluation (Stage IV). Five-year survival was 43% overall, 63% Stage I, 17% Stage II, and no survivors in Stages III or IV. Salvage in Stage I cases was not affected by histologic grade, stromal proliferation, relative percentage of “clear cells,” or extent of surgery (total hysterectomy with bilateral salpingo-oophorectomy vs unilateral adnexectomy). Endometriosis was demonstrated in only 9.5% of cases and ascites was seen in 8.4%. The authors believe the tumor to be of mesothelial origin and propose that it be called mesonephroid carcinoma of the ovary.  相似文献   

9.
BACKGROUND: Adult granulosa cell tumor of the ovary is an uncommon neoplasm. The overall prognosis is favorable. The prognostic factors that are related to survival have not been well defined and are discussed in the literature amidst controversy. METHODS: Thirty-five patients diagnosed with adult granulosa cell tumor of the ovary were reviewed retrospectively. Demographic data, pathologic findings, treatments, and survival times were reviewed and analyzed for prognostic significance. RESULTS: Of the 35 cases, there were 30 cases representing stage I tumors, one case at stage II, four cases at stage III, and no cases at stage IV. The mean overall survival time of all patients was 140.3 months. The 5- and 10-year survival rates were 92.0% and 85.8% respectively. The FIGO stage was the only independent prognostic factor. CONCLUSIONS: Despite the small number of patients, the study showed that the less advanced stage is the only favorable prognostic factor of significance.  相似文献   

10.
晚期子宫内膜癌预后相关因素分析   总被引:12,自引:1,他引:11  
目的 探讨晚期子宫内膜癌预后相关因素。方法 回顾性分析我院1986年1月~1999年9月间收治的41例晚期子宫内膜癌患者临床病理资料和随访结果。结果(1)41例患者,Ⅲ期30例,其中Ⅲa期15例(36.6%),Ⅲb期3例(7.3%),ⅢC期12例(29.3%),Ⅳ期11例(26.8%)(均为Ⅳb期);子宫内膜样腺癌30例(73.2%),腺鳞癌5例(12.2%),浆乳癌5例(12.2%),透明细胞癌1例(2.4%);单纯手术2例,单纯放疗3例,单纯孕激素治疗1例,综合治疗35例;死亡17例,5年生存率35.4%。(2)Ⅲ期患者中,Ⅲa期复发3例,死亡2例,5年生存率65.6%;Ⅲb期盆腹腔复发1例(死亡),Ⅲc期复发转移8例,均死亡,5年生存率14.5%。(3)Ⅳ期患者中,盆腹腔复发3例,肺转移5例,死亡6例,3年生存率 27.7%。(4)子宫外多处癌灶22例,其中复发转移16例,死亡14例,占全部死亡的82.4%。结论 子宫内膜癌Ⅲc期预后明显差于Ⅲa期,子宫浆膜受侵、子宫外多处癌灶、宫旁组织受侵犯、宫旁淋巴管或血管有癌栓及淋巴结癌转移仍是影响Ⅲ期子宫内膜癌预后的重要因素,Ⅳ期患者易盆腹腔复发和肺转移,预后更差,晚期子宫内膜癌应进行综合治疗。  相似文献   

11.
Seventy consecutive patients with carcinoma of the ovary in which all gross tumor had been surgically removed were treated with total abdominal irradiation plus a pelvic “boost.” The overall survival rate was 62%. The grade of the neoplasm influenced survival more than stage. Irradiation was a significant adjunct to surgery in stage II and III tumors. Therapy was well tolerated with no major complications.  相似文献   

12.
Thirty-six patients with low potential malignancy ovarian tumors were treated at our hospital from 1972 to 1986. Of these, 80.6% were classified as stage I, 5.6% as stage II, and 13.9% as stage III. Sixteen patients were treated by simple total hysterectomy and bilateral salpingo-oophorectomy, 15 patients by unilateral salpingo-oophorectomy, 2 patients by enucleation of the tumor, and 3 patients by exploratory laparotomy. In stage I no difference between the survival rates for the conservative therapy group and the radical therapy group was seen. Postoperative radiation therapy was given to 4 patients with dysgerminoma, and chemotherapy was given to 13 other patients. The five-year survival rate for stage I was 91.7%, better than for stage I malignant ovarian tumors, which was 78.9%. But the five-year survival rate for stage II and stage III was 0%. Analysis indicated that: 1. Prognosis of stage I patients is so good that treatments may be done in consideration of the patient's fertility. 2. The importance of adequate postoperative treatment and of strict follow up to guard against recurrence of malignancy is important in patients with stage II or stage III disease.  相似文献   

