Germ Cell Tumors, Hepatoblastoma and Retinoblastoma

Germ Cell Tumors, Hepatoblastoma and Retinoblastoma
Neyssa Marina, MD
Division of Hematology-Oncology, Lucile Salter Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
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Chapter Description:
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Pediatric germ cell tumors are rare representing only 2-3% of childho...
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Staging: the staging systems for germ cell tumors includes a combinat...
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There are at least 6 histologic sub-types of germ cell tumors as illu...
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When one compares pediatric and adult germ cell tumor patients, sever...
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The survival of pediatric germ cell tumors was poor before the consis...
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The introduction of chemotherapy including cyclophosphamide at 10 mg/...
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The introduction of the Einhorn regimen revolutionized the treatment ...
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Although preliminary results from St. Jude and the United Kingdom sug...
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Based on the differences between pediatric and adult germ cell tumors...
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This illustrates the 6-year EFS
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This slide illustrates the treatment schema for all patients. Patien...
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There were 74 patients with stage II testicular and stage I-II ovaria...
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This slide reviews the study design for patients with advanced germ c...
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299 patients with extracranial, advanced GCT were eligible for partic...
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This slide illustrates the 6-year EFS
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Multivariate Cox proportional hazard regression identified age > 12 y...
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In conclusion, patients with stage I germ cell tumors represent a low...
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Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, Bunin GR (...
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This presentation discusses Germ Cell Tumors, Hepatoblastoma and Retinoblastoma.
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References
http://home.ccr.cancer.gov
Frazier AL, Rumcheva P, Olson T, Giller R, Cushing B, Cullen J, Marina N, London WB; Children's Oncology Group. Application of the adult international germ cell classification system to pediatric malignant non-seminomatous germ cell tumors: a report from the Children's Oncology Group. Pediatr Blood Cancer. 2008 Apr;50(4):746-51.
Marina N, London WB, Frazier AL, Lauer S, Rescorla F, Cushing B, Malogolowkin MH, Castleberry RP, Womer RB, Olson T. Prognostic factors in children with extragonadal malignant germ cell tumors: a pediatric intergroup study. J Clin Oncol. 2006 Jun 1;24(16):2544-8.
Rogers PC, Olson TA, Cullen JW, Billmire DF, Marina N, Rescorla F, Davis MM, London WB, Lauer SJ, Giller RH, Cushing B; Pediatric Oncology Group 9048; Children's Cancer Group 8891. Treatment of children and adolescents with stage II testicular and stages I and II ovarian malignant germ cell tumors: A Pediatric Intergroup Study--Pediatric Oncology Group 9048 and Children's Cancer Group 8891. J Clin Oncol. 2004 Sep 1;22(17):3563-9.
Cushing B, Giller R, Cullen JW, Marina NM, Lauer SJ, Olson TA, Rogers PC, Colombani P, Rescorla F, Billmire DF, Vinocur CD, Hawkins EP, Davis MM, Perlman EJ, London WB, Castleberry RP; Pediatric Oncology Group 9049; Children's Cancer Group 8882. Randomized comparison of combination chemotherapy with etoposide, bleomycin, and either high-dose or standard-dose cisplatin in children and adolescents with high-risk malignant germ cell tumors: a pediatric intergroup study--Pediatric Oncology Group 9049 and Children's Cancer Group 8882. J Clin Oncol. 2004 Jul 1;22(13):2691-700.
