Facial nerve injury. Epub 2010 Oct 1. Bilateral parotid tumors are most common in Warthin tumors and HIV related lymphoepithelial cysts. If the history and physical are suggestive of a tumor, these patients should be referred to the otolaryngologist for workup. 2003;113(6):1070-1075. Cantisani V, David E, Sidhu PS, Sacconi B, Greco A, Pandolfi F, Tombolini M, Lo Mele L, Calliada F, Brunese L, Catalano C, De Vincentiis M, Di Leo N, Ascenti G, D'Ambrosio F. Ultraschall Med. These patients should be followed by the oncology nurse and/or the primary care clinician for several years as there is a small risk of recurrence. (2017) PLOS ONE. This content does not have an English version. Oncologic pharmacists are involved in the formulation, dosing, and patient education. These can be separated by a standard surgical sieve approach into infective, inflammatory, immune, neoplastic, infiltrative, and congenital causes. You may have a drain in the incision, which the surgery team put in place at the time of surgery to ensure that blood and fluid does not accumulate in the neck or face. The differential diagnosis includes mucous retention cyst, unilateral blockage of the parotid duct, benign mesenchymal tumors like lipoma, fibroma, hemangioma or neurofibroma, branchial cleft cyst, benign salivary gland tumors like pleomorphic adenoma, Warthin's tumor and malignant salivary gland tumor like muco-epidermoid tumor [3, 6]. Unable to load your collection due to an error, Unable to load your delegates due to an error, Squamous carcinoma of the left parotid gland. The commonest benign tumor (pleomorphic adenoma) has a malignant transformation potential, and, although considered benign, there is a propensity for recurrence after treatment. ISBN: 9780702029714 -, elevators, retractors and evertors of the upper lip, depressors, retractors and evertors of the lower lip, embryological development of the head and neck. Methods: A total of 208 patients with parotid gland tumors and presurgical MRI were included. Bookshelf Results of. 2004;13:716. These grow slowly and usually do not spread to local nodes. Most parotid tumors aren't cancerous. Warthin tumor is the 2nd most common benign lesion. Front Oncol. It is located in the parotid space. In this situation, experts in facial plastic and reconstructive surgery will perform anerve transfer or other facial reanimation procedure. The parotid gland is the largest of the salivary glands and secretes saliva via the parotid ductinto the oral cavity to facilitate mastication and swallowing. Methods: A total of 124 patients with parotid gland lesions for whom surgery was planned were examined using conventional ultrasound, Doppler examination, and shear wave elastography. World Journal of Otorhinolaryngology Head and Neck Surgery. . Tumors low in the tail of the parotid gland can easily be confused with an upper cervical lymph node. Epub 2018 Feb 12. Forpatients who work in certain industries linked with an increased risk of salivary gland cancer, taking precautions to protect themselves might help lower therisk of cancer. Epub 2017 Jun 13. 12. 11. Sood S, McGurk M, Vaz F. Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines. Typical findings of pleomorphic adenoma included hyperintensity on T2w images (p = 0.02), strong contrast enhancement (p < 0.001) and lobulated shape (p = 0.04). Parotid neoplasms: analysis of 600 patients attended at a single institution. Part A: from aetiopathogenesis to diagnosis. differential diagnosis of Warthin tumor from mucoepidermoid car- . Keywords: Moore EJ (expert opinion). Acta Otorhinolaryngol Ital. How likely is it that the facial nerve will be hurt? All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. 3. MECAs account for less than 2% of all salivary gland cancers and 0.1-0.45% of all salivary gland tumors [10,11,12,13 . The differential diagnosis for this appearance includes chronic bacterial or granulomatous infections and multiple parotid cysts associated with human immunodeficiency virus (HIV) infection. The usual presentation is a slow-growing painless mass. 2009;75:497501. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). The facial nerveand its branches pass through the parotid gland, as does the external carotid artery and retromandibular vein. Parotid gland enlargement in children is most commonly secondary to infectious and inflammatory lesions.1 Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children and accounts for 25% of all childhood cancers.2 Leukaemia typically presents with non-specific symptoms and signs such as anorexia, fatigue and irritability. There is one on each side of the face. Recurrence will occur if there has been incomplete excision and may occur if there has been tumor spillage. . Clipboard, Search History, and several other advanced features are temporarily unavailable. Parotid gland tumors account for approximately 2% to 10% of head and neck tumors. MATERIALS AND METHODS. The lesions have a smooth texture and are surrounded by a capsule. Unusual parotid gland lesions: a pictorial review. Salivary gland tumorsare variable in location, origin, and malignant potential. . Patient safety and quality improvements in parotid surgery. It is an Open Access platform to support scientific innovation and advancement in the research community by increasing access to peer-reviewed quality research articles. Adjuvant radiotherapy is recommended for large tumors (greater than 4 cm), patients with incomplete or close margins, recurrent disease, perineural and vascular invasion, nodal disease, in metastatic disease, and is usually indicated for adenoid cystic carcinomas and high-grade tumors. Current update on established and novel biomarkers in salivary gland carcinoma pathology and the molecular pathways involved. (2009) Acta Radiologica. See this image and copyright information in PMC. Anteriorly, there is often an accessory parotid gland, which may be separate from the main gland. Unusual presentation of parotid gland adenoid cystic carcinoma : A case presentation and literature review. ( a ) Coronal T2w image,, Atypical pleomorphic adenoma of the right parotid gland. Thisis overall (for all glands) the most frequent malignant salivary gland tumor and may arise from any salivary tissue, but is more common in the minor (rather than in major) salivary glands. In experienced hands, this can distinguish malignant from benign disease in 80% to 90% of cases. First, you will undergo imaging studies, or scans. Figure 3: submandibular gland pleomorphic adenoma, Case 4: oncocytoma of submandibular gland, Case 7: submandibular gland pleomorphic adenoma, Case 8: lymphoepithelial carcinoma - submandibular gland, squamous cell carcinoma of salivary glands, malignant mixed tumors of the salivary glands, staging of malignant salivary gland tumors, metastases (mostly to intraparotid lymph nodes), primary:arising from the parotid gland as a, secondary: involving the intraparotid lymph nodes. The oral examination should be with an inspection of the relevant salivary gland duct. Reference article, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-2015, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2015,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/salivary-gland-tumours/questions/1919?lang=us"}. Elsevier Australia. National Comprehensive Cancer Network. Most superficial lesions can be removed with simple enucleation. They can be confused with Warthin tumor on cytology, and larger tissue samples are usually requested, and immunohistochemistry is required. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). 1995 Jun;105(6):579-84. doi: 10.1288/00005537-199506000-00004. 6. contribution of apparent diffusion coefficient histogram analysis findings in differential diagnosis of parotid gland masses. ( Multiparametric magnetic resonance imaging of parotid tumors: A systematic review. Unable to process the form. 2013 Oct;41(8):501-8. doi: 10.1002/jcu.22054. Patients with stage III and IV diseases have a poorer prognosis with low survival rates (as low as 15% to 50%) at 10 years. A biopsy is a procedure to collect a sample of tissue for testing. Mcminn. Cancer or Tuberculosis: A Comprehensive Review of the Clinical and Imaging Features in Diagnosis of the Confusing Mass. 8600 Rockville Pike An Overview on the Histogenesis and Morphogenesis of Salivary Gland Neoplasms and Evolving Diagnostic Approaches. government site. 2016: 2672496. The Role of Radiomics in Salivary Gland Imaging: A Systematic Review and Radiomics Quality Assessment. Accessibility Bookshelf This study is based on retrospective evaluation of pre-surgical MRI of 94 patients with parotid gland tumours. Partial parotidectomy or hemi-superficial parotidectomy has become commonplace. Local