Case and Research Letter
Ulcerated Giant Pilomatrixoma in a Child
Pilomatrixoma gigante y ulcerado en un niño
a Servicio de Dermatología, Hospital Nacional de Pediatría Dr. Prof. JP Garrahan, Buenos Aires, Argentina
b Servicio de Cirugía Plástica, Hospital Nacional de Pediatría Dr. Prof. JP Garrahan, Buenos Aires, Argentina
c Servicio de Diagnóstico por Imágenes, Hospital Nacional de Pediatría Dr. Prof. JP Garrahan, Buenos Aires, Argentina
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Stefano, S. Apa, B. Balancini" "autores" => array:3 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Stefano" "email" => array:1 [ 0 => "paoladermatologia@yahoo.com.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Apa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Balancini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Nacional de Pediatría Dr. Prof. JP Garrahan, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Plástica, Hospital Nacional de Pediatría Dr. Prof. JP Garrahan, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Diagnóstico por Imágenes, Hospital Nacional de Pediatría Dr. Prof. JP Garrahan, Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pilomatrixoma gigante y ulcerado en un niño" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 952 "Ancho" => 951 "Tamanyo" => 146298 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nuclear magnetic resonance imaging: exophytic formation with a heterogeneous nodule surrounded by a hypointense halo and abundant vascularity in the stalk.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 7 year-old boy who presented with a lesion on the left arm that had developed 2 years earlier and had suddenly increased in size in the preceding month. A Doppler ultrasound performed 1 month earlier revealed an echogenic mass of 1.6 × 1.7 × 1<span class="elsevierStyleHsp" style=""></span>cm with posterior acoustic shadowing.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Examination revealed a stony-hard, exophytic, pedunculated tumor of 8<span class="elsevierStyleHsp" style=""></span>cm in diameter on the patient's left arm. The overlying skin was absent, exposing an eroded surface and a bleeding tumor bed with a crater-like appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Nuclear magnetic resonance imaging (MRI) and magnetic resonance angiography showed an exophytic formation consisting of a heterogeneous nodule with a hypointense halo surrounded by hyperintense tissue, and a large number of tortuous vessels in the stalk (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The tumor was excised and the defect reconstructed with a Dufourmentel flap. Histopathology revealed the presence of lobules of basaloid cells showing maturation toward the surface, the formation of cells with abundant eosinophilic cytoplasm, sheets of eosinophilic keratinous debris, and pilar keratinization. The lobules were surrounded by a fibrous stroma with mononuclear, histiocytic inflammatory infiltrate and foreign body-type multinucleated giant cells. Numerous foci of dystrophic calcification were observed. These findings were consistent with a diagnosis of giant pilomatrixoma with foreign-body giant-cell reaction (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The patient progressed favorably and there was no recurrence after 1 year of follow-up.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pilomatrixoma is a benign adnexal tumor with differentiation towards hair matrix cells, and is most common in children and those over 60.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although the etiology of this tumor is unknown, in 75% of cases a mutation has been identified in <span class="elsevierStyleItalic">CTNNB1</span>, the gene encoding beta-catenin, a signaling protein involved in hair follicle development.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Pilomatrixomas are slow-growing nodules measuring 1 to 1.5<span class="elsevierStyleHsp" style=""></span>cm across; they frequently calcify, giving rise to bluish discoloration of the overlying skin, which may extrude calcific material.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Nodules can be multiple or solitary. Solitary tumors have been described in genetic syndromes such as Turner syndrome, Sotos syndrome, myotonic dystrophy, Rubinstein-Taybi syndrome, Gardner syndrome, trisomy 9, basal cell nevus syndrome, and xeroderma pigmentosum.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Multiple pilomatrixomas have been reported in healthy patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Other clinicopathologic variants have also been described, including blistering, anetodermic, perforating/ulcerated, lymphangiectasic, and malignant forms.