13.
FIGO proposed new criteria for corpus cancer staging in 1988. One hundred and seventy-one cases of endometrial cancer were classified by these new staging criteria, and differences between grouping and survival rates for the new and old criteria were compared. 1) The number of cases grouped in old stages I, II, III and IV were 67, 86, 8 and 10, whereas those for new criteria 94, 25, 35 and 10, respectively. In 7 cases new staging was not possible because of preoperative radiation therapy and inoperability. 2) Cases of old stage I were reclassified as new stage I 54(80.5%), stage II 2(3.0%) and stage III 8(12.0%), and 3 cases were not classified. Those of old stage II were 39(45.2%), 21(24.55%), 25(29.1%) and 1(1.2%) and old stage III were 1(12.5%), 2(25.0%), 2(25.0%) and 3(37.5%), respectively. 3) Survival rates for the cases with both stage I and II cancer were very good without any apparent difference between them. Those for new stage III were very poor in comparison with old stage III. 4) In cases of stage I according to the new criteria, the depth of myometrial invasion correlated well with the survival rate. The prognosis of G3 cases with myometrial invasion over 1/2 was the poorest. 5) Survival rates among subclassifications of stages II and III were not significantly different from each other.  相似文献   

14.
Forty-one patients with endodermal sinus tumors of the ovary (EST) (23: pure EST, nine: EST with dysgerminoma; and nine: EST with immature teratoma) were treated with cytoreductive surgery, with or without subsequent adjuvant chemotherapy including VAC or PVB. Clinical staging of these patients showed 23 in stage I, six in stage II and 12 in stage III and IV. The outcome was good in the patients with stage I or II disease, with 5- and 10-year survival rates of around 80%. In contrast, all except two patients with stage III or IV disease died within 2 years. Aggressive surgery did not change the outcome of patients with stage I disease. In addition, postoperative chemotherapy was necessary, but the choice of vincristine, actinomycin-D and cyclophosphamide (VAC) or cis-platin, vinblastine and bleomycin (PVB) did not make any difference. Based on the results of the present study, VAC or PVB chemotherapy, after cytoreductive surgery, is essential for cure and conservative surgery followed by VAC or PVB regimen should be recommended for young patients.  相似文献   

15.
59 (80%) of 74 patients with vulvar cancer treated at the University Department of Obstetrics and Gynecology in Ljubljana in the period 1973-85 underwent radical vulvectomy with bilateral inguinofemoral lymphadenectomy, and 15 (20%) patients single vulvectomy because of advanced age and poor general condition. Histologically there were 69 cases of squamous cell carcinoma, 1 adenocarcinoma, 3 malignant melanoma and 1 rhabdomyosarcoma. 52% of the patients were classified as Stage I, 41% Stage II and 7% Stage III. Positive inguinofemoral nodes were observed in 24% (6.5% in Stage I, 35% in Stage II and 80% in Stage III). The total 5 year survival rate was 70% (83% in Stage I, 61% in Stage II and 20% in Stage III). The 5 year survival rate in the patients with negative nodes was 80%, and in cases with positive nodes only 50% in spite of postoperative irradiation. None of the 3 patients with melanoma survived 2 years nor did the patient with rhabdomyosarcoma. There was no case of primary mortality. Nowadays the cure rate for vulvar cancer is higher especially owing to the improvement of operability. The problem of lymphatic and distant metastases still remains unresolved.  相似文献   

16.
One hundred seventy-two cases of patients with squamous cell cancer of the vulva treated at the University of Michigan Medical Center from 1975 to 1988 are reported. The mean age was 66 years with a range of 21 to 101 years. The distribution by stage included Stage I, 65; Stage II, 44; Stage III, 50; and Stage IV, 13 patients. Groin node dissections performed on 145 patients showed negative nodes, 58%; unilateral positive nodes, 28%; and bilateral positive nodes, 14%. The distribution of patients with positive nodes was influenced by stage: Stage I, 14%; Stage II, 23%; Stage III, 72%; Stage IV, 92%. The overall cumulative 5-year survival was 71% and this was significantly influenced by stage of disease: Stage I, 94%; Stage II, 91%; Stage III, 36%; Stage IV, 26%. Stages I/II and III/IV were combined for analysis. In Stages I/II, survival was significantly influenced by tumor grade while size, patient age, and lymph node status did not influence survival. In Stage III/IV, survival was significantly influenced by tumor size, node status, and number of positive nodes while grade, patient age, and tumor location did not influence survival. Squamous cell cancer of the vulva is effectively treated with radical surgery but advanced-stage disease with regional metastases significantly alters survival.  相似文献   

