Images in Clinical Rheumatology
Myofibroblastic Sarcoma of the Trapezius Muscle
Sarcoma miofibroblástico de trapecio
Carlos Antonio Guillen Astete
, Carmen Larena Grijalva
Corresponding author
Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Myofibroblastic Sarcoma of the Trapezius Muscle" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e47" "paginaFinal" => "e48" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Antonio Guillen Astete, Carmen Larena Grijalva" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Carlos Antonio" "apellidos" => "Guillen Astete" "email" => array:1 [ 0 => "cguillen.hrc@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Larena Grijalva" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoma miofibroblástico de trapecio" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1667 "Tamanyo" => 171993 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Trapezius (TP) ultrasound scan, longitudinal slice on cephalic edge. A hypoechoic mass is observed, homogenous in appearance and completed contained within the thickness of the muscle with no contact with the fascia (F) or subcutaneous cellular tissue (SCCT). The power Doppler signal is essentially concentrated in peripheral regions. (B) NMR of the shoulder, DP/SPIR sequence to remove fatty tissue. Transversal slice of the trapezius (arrow). In its interior a hyperintense structure with well defined edges is enhanced and this occupies almost all of the muscle matter (*). (C) NMR of the shoulder, T1 sequence, sagittal slice. In this projection the longitudinal extension of the trapezius (arrow) is appreciated and the occupation by the same fusiform, hypointense structure, with respect to the adjacent tissues. (*).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Musculoskeletal ultrasound is groundbreaking in making direct assessment of diseases with musculoskeletal symptoms because of its accessibility and usefulness in diagnosis and in the treatment of many diseases of the locomotor apparatus.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Its use quickly resolves doubts on differential diagnosis and accelerates decision making.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We recently assessed a woman aged 26, a new mother of 3 months who had presented at the emergency department on 3 occasions over 15 days due to right paracervical pain. The patient had no other history of interest. She took exercise sporadically and had an athletic constitution. On 3 occasions she had been diagnosed with mechanical cervicalgia associated with muscular contracture attributed to the tasks of looking after a newborn. She consulted for a fourth time after failure of 3 lines of analgesic, muscle relaxant and anti-inflammatory treatment. There was obvious asymmetry of the trapezius muscles with swelling of the right and limitation in rotation and passive lateralisation of the neck towards the left and lateralisation towards the right. An X-ray of the cervical spine made in the second assessment showed no changes to the axial vertebral disposition. Due to the striking lack of improvement an ultrasound scan of the right trapezius muscle was performed where a tumour was found to be contained within its thickness, with smooth and well defined edges, homogeneous in appearance, hypochoic with respect to the adjacent muscle tissue and with a positive power Doppler signal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The longitudinal diameter of the mass was 7<span class="elsevierStyleHsp" style=""></span>cm and anterolateral diameter was 5.5<span class="elsevierStyleHsp" style=""></span>cm.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">On suspicion of a tumour dependent on striated tissue the patient was admitted to hospital for further study. NMR imaging confirmed the finding of a tumour mass contained within the right trapezius muscle (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and <span class="elsevierStyleSmallCaps">C</span>). After fine needle aspiration and complete resection a 158<span class="elsevierStyleHsp" style=""></span>g specimen was extracted, the pathological analysis of which revealed low grade myofibroblastic sarcoma (LGSM) which did not affect the resection margins.</p><p id="par0020" class="elsevierStylePara elsevierViewall">LGSM are atypical tumours which are rare and usually diagnosed in the neck and oral cavity.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> They are composed of an uncontrolled proliferation of myofibroblasts which are connective tissue cells that share physiological properties with smooth muscle cells and firbroblasts.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> These tumours have a high tendency to produce early metastasis and local relapses.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a> Most of shoulder sarcomas usually present in the deltoid muscles. There have been no reported cases of myofibroblastic sarcomas of the trapezius in the literature, although it may be the exceptional location of other tumours.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Signal capture from power Doppler is an unequivocal sign of hyperaemia which in the context of tumours occupying spaces denotes inflammatory (infectious or not) activity or neoangiogenesis (correlationable with neoprolipherative processes).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Notwithstanding the prevalence of these sarcomas in the described location, we believe it is right to point out the importance ultrasound of the locomotor apparatus has in differential diagnosis of musculoskeletal processes with atypical disease courses and to highlight its use in identification of expansive soft tissue tumours, especially those which demonstrate hyperaemia through power Doppler signal detection.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experiments have been carried out on humans or animals.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data confidentiality</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocols of their centre of work on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of Interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-08" "fechaAceptado" => "2017-06-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guillen Astete CA, Larena Grijalva C. Sarcoma miofibroblástico de trapecio. Reumatol Clin. 2019;15:e47–e48.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1667 "Tamanyo" => 171993 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Trapezius (TP) ultrasound scan, longitudinal slice on cephalic edge. A hypoechoic mass is observed, homogenous in appearance and completed contained within the thickness of the muscle with no contact with the fascia (F) or subcutaneous cellular tissue (SCCT). The power Doppler signal is essentially concentrated in peripheral regions. (B) NMR of the shoulder, DP/SPIR sequence to remove fatty tissue. Transversal slice of the trapezius (arrow). In its interior a hyperintense structure with well defined edges is enhanced and this occupies almost all of the muscle matter (*). (C) NMR of the shoulder, T1 sequence, sagittal slice. In this projection the longitudinal extension of the trapezius (arrow) is appreciated and the occupation by the same fusiform, hypointense structure, with respect to the adjacent tissues. (*).