Head and neck pathology最新文献

{"title":"Oral Juvenile Xanthogranuloma: A Clinicopathological, Immunohistochemical and BRAF V600E Study of Five New Cases, with Literature Review.","authors":"Carolina Peres Mota,&nbsp;John Lennon Silva Cunha,&nbsp;Maria Carolina Silva Versieux Magalhães,&nbsp;Mônica Simões Israel,&nbsp;Nathália de Almeida Freire,&nbsp;Emilia Rosaria Carvalho Dos Santos,&nbsp;Nathalie Henriques Silva Canedo,&nbsp;Michelle Agostini,&nbsp;Aline Corrêa Abrahão,&nbsp;Bruno Augusto Benevenuto de Andrade,&nbsp;Mário José Romañach,&nbsp;Sílvia Ferreira de Sousa","doi":"10.1007/s12105-021-01373-x","DOIUrl":"https://doi.org/10.1007/s12105-021-01373-x","url":null,"abstract":"<p><p>Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis and oral mucosal involvement is exceedingly rare. Histiocytic disorders harbor activating mutations in MAPK pathway, including the report of BRAF V600E in JXG of extracutaneous site. However, no information is available for oral JXG. Herein, the clinicopathological and immunohistochemical features of five new oral JXG were evaluated in conjunction with literature review. Also, we assessed the BRAF V600E in oral samples. Five oral JXG were retrieved from pathology archives. Morphological and immunohistochemical analyses were performed. The BRAF V600E status was determined with TaqMan allele-specific qPCR. The series comprised of three female and two male patients, most of them adults, with a median age of 39 years (range 13-68 years). Clinically, the lesions appeared as asymptomatic solitary nodules, measuring until 2.5 cm, with more incident to the buccal mucosa. Morphologically, most of the cases presented classical histological features of JXG, with histiocytic cells consistent with the non-Langerhans cell immunophenotype. BRAF V600E was not detected in the cases tested. This is the first and largest published series of oral JXG affecting adults and a Brazilian population. The molecular pathogenesis of oral JXG remains unknown. Clinicians and pathologists must recognize JXG to avoid misdiagnoses with oral benign or malignant lesions.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"407-415"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12105-021-01373-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39328817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blastoid Mantle Cell Lymphoma of the Palate: Report of a Rare Aggressive Entity and Review of the Literature.","authors":"Maria Georgaki,&nbsp;Vasileios Ionas Theofilou,&nbsp;Efstathios Pettas,&nbsp;Evangelia Piperi,&nbsp;Eleana Stoufi,&nbsp;Panayiotis Panayiotidis,&nbsp;Nikolaos G Nikitakis","doi":"10.1007/s12105-021-01391-9","DOIUrl":"https://doi.org/10.1007/s12105-021-01391-9","url":null,"abstract":"<p><p>Mantle cell lymphoma (MCL) is a well-defined, non-Hodgkin lymphoma of B-cell origin displaying diverse morphological phenotypes and variable disease course. The World Health Organization recognizes two aggressive histopathologic variants of this type of lymphoma: pleomorphic and blastoid MCL. To date, only few cases of MCL affecting the oral cavity have been reported. Additionally, the involvement of the oral and maxillofacial area by aggressive MCL subsets is considered extremely rare with only two patients reported in the English language literature to the best of our knowledge. Herein, we describe a 69 year-old male with a prior history of MCL of the right lateral pharyngeal wall developing a recurrent lesion extending to the palatal mucosa as diffuse ulceration and exhibiting histomorphological features of blastoid MCL. We also review the pertinent literature with emphasis on the diagnostic challenges and distinction between the different MCL variants.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"631-642"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187827/pdf/12105_2021_Article_1391.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39679267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency of Odontogenic Tumors: A Single Center Study of 1089 Cases in Japan and Literature Review.","authors":"Katsutoshi Kokubun,&nbsp;Kei Yamamoto,&nbsp;Kei Nakajima,&nbsp;Yoshihiko Akashi,&nbsp;Takatoshi Chujo,&nbsp;Masayuki Takano,&nbsp;Akira Katakura,&nbsp;Kenichi Matsuzaka","doi":"10.1007/s12105-021-01390-w","DOIUrl":"https://doi.org/10.1007/s12105-021-01390-w","url":null,"abstract":"<p><p>Several attempts have been made to classify odontogenic tumors; however, the need for a uniform international classification system led the World Health Organization (WHO) to present a classification of odontogenic tumors in 1971. We aimed to evaluate the number and types of odontogenic tumors examined at the Tokyo Dental College Hospital in Japan to determine the frequency and types of odontogenic