recurrences are common, and distant metastases occur in 30% to 40% patients, usually in the lungs, many years later. FOIA Federal government websites often end in .gov or .mil. A comprehensive history and physical examination, in conjunction with judicious use of radiographic imaging (MRI, compute Evaluation of Parotid Lesions 5. Treatment usually involves surgery to remove the tumor completely. Informed consent was obtained from all individual participants included in the study. Contributed by Dr. Amir Nadeem Chaudhary Radiology Department Jinnah Hospital Lahore, Submandibular mass. The facial nerve should, if at all feasible, not be sacrificed; rarely, radical surgery is needed with resection of the facial nerve. Clipboard, Search History, and several other advanced features are temporarily unavailable. Salivary gland tumor: a review of 599 cases in a brazilian population. The submandibular duct (Wharton duct) orifice is found on the floor of the mouth, and the parotid (Stenson duct) is situated opposite the uppersecond molar. The diagnosis is based on clinical confirmation of dry eyes and mouth and biopsy of the labial minor salivary glands, supported by detection of autoantibodies such as anti-Ro (anti-SS-A) and anti-La (anti-SS-B). The differential diagnosis mainly relies on methemoglobin determination, B-type ultrasound and hepatic angiography. eCollection 2022 Feb. Vernuccio F, Arnone F, Cannella R, Verro B, Comelli A, Agnello F, Stefano A, Gargano R, Rodolico V, Salvaggio G, Lagalla R, Midiri M, Lo Casto A. Br J Radiol. Parotid Gland Lesions: Multiparametric Ultrasound and MRI Features. Unable to load your collection due to an error, Unable to load your delegates due to an error. Parotid gland lesions in children can be divided into benign or malignant. This is the third most common cancer of the parotid gland. Management of a recurrent tumor is difficult. The predictive values were: PPV 66.8% and NPV 93.6%. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437. Cummings Otolaryngology: Head & Neck Surgery. The distinction between tumor types can be difficult, particularly based on material from fine-needle aspiration (FNA). Examples of criteria for the description of the echogenicity (slightly hypoechoic, highly hypoechoic), US of malignant parotid glands tumors: SCCpoor defined margins, highly hypoechogenic, slightly heterogenic,, US of: PA with irregular shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and, US of different pleomorphic adenomas: a1 , a2 polycyclic shape, highly hypoechogenic, highly, Receiver operating characteristic curves for, Receiver operating characteristic curves for malignant and benign parotid tumors, Receiver operating characteristic curves for pleomorphic adenomas/adenolymphomas of parotid gland, MeSH McGuirt WF, Keyes JW Jr, Greven KM, Williams DW 3rd, Watson NE Jr, Cappellari JO. Kato H, Kanematsu M, Watanabe H, Kajita K, Mizuta K, Aoki M, Okuaki T. Eur Radiol. Sometimes the facial nerve gets stretched during surgery. The WHO histological classification of salivary gland tumors now includes over 40 variantsas well as tumor-like lesions (e.g., salivary gland cysts). (2012) ISBN: 9783642178689. J R Coll Surg Edinb. sharing sensitive information, make sure youre on a federal 8. ( a ) Coronal T2w image,, Warthin's tumour of the left parotid gland. However, they do recur or present with distant metastases many years after apparent disease-free survival. The greater auricular nerve as a donor is an option, but it may be involved, so the sural nerve from the leg may be preferred. Image courtesy S Bhimji MD, Superficial parotidectomy for a benign salivary gland tumor. Duplication of the parotid duct: a previously unreported anomaly. Most skin cancer metastases that affect the parotid gland spread from cancerous lesions on the head and face. In the lab, tests can show what types of cells are involved and tell if they're cancerous. Epub 2020 May 20. Ouatassi N, Elguerch W, Bensalah A, Maaroufi M, Alami MN. Malignant salivary gland tumors usually present after the 6th decade of life, whereas benign lesions present in the 4-5th decade of life. In addition to facial nerve injury, possible complications include: For a parotidectomy alone with no complications, you will likely go home the day of surgery. Following surgery, the patient developed temporary facial paralysis. A few weeks