The clinico‐pathological spectrum of plaque‐type blue naevi and their potential for malignant transformation
Aims Plaque‐type blue naevi are rare melanocytic tumours presenting as large, pigmented plaques at birth or during childhood. There is a risk for malignant transformation, but no larger comprehensive studies exist and the diagnosis is challenging, especially on limited biopsy material. The aim is to...
Gespeichert in:
| Veröffentlicht in: | Histopathology 2024-05, Vol.84 (6), p.1047-1055 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1055 |
|---|---|
| container_issue | 6 |
| container_start_page | 1047 |
| container_title | Histopathology |
| container_volume | 84 |
| creator | Tseng, Calvin Wiedemeyer, Katharina Mehta, Arjun Rojas‐Garcia, Priscila Temple‐Oberle, Claire Orlando, Antonio Miller, Keith Gharpuray‐Pandit, Deepa Brenn, Thomas |
| description | Aims
Plaque‐type blue naevi are rare melanocytic tumours presenting as large, pigmented plaques at birth or during childhood. There is a risk for malignant transformation, but no larger comprehensive studies exist and the diagnosis is challenging, especially on limited biopsy material. The aim is to describe the clinicopathological features and behaviour of the disease more comprehensively.
Methods and results
We retrieved eight plaque‐type blue naevi, presenting as large, pigmented plaques (median = 7 cm; range = 3–26) most frequently affecting the scalp (four) followed by the cheek, arm, abdominal wall and gluteal cleft (one each), with a slight female predilection. Median age at time of biopsy was 39.5 years (range = 15–90), but three tumours had been present at birth and one since childhood. Histopathologically, the tumours were poorly circumscribed and composed of cellular fascicles of uniform spindle cells in a background of variably prominent pigmented dendritic cells affecting dermis and subcutaneous tissues. The majority had mutations in GNAQ. One tumour showed malignant transformation, characterised by an expansile nodule of pleomorphic epithelioid melanocytes with rhabdoid morphology, high mitotic activity and areas of necrosis. This patient developed metastatic melanoma to lymph nodes. All patients are alive with a median follow‐up of 60 months.
Conclusion
Plaque‐type blue naevi are diagnostically challenging tumours with risk for malignant transformation. Awareness and familiarity with the salient clinicopathological features are necessary for reliable diagnosis, and long‐term clinical follow‐up is required to monitor for malignant transformation.
Plaque‐type blue naevi are rare melanocytic tumours in the spectrum of blue naevi, presenting during childhood as large, pigmented plaques with a predilection for the head and neck and trunk. They may undergo malignant transformation, characterised by epithelioid cell morphology, nuclear pleomorphism, high mitotic rate and necrosis, and patients require life‐long clinical follow‐up. |
| doi_str_mv | 10.1111/his.15152 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2929131114</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2929131114</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3482-16a059673b1625706a72f355db1b11c31f5dae2fe66e4a6e4bf6f1a47e753b013</originalsourceid><addsrcrecordid>eNp1kcFKXTEQhkOx1FvbRV-gBNzYxdFMcpNzz1JEqyB0UbsOOedOvJGc5JjkWO6uj-Az-iTGXttFoQPDwPDNz_D_hHwCdgy1TjYuH4MEyd-QBQglGy5lt0cWTLCuYaDaffI-5zvGoBWcvyP7YiWYBM4XZLrZIB28C26IT78eJ1M20cdbNxhP84RDSfNIo6WTN_czVqJsJ6S9n5EGgw-OmrCmZYMu0SkWDMXVQxsTHY13t8GEQksyIdfVaIqL4QN5a43P-PF1HpAfF-c3Z5fN9bevV2en180glivegDJMdqoVPSguW6ZMy62Qct1DDzAIsHJtkFtUCpemdm-VBbNssZWiZyAOyNFOd0qxfp6LHl0e0HsTMM5Z8453IKp7y4oe_oPexTmF-p0WLxaKVatEpb7sqCHFnBNaPSU3mrTVwPRLDLrGoH_HUNnPr4pzP-L6L_nH9wqc7ICfzuP2_0r68ur7TvIZE3uUEg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3030938763</pqid></control><display><type>article</type><title>The clinico‐pathological spectrum of plaque‐type blue naevi and their potential for malignant transformation</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Tseng, Calvin ; Wiedemeyer, Katharina ; Mehta, Arjun ; Rojas‐Garcia, Priscila ; Temple‐Oberle, Claire ; Orlando, Antonio ; Miller, Keith ; Gharpuray‐Pandit, Deepa ; Brenn, Thomas</creator><creatorcontrib>Tseng, Calvin ; Wiedemeyer, Katharina ; Mehta, Arjun ; Rojas‐Garcia, Priscila ; Temple‐Oberle, Claire ; Orlando, Antonio ; Miller, Keith ; Gharpuray‐Pandit, Deepa ; Brenn, Thomas</creatorcontrib><description>Aims