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Pilomatrixomas of over 5<span class="elsevierStyleHsp" style=""></span>cm in diameter are considered giant. Only 4 cases of giant pilomatrixoma have been described, all in adults<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a>: 2 ulcerated and 2 with areas of erosion. Two cases of giant pilomatrixoma associated with hypercalcemia have also been described, both of which resolved after resection.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis includes dermatofibrosarcoma protuberans, calcinosis cutis, osteoma cutis, cutaneous lymphomas, sarcomas, squamous carcinoma, and cutaneous metastases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The giant, ulcerated clinical form must be differentiated from the malignant form, and should be suspected in cases of sudden growth of a pre-existing lesion with ulceration and bleeding. Indicators of malignancy include necrosis, atypical mitotic figures, perineural or perivascular invasion, and the degree and extent of infiltration.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Ultrasound reveals an echogenic lesion with posterior acoustic shadowing. In the present case the extension of the lesion was evaluated by MRI, which revealed an exophytic formation with hypervascularization, as described in a previous case of giant pilomatrixoma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The pilomatrixoma case described here is of interest due to the sudden increase in the size of the lesion; while this characteristic suggested a malignant tumor, malignancy was subsequently ruled out by histopathology.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Stefano P, Apa S, Balancini B. Pilomatrixoma gigante y ulcerado en un niño. Actas Dermosifiliogr. 2013;104:924–925.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 951 "Tamanyo" => 97187 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pedunculated exophytic tumor with eroded and bleeding surface.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 952 "Ancho" => 951 "Tamanyo" => 146298 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nuclear magnetic resonance imaging: exophytic formation with a heterogeneous nodule surrounded by a hypointense halo and abundant vascularity in the stalk.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 713 "Ancho" => 951 "Tamanyo" => 182697 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology: lobules of basaloid cells with maturation toward the surface and ghost cell formation (hematoxylin-eosin, original magnification ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A clinical review of 209 pilomatricomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.G. 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Martinez Murillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2000" "volumen" => "91" "paginaInicial" => "529" "paginaFinal" => "530" "itemHostRev" => array:3 [ "pii" => "S0015028211005863" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant pilomatrixoma (benign calcifyng epithelioma of Malherbe) of the neck and face" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Kovacic" 1 => "M. Rudic" 2 => "I. Nekic" 3 => "N. Lisica-Sikic" 4 => "Z. Kranjcec" 5 => "T. Simurina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatology Surgery" "fecha" => "2007" "volumen" => "33" "paginaInicial" => "340" "paginaFinal" => "343" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three cases of giant pilomatrixoma-considerations for diagnosis and treatment of giant skin tumours with abundant inner calcification present on the upper body" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Yamauchi" 1 => "T. Yotsuyanagi" 2 => "T. Saito" 3 => "K. Ikeda" 4 => "S. Urushidate" 5 => "Y. Higuma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Plastic Reconstr Aesthet Surg" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "e519" "paginaFinal" => "e524" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Large, rapidly growing pilomatrixoma of the upper eyelid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Huerva" 1 => "C. Sanchez" 2 => "J. Asenjo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.iop.0000235816.50701.ba" "Revista" => array:6 [ "tituloSerie" => "Ophthal Plast Reconstr Surg" "fecha" => "2006" "volumen" => "22" "paginaInicial" => "401" "paginaFinal" => "403" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16985434" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant pilomatricoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.P. Lozzi" 1 => "H.P. Soyer" 2 => "J. Freuhauf" 3 => "C. Massone" 4 => "K. Helmut" 5 => "P. Ketty" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Dermopathol" "fecha" => "2007" "volumen" => "29" "paginaInicial" => "286" "paginaFinal" => "289" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack69007" "titulo" => "Acknowledgments" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We thank the doctors in the Hospital Nacional de Pediatría Prof. Dr. JP Garrahan who were involved in the handling and resolution of this case: Dr. Adrián Martín Pierini, Dr. Amelia Laterza, and Dr. Fabiana Lubieniecki.