delays can make a significant difference to the complexity of the planned surgery, with tumors readily invading the skin andsurrounding structures. How will you be sure that you've removed all of the tumor? Comparative Study of Qualitative and Quantitative Analyses of Contrast-Enhanced Ultrasound and the Diagnostic Value of B-Mode and Color Doppler for Common Benign Tumors in the Parotid Gland. Intraparotid nodes drain into the deep cervical chain. Ishibashi M, Fujii S, Kawamoto K, Nishihara K, Matsusue E, Kodani K, Kaminou T, Ogawa T. Acta Radiol. Excretory stem cells give rise to mucoepidermoid and squamous cell carcinomas, while intercalated stem cells can lead to pleomorphic adenomas, adenoid cystic carcinomas, oncocytomas, adenocarcinomas, and acinic cell carcinomas. 2012 Jun;33(3):283-8. doi: 10.1055/s-0031-1299130. The tail is not distinct from the rest of the gland, but it has been defined as the inferior 2 cm of the gland 11. If there are no complications, you will likely be able to return home the same day. Radiol Med. Hamilton BE, Salzman KL, Wiggins RH, Harnsberger HR. The inferior projection of the parotid is often referred to as the "tail", which overlies the angle of the mandible. It is less common for a cancer arising in a location below the collarbone to spread to the gland.. 6. Facial nerve involvement generally suggests a malignant tumor, which may present with pain or paralysis. Congenital masses, such as branchial anomalies and thyroglossal duct cysts, must be considered in the differential diagnosis. This can cause loss of movement in the face muscles. There were 69 cases of benign (73%) and 25 cases of malignant (27%) tumours, including 44 pleomorphic adenomas, 18 Warthin's tumours, 7 various benign tumours, 6 squamous cell carcinomas, 3 carcinoma ex pleomorphic adenomas, 2 mucoepidermoid carcinomas, 1 adenoid cystic carcinoma and 13 various malignant tumours. Case Discussion. Parotid tumors are growths of cells that start in the parotid glands. Outline the types of salivary gland tumors. Differential diagnosis includes chronic sialoadenitis, necrotizing sialometaplasia, and other carcinomas. Would you like email updates of new search results? It is usually combined with FNA (USSgFNAB), which improves the adequacy rate. These lesions are firm and are identified using electron microscopy. eCollection 2021. CONCLUSION When an asymptomatic mass in the parotid region is identified, parotid gland teratoma should be included in the differential diagnosis . (2011) Page 22-24. The tumor usually presents as a slow-growing mass and tends to spread along nerve sheaths. Le caratteristiche tipiche del tumore di Warthin sono risultate le componenti iperintense nelle immagini T1-pesate (p < 0,001), la localizzazione nel processo parotideo inferiore (p < 0,001) e l'impregnazione post-contrastografica lieve/incompleta (p = 0,01). At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, nerve transfer or other facial reanimation procedure, Learn more about the Salivary Gland Center. It is usually combined with FNA (USSgFNAB), which improves the adequacy rate. 2022 Dec 1;12(12):3002. doi: 10.3390/diagnostics12123002. Find more COVID-19 testing locations on Maryland.gov. The site is secure. The parotid gland surrounds the nerve that moves the muscles of the face. Stephanie Ryan, Michelle McNicholas, Stephen J. Eustace. The parotid gland is wrapped around the mandibular ramus and extends to a position anterior and inferior to the ear. Flint PW, et al., eds. The classification applies only to carcinomas of the major salivary glands. 3. Parotid tumor or parotid mass is a condition characterised by abnormal growths within the parotid glands. sharing sensitive information, make sure youre on a federal The patients often complain of facial pain and may present with facial paresis. Evaluation of parotid gland lesions with standard ultrasound, color duplex sonography, sonoelastography, and acoustic radiation force impulse imaging - a pilot study. 2. Zengel P, Notter F, Clevert DA. Sakamoto M, Sasano T, Higano S, Takahashi S, Iikubo M, Kakehata S. Dentomaxillofac Radiol. In the parotid, this may threaten local structures and so prompt surgical intervention is required. This right parotid mass demonstrates the classical imaging findings of a salivary gland pleomorphic adenoma, lobulated hypoechoic lesion on US and T1 hypointensity /STIR hyperintensity on MR. Fine needle aspiration was performed and this was confirmed as pleomorphic adenoma on cytohistopathology. Cheung RL, Russell AC, Freeman J. The energy can come from sources such as X-rays and protons. 