Plaque‐type blue naevi are rare melanocytic tumours presenting as large, pigmented plaques at birth or during childhood. There is a risk for malignant transformation, but no larger comprehensive studies exist and the diagnosis is challenging, especially on limited biopsy material. The aim is to describe the clinicopathological features and behaviour of the disease more comprehensively.
Methods and results
We retrieved eight plaque‐type blue naevi, presenting as large, pigmented plaques (median = 7 cm; range = 3–26) most frequently affecting the scalp (four) followed by the cheek, arm, abdominal wall and gluteal cleft (one each), with a slight female predilection. Median age at time of biopsy was 39.5 years (range = 15–90), but three tumours had been present at birth and one since childhood. Histopathologically, the tumours were poorly circumscribed and composed of cellular fascicles of uniform spindle cells in a background of variably prominent pigmented dendritic cells affecting dermis and subcutaneous tissues. The majority had mutations in GNAQ. One tumour showed malignant transformation, characterised by an expansile nodule of pleomorphic epithelioid melanocytes with rhabdoid morphology, high mitotic activity and areas of necrosis. This patient developed metastatic melanoma to lymph nodes. All patients are alive with a median follow‐up of 60 months.
Conclusion
Plaque‐type blue naevi are diagnostically challenging tumours with risk for malignant transformation. Awareness and familiarity with the salient clinicopathological features are necessary for reliable diagnosis, and long‐term clinical follow‐up is required to monitor for malignant transformation.
Plaque‐type blue naevi are rare melanocytic tumours in the spectrum of blue naevi, presenting during childhood as large, pigmented plaques with a predilection for the head and neck and trunk. They may undergo malignant transformation, characterised by epithelioid cell morphology, nuclear pleomorphism, high mitotic rate and necrosis, and patients require life‐long clinical follow‐up.</description><identifier>ISSN: 0309-0167</identifier><identifier>EISSN: 1365-2559</identifier><identifier>DOI: 10.1111/his.15152</identifier><identifier>PMID: 38305122</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Abdominal wall ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Children ; congenital naevus ; Dendritic cells ; Dermis ; Diagnosis ; Familiarity ; Female ; Genetic transformation ; GNAQ mutation ; Humans ; Infant, Newborn ; Lymph nodes ; malignant blue naevus ; Melanocytes ; Melanocytes - pathology ; Melanoma ; Melanoma - pathology ; Metastases ; Middle Aged ; Nevus, Blue - diagnosis ; Nevus, Blue - pathology ; Nevus, Pigmented - pathology ; Plaques ; plaque‐type blue naevus ; Skin Neoplasms - diagnosis ; Skin Neoplasms - pathology ; Tumors ; Young Adult</subject><ispartof>Histopathology, 2024-05, Vol.84 (6), p.1047-1055</ispartof><rights>2024 The Author(s). Histopathology published by John Wiley & Sons Ltd.</rights><rights>2024 John Wiley & Sons Ltd.