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound in rheumatology: where are we and where are we going?" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo de Trabajo de Ecografía de la Sociedad Española de Reumatología (ECOSER)" "etal" => false "autores" => array:4 [ 0 => "E. de Miguel" 1 => "J.L. Andreu" 2 => "E. Naredo" 3 => "I. Möller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2013.04.005" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "6" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23856277" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importancia de la ecografía musculoesquelética en el diagnóstico diferencial de la patología inflamatoria de rodilla" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Guillen" 1 => "L. Alba" 2 => "C. de la Casa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2015" "volumen" => "27" "paginaInicial" => "350" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29087070" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside musculoskeletal ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. Connell" 1 => "T.S. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccc.2013.10.003" "Revista" => array:6 [ "tituloSerie" => "Crit Care Clin" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "243" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24606776" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myofibrosarcoma: a clinicopathologic study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Montgomery" 1 => "J.R. Goldblum" 2 => "C. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-200102000-00010" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2001" "volumen" => "25" "paginaInicial" => "219" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11176071" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low-grade myofibroblastic sarcoma: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.Y. Chan" 1 => "Z. Gooi" 2 => "E.W. Wong" 3 => "S.K. Ng" 4 => "M.C. Tong" 5 => "A.C. Vlantis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lary.26146" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2017" "volumen" => "127" "paginaInicial" => "116" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27377169" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The story of the myofibroblasts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Majno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-197912000-00006" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1979" "volumen" => "3" "paginaInicial" => "535" "paginaFinal" => "542" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/534390" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low grade myofibroblastic sarcoma occurred in the scalp" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.R. Han" 1 => "G.T. Yee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3340/jkns.2015.58.4.385" "Revista" => array:6 [ "tituloSerie" => "J Korean Neurosurg Soc" "fecha" => "2015" "volumen" => "58" "paginaInicial" => "385" "paginaFinal" => "388" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26587195" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myofibroblastic sarcoma of the base of tongue. Case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Z. Takácsi-Nagy" 1 => "G. Muraközy" 2 => "P. Pogány" 3 => "J. Fodor" 4 => "Z. Orosz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00066-009-1925-8" "Revista" => array:6 [ "tituloSerie" => "Strahlenther Onkol" "fecha" => "2009" "volumen" => "185" "paginaInicial" => "198" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19330298" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastatic meningioma presenting as a malignant soft tissue tumour" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. McCarthy" 1 => "M. Hofer" 2 => "M. Vlychou" 3 => "R. Khundkar" 4 => "P. Critchley" 5 => "S. Cudlip" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13569-016-0063-1" "Revista" => array:5 [ "tituloSerie" => "Clin Sarcoma Res" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28042470" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-enhanced color Doppler ultrasonography increases diagnostic accuracy for soft tissue tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Oebisu" 1 => "M. Hoshi" 2 => "M. Ieguchi" 3 => "J. Takada" 4 => "T. Iwai" 5 => "M. Ohsawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/or.2014.3378" "Revista" => array:6 [ "tituloSerie" => "Oncol Rep" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "1654" "paginaFinal" => "1660" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25109621" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301394/v1_201910260908/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000005/v1_201910260908/S2173574318301394/v1_201910260908/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301394?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 2 | 17 |
| 2024 October | 351 | 36 | 387 |
| 2024 September | 321 | 37 | 358 |
| 2024 August | 396 | 53 | 449 |
| 2024 July | 477 | 36 | 513 |
| 2024 June | 375 | 39 | 414 |
| 2024 May | 294 | 40 | 334 |
| 2024 April | 289 | 34 | 323 |
| 2024 March | 275 | 32 | 307 |
| 2024 February | 305 | 31 | 336 |
| 2024 January | 280 | 30 | 310 |
| 2023 December | 232 | 46 | 278 |
| 2023 November | 298 | 35 | 333 |
| 2023 October | 356 | 36 | 392 |
| 2023 September | 398 | 49 | 447 |
| 2023 August | 394 | 23 | 417 |
| 2023 July | 300 | 31 | 331 |
| 2023 June | 338 | 32 | 370 |
| 2023 May | 319 | 19 | 338 |
| 2023 April | 348 | 20 | 368 |
| 2023 March | 441 | 42 | 483 |
| 2023 February | 388 | 27 | 415 |
| 2023 January | 405 | 19 | 424 |
| 2022 December | 386 | 31 | 417 |
| 2022 November | 392 | 31 | 423 |
| 2022 October | 382 | 36 | 418 |
| 2022 September | 404 | 29 | 433 |
| 2022 August | 358 | 52 | 410 |
| 2022 July | 369 | 49 | 418 |
| 2022 June | 347 | 39 | 386 |
| 2022 May | 451 | 65 | 516 |
| 2022 April | 525 | 55 | 580 |
| 2022 March | 538 | 67 | 605 |
| 2022 February | 531 | 43 | 574 |
| 2022 January | 494 | 67 | 561 |
| 2021 December | 455 | 53 | 508 |
| 2021 November | 468 | 53 | 521 |
| 2021 October | 539 | 85 | 624 |
| 2021 September | 493 | 60 | 553 |
| 2021 August | 466 | 49 | 515 |
| 2021 July | 438 | 47 | 485 |
| 2021 June | 416 | 33 | 449 |
| 2021 May | 473 | 62 | 535 |
| 2021 April | 863 | 151 | 1014 |
| 2021 March | 467 | 39 | 506 |
| 2021 February | 341 | 16 | 357 |
| 2021 January | 352 | 23 | 375 |
| 2020 December | 310 | 22 | 332 |
| 2020 November | 228 | 28 | 256 |
| 2020 October | 200 | 33 | 233 |
| 2020 September | 228 | 20 | 248 |
| 2020 August | 160 | 29 | 189 |
| 2020 July | 92 | 19 | 111 |
| 2020 June | 66 | 17 | 83 |
| 2020 May | 53 | 11 | 64 |
| 2020 April | 22 | 30 | 52 |
| 2020 March | 18 | 8 | 26 |
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