2006;26 (3): 147-53. J Pathol. If you're facing surgery for a parotid tumor, meet with your surgeon before your operation to ask questions. Accessed Dec. 2, 2022. The differential diagnosis of a neck mass includes: Infectious lymphadenitis - most common cause of a neck mass. 2002 Aug;57(8):692-701. doi: 10.1053/crad.2001.0865. Diagnosis and treatment for parotid tumors is often done by doctors who specialize in problems that affect the ear, nose and throat. 2009;37 (3): 430-4. Loss of appetite. Salivary gland cancer treatment (adult) (PDQ) Patient version. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. If you have already had these tests done at one medical institution and choose another for surgery, your surgeon may request that his or her colleagues in radiology and pathology review your imaging studies and biopsy slides so they can double-check the interpretation of these tests. They often don't cause pain. ( a ) Axial T2w image,, Pleomorphic adenoma of the right parotid gland. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. Cystic lesions observed in parotid glands are relatively rare and comprise 2-5% of all parotid primaries. The facial nerve and its branches pass through the parotid gland, as does the external carotid arteryand retromandibular vein. It is rare in the parotid. It has superficial and deep lobes, separated by the facial nerve. Epub 2020 Sep 14. Results of the examinations were compared with those ones of histology. Diagnostic grading of parotid lesions by conventional ultrasound: a pilot study. Please enable it to take advantage of the complete set of features! . Lymphomas may develop in intra-parotid lymph nodes. JAMA Otolaryngology-Head & Neck Surgery. During the follow-up care,the otolaryngologist can give patients personalized information aboutthe risk of recurrence. This article reviews the key history and physical elements and adjunctive diagnostic tools available for working up parotid lesions. Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions. Patients may have blood tests or imaging tests as part of regular follow-up care. Complications from parotid surgery are well documented and include a scar, facial nerve injury, hematoma, seroma, salivary fistula, and Frey syndrome (gustatory sweating). Diagnosing salivary gland cancer The patient should be discussed in the team for the suitability of postoperative RT to reduce recurrence. In: Carlson ER, Ord R (eds) Textbook and color atlas of salivary gland pathology. A prophylactic selective neck dissection (levels I to III) should be performed for patients with high-stage (T3/T4) disease-free clinically high-grade tumors (i.e., high-grade mucoepidermoid carcinoma, carcinoma ex-pleomorphic adenoma, adenocarcinoma, squamous and undifferentiated carcinomas). Salivary gland carcinomas are a remain a heterogeneous group of tumors challenging to both pathologists and clinicians. Hugh CD. Although high-grade malignancies of the parotid gland usually have poorly defined margins, low signal intensity on T2-weighted images and invasion of surrounding structures, tumour margins, homogeneity, and signal intensity are not discriminative factors for correctly predicting benign or malignant tumours [12]. 2021 Jun;41(3):206-214. doi: 10.14639/0392-100X-N1379. Another step in evaluating the mass is taking a sample of tissue from it abiopsy which can be examined under a microscope by a pathologist. 2022 May 1;51(4):20210484. doi: 10.1259/dmfr.20210484. Forty-nine patients with increased FDG uptake in the parotid gland were selected for the study group (29 men and 20 women; mean age, 63.14 12.32 years). Biopsy; Malignancy; Mass; Parotid; Radiology. It generally behaves in an indolent, low-grade fashion, but can be unpredictable with perineural invasion and lymph node metastases. Mayo Clinic is a not-for-profit organization. The incision is made where it is less likely to leave a noticeable scar: either in a crease of the neck or hidden along the earlobe and hairline, similar to the approach used in a face-lift. Scheipers U, Siebers S, Gottwald F, Ashfaq M, Bozzato A, Zenk J, Iro H, Ermert H. Ultrasound Med Biol. The