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3482-16a059673b1625706a72f355db1b11c31f5dae2fe66e4a6e4bf6f1a47e753b013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fhis.15152$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fhis.15152$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1416,27922,27923,45572,45573</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38305122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tseng, Calvin</creatorcontrib><creatorcontrib>Wiedemeyer, Katharina</creatorcontrib><creatorcontrib>Mehta, Arjun</creatorcontrib><creatorcontrib>Rojas‐Garcia, Priscila</creatorcontrib><creatorcontrib>Temple‐Oberle, Claire</creatorcontrib><creatorcontrib>Orlando, Antonio</creatorcontrib><creatorcontrib>Miller, Keith</creatorcontrib><creatorcontrib>Gharpuray‐Pandit, Deepa</creatorcontrib><creatorcontrib>Brenn, Thomas</creatorcontrib><title>The clinico‐pathological spectrum of plaque‐type blue naevi and their potential for malignant transformation</title><title>Histopathology</title><addtitle>Histopathology</addtitle><description>Aims
Plaque‐type blue naevi are rare melanocytic tumours presenting as large, pigmented plaques at birth or during childhood. There is a risk for malignant transformation, but no larger comprehensive studies exist and the diagnosis is challenging, especially on limited biopsy material. The aim is to describe the clinicopathological features and behaviour of the disease more comprehensively.
Methods and results
We retrieved eight plaque‐type blue naevi, presenting as large, pigmented plaques (median = 7 cm; range = 3–26) most frequently affecting the scalp (four) followed by the cheek, arm, abdominal wall and gluteal cleft (one each), with a slight female predilection. Median age at time of biopsy was 39.5 years (range = 15–90), but three tumours had been present at birth and one since childhood. Histopathologically, the tumours were poorly circumscribed and composed of cellular fascicles of uniform spindle cells in a background of variably prominent pigmented dendritic cells affecting dermis and subcutaneous tissues. The majority had mutations in GNAQ. One tumour showed malignant transformation, characterised by an expansile nodule of pleomorphic epithelioid melanocytes with rhabdoid morphology, high mitotic activity and areas of necrosis. This patient developed metastatic melanoma to lymph nodes. All patients are alive with a median follow‐up of 60 months.
Conclusion
Plaque‐type blue naevi are diagnostically challenging tumours with risk for malignant transformation. Awareness and familiarity with the salient clinicopathological features are necessary for reliable diagnosis, and long‐term clinical follow‐up is required to monitor for malignant transformation.
Plaque‐type blue naevi are rare melanocytic tumours in the spectrum of blue naevi, presenting during childhood as large, pigmented plaques with a predilection for the head and neck and trunk. They may undergo malignant transformation, characterised by epithelioid cell morphology, nuclear pleomorphism, high mitotic rate and necrosis, and patients require life‐long clinical follow‐up.</description><subject>Abdominal wall</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biopsy</subject><subject>Children</subject><subject>congenital naevus</subject><subject>Dendritic cells</subject><subject>Dermis</subject><subject>Diagnosis</subject><subject>Familiarity</subject><subject>Female</subject><subject>Genetic transformation</subject><subject>GNAQ mutation</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Lymph nodes</subject><subject>malignant blue naevus</subject><subject>Melanocytes</subject><subject>Melanocytes - pathology</subject><subject>Melanoma</subject><subject>Melanoma - pathology</subject><subject>Metastases</subject><subject>Middle Aged</subject><subject>Nevus, Blue - diagnosis</subject><subject>Nevus, Blue - pathology</subject><subject>Nevus, Pigmented - pathology</subject><subject>Plaques</subject><subject>plaque‐type blue naevus</subject><subject>Skin Neoplasms - diagnosis</subject><subject>Skin Neoplasms - pathology</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>0309-0167</issn><issn>1365-2559</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kcFKXTEQhkOx1FvbRV-gBNzYxdFMcpNzz1JEqyB0UbsOOedOvJGc5JjkWO6uj-Az-iTGXttFoQPDwPDNz_D_hHwCdgy1TjYuH4MEyd-QBQglGy5lt0cWTLCuYaDaffI-5zvGoBWcvyP7YiWYBM4XZLrZIB28C26IT78eJ1M20cdbNxhP84RDSfNIo6WTN_czVqJsJ6S9n5EGgw-OmrCmZYMu0SkWDMXVQxsTHY13t8GEQksyIdfVaIqL4QN5a43P-PF1HpAfF-c3Z5fN9bevV2en180glivegDJMdqoVPSguW6ZMy62Qct1DDzAIsHJtkFtUCpemdm-VBbNssZWiZyAOyNFOd0qxfp6LHl0e0HsTMM5Z8453IKp7y4oe_oPexTmF-p0WLxaKVatEpb7sqCHFnBNaPSU3mrTVwPRLDLrGoH_HUNnPr4pzP-L6L_nH9wqc7ICfzuP2_0r68ur7TvIZE3uUEg</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Tseng, Calvin</creator><creator>Wiedemeyer, Katharina</creator><creator>Mehta, Arjun</creator><creator>Rojas‐Garcia, Priscila</creator><creator>Temple‐Oberle, Claire</creator><creator>Orlando, Antonio</creator><creator>Miller, Keith</creator><creator>Gharpuray‐Pandit, Deepa</creator><creator>Brenn, Thomas</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7T5</scope><scope>7TK</scope><scope>7TM</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>202405</creationdate><title>The clinico‐pathological spectrum of plaque‐type blue naevi and their potential for malignant transformation</title><author>Tseng, Calvin ; Wiedemeyer, Katharina ; Mehta, Arjun ; Rojas‐Garcia, Priscila ; Temple‐Oberle, Claire ; Orlando, Antonio ; Miller, Keith ; Gharpuray‐Pandit, Deepa ; Brenn, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3482-16a059673b1625706a72f355db1b11c31f5dae2fe66e4a6e4bf6f1a47e753b013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal wall</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biopsy</topic><topic>Children</topic><topic>congenital naevus</topic><topic>Dendritic cells</topic><topic>Dermis</topic><topic>Diagnosis</topic><topic>Familiarity</topic><topic>Female</topic><topic>Genetic transformation</topic><topic>GNAQ mutation</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Lymph nodes</topic><topic>malignant blue naevus</topic><topic>Melanocytes</topic><topic>Melanocytes - pathology</topic><topic>Melanoma</topic><topic>Melanoma - pathology</topic><topic>Metastases</topic><topic>Middle Aged</topic><topic>Nevus, Blue - diagnosis</topic><topic>Nevus, Blue - pathology</topic><topic>Nevus, Pigmented - pathology</topic><topic>Plaques</topic><topic>plaque‐type blue naevus</topic><topic>Skin Neoplasms - diagnosis</topic><topic>Skin Neoplasms - pathology</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tseng, Calvin</creatorcontrib><creatorcontrib>Wiedemeyer, Katharina</creatorcontrib><creatorcontrib>Mehta, Arjun</creatorcontrib><creatorcontrib>Rojas‐Garcia, Priscila</creatorcontrib><creatorcontrib>Temple‐Oberle, Claire</creatorcontrib><creatorcontrib>Orlando, Antonio</creatorcontrib><creatorcontrib>Miller, Keith</creatorcontrib><creatorcontrib>Gharpuray‐Pandit, Deepa</creatorcontrib><creatorcontrib>Brenn, Thomas</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Histopathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tseng, Calvin</au><au>Wiedemeyer, Katharina</au><au>Mehta, Arjun</au><au>Rojas‐Garcia, Priscila</au><au>Temple‐Oberle, Claire</au><au>Orlando, Antonio</au><au>Miller, Keith</au><au>Gharpuray‐Pandit, Deepa</au><au>Brenn, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The clinico‐pathological spectrum of plaque‐type blue naevi and their potential for malignant transformation</atitle><jtitle>Histopathology</jtitle><addtitle>Histopathology</addtitle><date>2024-05</date><risdate>2024</risdate><volume>84</volume><issue>6</issue><spage>1047</spage><epage>1055</epage><pages>1047-1055</pages><issn>0309-0167</issn><eissn>1365-2559</eissn><abstract>Aims
Plaque‐type blue naevi are rare melanocytic tumours presenting as large, pigmented plaques at birth or during childhood. There is a risk for malignant transformation, but no larger comprehensive studies exist and the diagnosis is challenging, especially on limited biopsy material. The aim is to describe the clinicopathological features and behaviour of the disease more comprehensively.