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000010/v1_201311281142/S1578219013002448/v1_201311281142/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000010/v1_201311281142/S1578219013002448/v1_201311281142/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002448?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 6 | 20 |
| 2024 Octubre | 72 | 58 | 130 |
| 2024 Septiembre | 62 | 24 | 86 |
| 2024 Agosto | 95 | 60 | 155 |
| 2024 Julio | 82 | 37 | 119 |
| 2024 Junio | 91 | 60 | 151 |
| 2024 Mayo | 79 | 33 | 112 |
| 2024 Abril | 64 | 16 | 80 |
| 2024 Marzo | 77 | 25 | 102 |
| 2024 Febrero | 87 | 46 | 133 |
| 2024 Enero | 52 | 31 | 83 |
| 2023 Diciembre | 65 | 13 | 78 |
| 2023 Noviembre | 93 | 29 | 122 |
| 2023 Octubre | 80 | 17 | 97 |
| 2023 Septiembre | 78 | 29 | 107 |
| 2023 Agosto | 66 | 20 | 86 |
| 2023 Julio | 58 | 35 | 93 |
| 2023 Junio | 54 | 26 | 80 |
| 2023 Mayo | 87 | 29 | 116 |
| 2023 Abril | 75 | 25 | 100 |
| 2023 Marzo | 60 | 20 | 80 |
| 2023 Febrero | 57 | 16 | 73 |
| 2023 Enero | 50 | 25 | 75 |
| 2022 Diciembre | 58 | 36 | 94 |
| 2022 Noviembre | 42 | 22 | 64 |
| 2022 Octubre | 41 | 19 | 60 |
| 2022 Septiembre | 36 | 27 | 63 |
| 2022 Agosto | 21 | 42 | 63 |
| 2022 Julio | 28 | 38 | 66 |
| 2022 Junio | 30 | 31 | 61 |
| 2022 Mayo | 47 | 46 | 93 |
| 2022 Abril | 53 | 33 | 86 |
| 2022 Marzo | 53 | 50 | 103 |
| 2022 Febrero | 57 | 27 | 84 |
| 2022 Enero | 75 | 28 | 103 |
| 2021 Diciembre | 45 | 38 | 83 |
| 2021 Noviembre | 52 | 55 | 107 |
| 2021 Octubre | 101 | 55 | 156 |
| 2021 Septiembre | 66 | 47 | 113 |
| 2021 Agosto | 84 | 31 | 115 |
| 2021 Julio | 29 | 37 | 66 |
| 2021 Junio | 68 | 39 | 107 |
| 2021 Mayo | 85 | 38 | 123 |
| 2021 Abril | 176 | 61 | 237 |
| 2021 Marzo | 97 | 28 | 125 |
| 2021 Febrero | 75 | 22 | 97 |
| 2021 Enero | 49 | 18 | 67 |
| 2020 Diciembre | 32 | 17 | 49 |
| 2020 Noviembre | 24 | 14 | 38 |
| 2020 Octubre | 27 | 11 | 38 |
| 2020 Septiembre | 29 | 8 | 37 |
| 2020 Agosto | 27 | 16 | 43 |
| 2020 Julio | 42 | 12 | 54 |
| 2020 Junio | 38 | 20 | 58 |
| 2020 Mayo | 28 | 23 | 51 |
| 2020 Abril | 29 | 26 | 55 |
| 2020 Marzo | 33 | 28 | 61 |
| 2020 Febrero | 2 | 0 | 2 |
| 2020 Enero | 4 | 4 | 8 |
| 2019 Diciembre | 8 | 4 | 12 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 10 | 3 | 13 |
| 2019 Agosto | 4 | 1 | 5 |
| 2019 Julio | 4 | 8 | 12 |
| 2019 Junio | 4 | 17 | 21 |
| 2019 Mayo | 6 | 20 | 26 |
| 2019 Abril | 2 | 15 | 17 |
| 2019 Marzo | 0 | 18 | 18 |
| 2019 Febrero | 4 | 1 | 5 |
| 2019 Enero | 0 | 6 | 6 |
| 2018 Diciembre | 1 | 7 | 8 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 2 | 3 | 5 |
| 2018 Febrero | 42 | 8 | 50 |
| 2018 Enero | 42 | 7 | 49 |
| 2017 Diciembre | 53 | 7 | 60 |
| 2017 Noviembre | 35 | 10 | 45 |
| 2017 Octubre | 53 | 11 | 64 |
| 2017 Septiembre | 34 | 6 | 40 |
| 2017 Agosto | 43 | 10 | 53 |
| 2017 Julio | 62 | 7 | 69 |
| 2017 Junio | 43 | 8 | 51 |
| 2017 Mayo | 46 | 6 | 52 |
| 2017 Abril | 54 | 8 | 62 |
| 2017 Marzo | 38 | 35 | 73 |
| 2017 Febrero | 112 | 5 | 117 |
| 2017 Enero | 49 | 14 | 63 |
| 2016 Diciembre | 63 | 4 | 67 |
| 2016 Noviembre | 69 | 5 | 74 |
| 2016 Octubre | 127 | 10 | 137 |
| 2016 Septiembre | 164 | 3 | 167 |
| 2016 Agosto | 163 | 6 | 169 |
| 2016 Julio | 61 | 8 | 69 |
| 2016 Junio | 15 | 8 | 23 |
| 2016 Mayo | 12 | 5 | 17 |
| 2016 Abril | 14 | 5 | 19 |
| 2016 Marzo | 18 | 2 | 20 |
| 2016 Febrero | 17 | 8 | 25 |
| 2016 Enero | 9 | 10 | 19 |
| 2015 Diciembre | 15 | 3 | 18 |
| 2015 Noviembre | 15 | 1 | 16 |
| 2015 Octubre | 12 | 2 | 14 |
| 2015 Septiembre | 12 | 0 | 12 |
| 2015 Agosto | 14 | 1 | 15 |
| 2015 Julio | 97 | 8 | 105 |
| 2015 Junio | 63 | 6 | 69 |
| 2015 Mayo | 51 | 4 | 55 |
| 2015 Abril | 55 | 9 | 64 |
| 2015 Marzo | 66 | 8 | 74 |
| 2015 Febrero | 71 | 2 | 73 |
| 2015 Enero | 67 | 5 | 72 |
| 2014 Diciembre | 48 | 4 | 52 |
| 2014 Noviembre | 35 | 6 | 41 |
| 2014 Octubre | 53 | 3 | 56 |
| 2014 Septiembre | 35 | 2 | 37 |
| 2014 Agosto | 33 | 3 | 36 |
| 2014 Julio | 55 | 8 | 63 |
| 2014 Junio | 68 | 2 | 70 |
| 2014 Mayo | 58 | 7 | 65 |
| 2014 Abril | 41 | 5 | 46 |
| 2014 Marzo | 45 | 6 | 51 |
| 2014 Febrero | 37 | 5 | 42 |
| 2014 Enero | 40 | 4 | 44 |
| 2013 Diciembre | 30 | 9 | 39 |
| 2013 Noviembre | 0 | 1 | 1 |
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