parotid glands are salivary glands that sit just in front of the ears. For this reason, some doctors don't do a biopsy before surgery. Neoplasms (benign and malignant) are more likely to be present in. The pathologist tells the surgeon if the tumor is cancerous. Some agents include: Viral Adenovirus Coxsackie Epstein Barr virus Influenza Parainfluenza Other respiratory viruses Bacterial Staphlococcus aureus Streptococcus, group A beta-hemolytic Bartonella henselae Haemophilus influenzae An official website of the United States government. An extracapsular dissection for benign pathology, away from the main branches of the facial nerve is an option, and even endoscopically-assisted parotidectomy can be effective in selected patients. Does routine preoperative imaging of parotid tumours affect surgical management decision making?. Salivary fistula: saliva leaking through the incision (this is usually temporary), Sialocele: a cavity or cyst containing saliva, Freys syndrome: a rare complication of parotid gland surgery that causes sweating or flushing in an area of the face when eating, especially spicy, salty or sour foods, Seroma: a pocket of serum that forms near the surgical incision. Ultrasound scan (USS) provides invaluable information about the site, size, and nature of salivary gland tumors and the presence of any significant cervical lymphadenopathy. We are vaccinating all eligible patients. Sometimes patients notice a fullness or swelling of the cheek or an asymmetry in the mouth. Braz J Otorhinolaryngol. -, Eveson JW, Cawson RA. Aringhieri G, Fanni SC, Febi M, Colligiani L, Cioni D, Neri E. Diagnostics (Basel). Ahuja, Diagnostic Ultrasound: Head and Neck 2e Anatomy Head and Neck Neck Sublingual/Submental Region Submandibular Region Parotid Region Upper Cervical Level Midcervical Level Lower Cervical Level and Supraclavicular Fossa Posterior Triangle Thyroid Gland Parathyroid Gland Larynx and Hypopharynx Cervical Trachea and Esophagus Brachial Plexus Vagus Nerve Cervical Carotid Arteries Vertebral . It is now generally accepted that an adequate margin in benign tumors, is a cuff of 1 to 2 mm. The purpose of this article is to establish 18 F-FDG metabolic imaging parameters to differentiate benign and malignant tumors of the parotid gland. -, Lee YYP, Wong KT, King AD. L'intensit di segnale nelle immagini T1-pesate e T2- pesate e l'impregnazione post-contrastografica si sono rivelate utili nella diagnosi differenziale tra adenoma pleomorfo e tumore di Warthin. 1: digastric muscle 2: main trunk of the facial nerve 3: cervical branch of the facial nerve 4: marginal mandibular branch of the facial nerve 5: great auricular nerve divided distally. Ultrasoundis often the first diagnostic procedure to evaluate morphological and structural changes of the parotid gland; for small (<3 cm) and superficial lesions, ultrasound and cytology are often sufficient for a definitive diagnosis 2. appears homogeneous with increased echogenicity compared to nearby muscle 1, intraparotid lymph nodes are normally seen (unlike the submandibular gland), retromandibular veinand external carotid artery are also easily seen and by inference the facial nerve, which lies lateral to these vessels 1, difficulty visualizing deep lesions: the deep lobe is not able to be assessed as it is protected by the mandibular ramus, CT and MRI provide useful additional diagnostic imaging if malignancy is suspected 4, with the sensitivity approaching 100% for detecting parotid neoplasms 5, the parotid duct and retromandibular vein are usually seen and approximate the plane separating the superficial and deep lobes 12, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 4. 1732. Inflammation, infection, and/or blockage of the parotid or submandibular glands or their ducts can produce neck masses. 1: digastric muscle 2: main trunk of the facial nerve 3: cervical branch of the facial nerve 4: marginal mandibular branch of the facial nerve 5: great auricular nerve divided distally. Review the treatment and management options available for salivary gland tumors. Advanced magnetic resonance imaging findings in salivary gland tumors. The differential diagnosis of a parotid lesion is broad, and the otolaryngologist must consider inflammatory, neoplastic, autoimmune, traumatic, infectious, or congenital causes.
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