Methods and results
We retrieved eight plaque‐type blue naevi, presenting as large, pigmented plaques (median = 7 cm; range = 3–26) most frequently affecting the scalp (four) followed by the cheek, arm, abdominal wall and gluteal cleft (one each), with a slight female predilection. Median age at time of biopsy was 39.5 years (range = 15–90), but three tumours had been present at birth and one since childhood. Histopathologically, the tumours were poorly circumscribed and composed of cellular fascicles of uniform spindle cells in a background of variably prominent pigmented dendritic cells affecting dermis and subcutaneous tissues. The majority had mutations in GNAQ. One tumour showed malignant transformation, characterised by an expansile nodule of pleomorphic epithelioid melanocytes with rhabdoid morphology, high mitotic activity and areas of necrosis. This patient developed metastatic melanoma to lymph nodes. All patients are alive with a median follow‐up of 60 months.
Conclusion
Plaque‐type blue naevi are diagnostically challenging tumours with risk for malignant transformation. Awareness and familiarity with the salient clinicopathological features are necessary for reliable diagnosis, and long‐term clinical follow‐up is required to monitor for malignant transformation.
Plaque‐type blue naevi are rare melanocytic tumours in the spectrum of blue naevi, presenting during childhood as large, pigmented plaques with a predilection for the head and neck and trunk. They may undergo malignant transformation, characterised by epithelioid cell morphology, nuclear pleomorphism, high mitotic rate and necrosis, and patients require life‐long clinical follow‐up.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>38305122</pmid><doi>10.1111/his.15152</doi><tpages>1055</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0309-0167 |
| ispartof | Histopathology, 2024-05, Vol.84 (6), p.1047-1055 |
| issn | 0309-0167 1365-2559 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2929131114 |
| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Abdominal wall Adolescent Adult Aged Aged, 80 and over Biopsy Children congenital naevus Dendritic cells Dermis Diagnosis Familiarity Female Genetic transformation GNAQ mutation Humans Infant, Newborn Lymph nodes malignant blue naevus Melanocytes Melanocytes - pathology Melanoma Melanoma - pathology Metastases Middle Aged Nevus, Blue - diagnosis Nevus, Blue - pathology Nevus, Pigmented - pathology Plaques plaque‐type blue naevus Skin Neoplasms - diagnosis Skin Neoplasms - pathology Tumors Young Adult |
| title | The clinico‐pathological spectrum of plaque‐type blue naevi and their potential for malignant transformation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T23%3A45%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20clinico%E2%80%90pathological%20spectrum%20of%20plaque%E2%80%90type%20blue%20naevi%20and%20their%20potential%20for%20malignant%20transformation&rft.jtitle=Histopathology&rft.au=Tseng,%20Calvin&rft.date=2024-05&rft.volume=84&rft.issue=6&rft.spage=1047&rft.epage=1055&rft.pages=1047-1055&rft.issn=0309-0167&rft.eissn=1365-2559&rft_id=info:doi/10.1111/his.15152&rft_dat=%3Cproquest_cross%3E2929131114%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3030938763&rft_id=info:pmid/38305122&rfr_iscdi=true |