tumors, based on the 2017 WHO classification system, as this information has not been reported previously in Japan. We also compared the results of our evaluation with those reported in previous studies. We conducted a clinicopathological evaluation of odontogenic tumors examined at the Tokyo Dental College Hospital between 1975 and 2020. This included an analysis of 1089 cases (malignant, n = 10, 0.9%; benign, n = 1079, 99.1%) based on the 2017 World Health Organization Classification of Head and Neck Tumors. We identified 483 (44.3%), 487 (44.7%), and 109 (10.0%) benign epithelial odontogenic, mixed odontogenic, and mesenchymal tumors, respectively. The most common tumor types were odontoma (42.5%) and ameloblastoma (41.9%). Of the 1089 cases, 585 (53.7%) and 504 (46.3%) were male and female patients, respectively. Ameloblastoma and ameloblastic fibroma occurred more commonly in male patients, whereas odontogenic fibroma and cemento-ossifying fibroma affected female patients primarily. The age at diagnosis ranged from three to 87 (mean, 29.05) years. In 319 (29.3%) patients, the age at diagnosis ranged from 10 to 19 years. Ameloblastoma and odontoma were the most common tumor types among patients in their 20s and those aged 10-19 years, respectively. In 737 (67.7%) and 726 (66.7%) patients, the tumors were located in the mandible and posterior region, respectively. Ameloblastoma was particularly prevalent in the posterior mandible. Odontogenic tumors are rare lesions and appear to show a definite geographic variation.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"494-502"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187835/pdf/12105_2021_Article_1390.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39679268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Transformation Rate of Non-reactive Oral Hyperkeratoses Suggests an Early Dysplastic Phenotype.","authors":"Ivan J Stojanov,&nbsp;Sook-Bin Woo","doi":"10.1007/s12105-021-01363-z","DOIUrl":"https://doi.org/10.1007/s12105-021-01363-z","url":null,"abstract":"<p><p>The presence of epithelial dysplasia (ED) in oral leukoplakia is the single most important predictor of malignant transformation (MT). The majority of leukoplakias, however, do not show evidence of ED and yet MT of these lesions is well-recognized. These lesions have been referred to as \"hyperkeratosis/hyperplasia, no dysplasia,\" \"keratosis of unknown significance\" and \"hyperkeratosis, not reactive (HkNR).\" This study evaluates the MT rate of such leukoplakias. A literature review was performed to identify cohort studies on leukoplakias where (1) there was a recorded histopathologic diagnosis, (2) cases of \"hyperkeratosis/hyperplasia, no dysplasia\" comprised part of the cohort, and (3) follow-up information was available. There were 9,358 leukoplakias, of which 28.5% exhibited ED while 37.7% consisted of HkNR. Follow-up ranged from 15 to 73 months. The incidence of MT in leukoplakia exhibiting HkNR was 4.9%, compared to 15.3% for ED. Among oral squamous cell carcinomas (SCC) with previously biopsied, site-specific precursor lesions, 55.7% arose from ED/carcinoma in situ and 28.0% arose from HkNR. Leukoplakia exhibiting HkNR has a substantial MT rate, similar to that of mild ED, and must be recognized and managed appropriately to reduce oral SCC incidence.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"366-374"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12105-021-01363-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39180672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it Anaplastic Thyroid Cancer, Primary Thyroid Lymphoma, or Rosai Dorfman Disease? An Elusive Histopathologic Diagnosis of a Thyroid Mass.","authors":"Stephanie Kim,&nbsp;Austin L Gray,&nbsp;Wilson P Lao,&nbsp;Mia N Perez,&nbsp;Yan Liu,&nbsp;Steve C Lee","doi":"10.1007/s12105-021-01392-8","DOIUrl":"https://doi.org/10.1007/s12105-021-01392-8","url":null,"abstract":"<p><p>The aim of this study is to present an elusive case of primary thyroid lymphoma (PTL), initially thought to be anaplastic thyroid carcinoma, then Rosai Dorfman disease, before the final diagnosis of PTL was made. An elderly female with hypothyroidism presented with compressive airway symptoms secondary to an enlarging neck mass. Imaging was suggestive of undifferentiated thyroid cancer. The initial biopsy was unexpectedly consistent with a lymphoproliferative disorder such as Rosai-Dorfman disease. A repeat biopsy with immunohistochemical analysis yielded a diagnosis of diffuse large B-cell lymphoma of germinal center subtype. The patient was spared thyroid surgery and started on appropriate chemotherapy. PTL is within the differential diagnosis that physicians must consider in a patient with a rapidly-enlarging neck mass. A clinical index of suspicion and early accurate diagnosis may spare the patient from unnecessary surgery that is required of most other non-hematopoeitic thyroid malignancies.