17.
Twenty-five cases of pure ovarian dysgerminoma treated at UCLA Medical Center between 1958 and 1992 were reviewed retrospectively. Patterns of recurrence and overall survival were analyzed with regard to primary surgery (conservative versus nonconservative), use of adjuvant therapy, and stage of disease. Fourteen patients (56%) underwent conservative surgical therapy defined as preservation of the contralateral ovary, 10 patients (40%) had nonconservative primary surgery, and one patient (4%) had chemotherapy as primary treatment. Three patients (12%) received adjuvant chemotherapy and nine patients (36%) received postoperative radiation therapy. Fifteen patients (60%) had stage I disease, four (16%) stage II, and three each (12%) had stage III and IV disease. Nine patients (36%) experienced recurrence of disease. Seven of these nine patients (78%) had stage I disease and all seven had undergone conservative primary surgery with preservation of the contralateral ovary. Six of the seven had received no adjuvant therapy. Only one of these seven patients experienced recurrence in the preserved ovary. She was found to have a dysgenetic ovary and an XY karyotype. Three patients with recurrent disease had received radiation therapy after primary surgery. Twenty patients (80%) were alive without disease at follow-up, two patients (8%) were alive with disease, and three (12%) had died of disease. There was no statistically significant difference in recurrence rates between those patients treated with conservative surgery and those treated with nonconservative surgery, although the total number of patients with recurrences was greater in the former group. Our data suggest that a conservative surgical approach is the preferred treatment in patients with pure dysgerminoma of the ovary who desire future fertility. Lack of adjuvant chemotherapy or radiation therapy, rather than type of initial surgery, may be associated with a higher risk of recurrence.  相似文献   

18.
AIM: The aim of this study was to investigate whether fertility preservation influences the clinical outcome in patients with malignant germ cell tumors of the ovary (MGCTO). METHODS: A case study analysis was performed on patients with MGCTO treated at Kurume University Hospital between 1986 and 2004. Thirty-five patients were included in the study, 14 with immature teratoma, 11 with dysgerminoma, eight with endodermal sinus tumor, and two with mixed germ cell tumor. Twenty-three patients had International Federation of Gynecology and Obstetrics stage I (Ia, 11; Ib, 2; Ic, 10), one had stage II, seven had stage III, and four had stage IV disease. RESULTS: Five patients with stage III or IV disease received radical surgery. Thirty patients underwent conservative surgery. As the adjuvant treatment, 30 patients received chemotherapy, while five patients did not receive any chemotherapy. The overall survival rate was 97.1%. One patient died of the disease. She was 13 years old with a stage IV endodermal sinus tumor. Twelve have attempted conception, and eight have achieved at least one pregnancy (66.7%). CONCLUSIONS: Irrespective of the stage of the disease, conservative surgery and adjuvant chemotherapy for MGCTO can achieve a favorable outcome in terms of survival and fertility.  相似文献   

19.
Sixty-eight patients with epithelial ovarian tumors of low malignant potential treated at the University of Michigan Medical Center were reviewed for clinical and pathologic features related to recurrence or death. The ovarian tumor of low malignant potential represented 12.6% of all ovarian cancers and 22% of all serous or mucinous tumors. Thirty-four patients were stage I (50%), 13 were stage II (19%), 17 were stage III (25%), two patients could not be staged, and two patients developed ovarian tumor of low malignant potential in a residual ovary. The risk of recurrence was significantly related to stage III disease (P = .023), high nuclear atypia (P = .020), and high grade (P = .017); and was unrelated to capsular status, the presence of psammoma bodies, nucleoli, cribriform pattern, stratification, cystadenofibroma, tumor size, or spillage at surgery. Therapy in all stages included observation, chemotherapy, or radiotherapy. There was one recurrence in 47 patients with stages I-II, and 11 recurrences in 17 patients with stage III disease. The ovarian tumor of low malignant potential carries an extremely favorable prognosis in stage I and II regardless of therapy. Radiotherapy appeared to extend disease-free survival in stage III disease, and future randomized studies should consider this treatment modality.  相似文献   

20.
卵巢透明细胞癌的临床特点   总被引:9,自引:0,他引:9  
目的 探讨卵巢透明细胞癌的临床特点。方法 将北京协和医科妇产科自1984年至2000年收治的43例卵巢透明细胞癌患者进行回顾性分析,并将卵巢透明细胞癌对化学药物治疗(化疗)的敏感性和生存率,与51例卵巢浆液性乳头状囊腺癌患者进行比较。结果 卵巢透明细胞癌早期患者所占比例为14.4%,浆液性乳头状囊腺癌为3.8%,两者比较,差异有极显著性(P<0.005)。行满意肿瘤细胞减灭术的晚期透明细胞癌化疗耐药型患者为88.9%,明显多于浆液性乳头状囊腺癌患者的57.1%;1年生存率(79.0%)明显低于浆液性乳头状囊腺癌患者(96.2%,P<0.01);行不满意肿瘤细胞减灭术的晚期透明细胞癌患者化疗耐药型的比例(83.3%)和生存率(71.4%)与浆液性乳头状囊腺癌患者(94.1%和85.1%)比较,差异均无显著性(P>0.05)。结论 卵巢透明细胞癌早期患者较多,易复发,预后差,应于术后进行以顺铂为主的化疗,并严密随诊。  相似文献   

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