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"507-512"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187825/pdf/12105_2021_Article_1392.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39605856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Primordial Odontogenic Tumor: Epithelium-Rich Variant.","authors":"Asma Almazyad,&nbsp;David Collette,&nbsp;Dahua Zhang,&nbsp;Sook-Bin Woo","doi":"10.1007/s12105-021-01354-0","DOIUrl":"https://doi.org/10.1007/s12105-021-01354-0","url":null,"abstract":"<p><p>Primordial odontogenic tumor (POT) is a rare, mixed odontogenic neoplasm composed of spindled and stellate-shaped cells in myxoid stroma resembling dental papilla, surfaced by cuboidal-to-columnar odontogenic epithelium. Most POTs present in the posterior mandible as a well-demarcated radiolucency associated with a developing tooth in children and adolescents. POT is treated conservatively with no recurrences documented to-date. To describe the clinicopathological features of a recurrent POT. A 19-year-old female presented with an asymptomatic swelling, and panoramic radiograph revealed a multiloculated radiolucency in the mandibular body and ramus, with buccal and lingual perforation. The tumor was composed of plump spindle and stellate cells in a delicately collagenous and myxoid stroma, surfaced by columnar epithelial cells with reverse nuclear polarization. There was extensive epithelial proliferation forming invaginations within the tumor mass and organoid/enamel organ-like structures with enameloid-like deposits, dentinoid, and dystrophic calcifications. This was similar to the POT that had been excised four years prior from the same location. The patient underwent hemi-mandibulectomy and currently is free of disease at a thirteen-month follow-up. This report describes the first recurrent POT exhibiting extensive epithelial proliferation.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"550-559"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12105-021-01354-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39158093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polymorphous Adenocarcinoma, Low Grade Variant, Colliding with a Neurofibroma.","authors":"Nikolaos G Katsoulas,&nbsp;Konstantinos I Tosios,&nbsp;Hannah Afwerke Lynch,&nbsp;Rachel Uppgaard,&nbsp;Ioannis G Koutlas","doi":"10.1007/s12105-021-01377-7","DOIUrl":"https://doi.org/10.1007/s12105-021-01377-7","url":null,"abstract":"<p><p>Collision tumors, composed of two distinct benign or malignant neoplasms, are rarely reported in the oral cavity. We present a case of a 61-year-old female with an asymptomatic non-demarcated lump on the soft palate of unknown duration. An incisional biopsy revealed the presence of two neoplastic populations, a neurofibroma that was partially infiltrated by a polymorphous adenocarcinoma, low-grade variant. Total surgical excision was performed, with uneventful follow-up period. The development of collision tumors may be incidental, although molecular events may influence the pathogenetic mechanism of the phenomenon.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"602-606"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187840/pdf/12105_2021_Article_1377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39376712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frozen-Permanent Section Discrepancy Rate in Oral Cavity and Oropharyngeal Squamous Cell Carcinoma.","authors":"Serenella Serinelli,&nbsp;Stephanie M Bryant,&nbsp;Michael P A Williams,&nbsp;Mark Marzouk,&nbsp;Daniel J Zaccarini","doi":"10.1007/s12105-021-01385-7","DOIUrl":"https://doi.org/10.1007/s12105-021-01385-7","url":null,"abstract":"<p><p>Frozen section evaluation of head and neck squamous cell carcinoma (SCC) is critical for margin status and subsequent patient therapy. In this study, we retrospectively reviewed the rate of frozen-permanent section discrepancies in blocks with two frozen section levels compared to ≥ three levels in oral cavity and oropharyngeal SCCs. A search of the cases with both intraoperative frozen sections and corresponding permanent sections for SCCs in the oral cavity and oropharynx was performed. Frozen sections and permanent slides were compared. The nature of discrepancies was assigned to one of the following: change in diagnosis, margin status, or distance of the tumor from the margin. The cause of the discrepancy was designated as one of the following: block sampling, gross sampling, interpretation, or technical error. The pathologist experience, frozen section technical experience, and intraoperative impact of each discrepancy were also evaluated. A total of 654 frozen and corresponding permanent blocks were assessed. For 532 of the frozen section blocks, two levels were cut, while 122 frozen section blocks had ≥ three levels. Thirty-five frozen-permanent section discrepancies were observed (5.4% of all blocks). Among these, 2.5% had a possible or definitive intraoperative impact. The percentage of discrepancies in the ≥ three levels group (5.7%) was slightly higher than the two-level group (5.3%), and this difference was not statistically significant. For the two-level group, the overall block sampling error rate was 4.5%. This was not significantly different from the 4.1% block sampling error rate seen in the ≥ three levels group. The rate of block sampling discrepancy did not show significant differences based on attending or frozen section technical experience. A change in margin distance (closer margin detected on permanent) occurred in 4% of the blocks and involved 16% of the patients. This review of oral cavity and oropharynx SCCs frozen/permanent section discrepancies shows that the error rate is not significantly different depending on the number of levels cut. The results suggest that always performing more than two frozen section levels may not yield a decreased discrepancy rate. A change in margin distance occurred quite frequently, but only in rare cases it had a definitive impact on the intraoperative management. Given the importance of correct intraoperative diagnosis in patient management, additional levels may be warranted depending on the clinical scenario.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"466-475"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187809/pdf/12105_2021_Article_1385.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39522687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clear Cell Carcinoma in the Oral Cavity with Three Novel Types of EWSR1-ATF1 Translocation: A Case Report.","authors":"Satoshi Nojima,&nbsp;Masaharu Kohara,&nbsp;Hiroshi Harada,&nbsp;Hitomi Kajikawa,&nbsp;Katsutoshi Hirose,&nbsp;Shin-Ichi Nakatsuka,&nbsp;Yukinobu Nakagawa,&nbsp;Kaori Oya,&nbsp;Yasuo Fukuda,&nbsp;Kazuhide Matsunaga,&nbsp;Narikazu Uzawa,&nbsp;Manabu Fujimoto,&nbsp;Satoru Toyosawa,&nbsp;Eiichi Morii","doi":"10.1007/s12105-021-01356-y","DOIUrl":"https://doi.org/10.1007/s12105-021-01356-y","url":null,"abstract":"<p><p>Clear cell carcinoma (CCC) is a rare epithelial malignant tumor of the salivary glands. It is characterized by tumor cells with clear cytoplasm, hyalinized stroma, and most importantly the fusion genes EWSR1-ATF1, EWSR1-CREM, and EWSR1-PLAG1. Break-apart FISH has been performed for multiple CCC cases, but direct sequencing analysis has been performed in relatively few. Herein, we report an interesting case of CCC harboring three EWSR1-ATF1 translocations: EWSR1 exon 8-ATF1 exon 4, EWSR1 exon 7-ATF1 exon 4, and EWSR1 exon 7-ATF1 exon 5. This case indicates the possibility of independent EWSR1-ATF1 gene translocations, and could provide insight into CCC tumorgenesis.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"560-566"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12105-021-01356-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39176078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lingual Choristoma with Gastric Epithelium Revisited.","authors":"Christina M Ombres,&nbsp;Isabelle Lestadi,&nbsp;Juan Putra","doi":"10.1007/s12105-021-01362-0","DOIUrl":"https://doi.org/10.1007/s12105-021-01362-0","url":null,"abstract":"<p><p>The term 'choristoma' refers to normal appearing tissue in an abnormal location. We describe a case of choristoma with gastric epithelium of the dorsal tongue in a pediatric patient. Lingual choristomas are uncommon cystic or solid lesions which may demonstrate different types of tissue (e.g. gastric epithelium, respiratory epithelium, osseous and neuroglial tissue) histologically. Choristomas with gastric epithelium, also known as heterotropic gastric mucosa or foregut duplication cysts, are thought to arise from pluripotential cells of the embryonic foregut. They most frequently involve the anterior two-thirds of the tongue. Most patients are asymptomatic, but larger lesions may lead to feeding and breathing difficulties. Pathologic evaluation and surgical excision remain the mainstay of diagnosis and treatment, respectively. The pathologic characteristics of other congenital tongue lesions are also discussed.</p>","PeriodicalId":520636,"journal":{"name":"Head and neck pathology","volume":" ","pages":"503-506"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187806/pdf/12105_2021_Article_1362.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39182497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}