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			<span style="display:none;" id="span_2">Pediatric germ cell tumors are rare representing only 2-3% of childhood malignancies.  They arise from pluripotent stem cells and are usually composed of tissues foreign to the original site of origin.  Tumors can arise in both gonadal and extragonadal sites.  During the rest of the time, I will be discussing extracranial germ cell tumors since their intracranial counterparts are usually discussed in the context of brain tumors.|~|/files/powerpoints_images/node257239/Slide2.JPG|~|563|~|422|~|0</span>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257246">Pediatric germ cell tumors are rare representing only 2-3% of childho...</div></td>
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			<span style="display:none;" id="span_6">Staging: the staging systems for germ cell tumors includes a combination of clinical presentation and the extent of surgical resection at the time of diagnosis.  As illustrated:Stage I: completely resected with normalization of markers according to half-lifeStage II: microscopic residual as evidenced by persistent marker elevation or retroperitoneal lymph nodes < 2 cmsStage III: gross residual disease or retroperitoneal lymph nodes > 2 cms without evidence of extra-abdominal or visceral metastases.Stage IV: distant metastases.|~|/files/powerpoints_images/node257239/Slide6.JPG|~|563|~|422|~|0</span>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257254">Staging: the staging systems for germ cell tumors includes a combinat...</div></td>
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			<span style="display:none;" id="span_7">There are at least 6 histologic sub-types of germ cell tumors as illustrated in the table on the left abstracted from a recent paper by J. Mann.  This include germinomas, teratomas, which can be further classified as mature, immature or frankly malignant.  In addition, the tumor can include yolk sac carcinoma, embryonal carcinoma or choriocarcinoma.|~|/files/powerpoints_images/node257239/Slide7.JPG|~|563|~|422|~|0</span>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257256">There are at least 6 histologic sub-types of germ cell tumors as illu...</div></td>
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			<span style="display:none;" id="span_8">When one compares pediatric and adult germ cell tumor patients, several differences become apparent.  First, in children less than 4 years of age, the most common histologic sub-type is endodermal sinus tumors, whereas in adolescents and young adults the most common sub-type are mixed germ cell tumors.In addition to the histologic differences, cytogenetically tumors in these two age groups are also different.  For instance, pediatric tumors (illustrated in the top panel) are commonly diploid |~|/files/powerpoints_images/node257239/Slide8.JPG|~|563|~|422|~|0</span>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257258">When one compares pediatric and adult germ cell tumor patients, sever...</div></td>
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			<span style="display:none;" id="span_9">The survival of pediatric germ cell tumors was poor before the consistent use of effective chemotherapy with survival in the 20% range as illustrated in this slide from a paper describing outcome of 63 patients with endodermal sinus tumor of the ovary.  In that series, the actuarial survival at 3 years was 13%.|~|/files/powerpoints_images/node257239/Slide9.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>9</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257260">The survival of pediatric germ cell tumors was poor before the consis...</div></td>
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			<span style="display:none;" id="span_10">The introduction of chemotherapy including cyclophosphamide at 10 mg/kg/d x 5 days every 6 weeks improved the prognosis for pediatric patients with germ cell tumors as illustrated in this slide.  However, the outcome for patients with advanced disease especially stage IV continued to be poor.|~|/files/powerpoints_images/node257239/Slide10.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>10</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257262">The introduction of chemotherapy including cyclophosphamide at 10 mg/...</div></td>
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			<span style="display:none;" id="span_11">The introduction of the Einhorn regimen revolutionized the treatment of testicular tumors in adults since it produced high-remission rates.  |~|/files/powerpoints_images/node257239/Slide11.JPG|~|563|~|422|~|0</span>
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								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide11.JPG" id="image_11"/>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>11</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257264">The introduction of the Einhorn regimen revolutionized the treatment ...</div></td>
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			<span style="display:none;" id="span_12">Although preliminary results from St. Jude and the United Kingdom suggested that cisplatin-based therapy was effective in children with 67-84% survival at 5 years.  Pediatricians continued to have significant concerns regarding the toxicity of this combination.  This included concerns regarding both the pulmonary toxicity of bleomycin as well as hearing loss with cisplatin.|~|/files/powerpoints_images/node257239/Slide12.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>12</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257266">Although preliminary results from St. Jude and the United Kingdom sug...</div></td>
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			<span style="display:none;" id="span_13">Based on the differences between pediatric and adult germ cell tumors, the POG |~|/files/powerpoints_images/node257239/Slide13.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>13</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257268">Based on the differences between pediatric and adult germ cell tumors...</div></td>
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			<span style="display:none;" id="span_14">This illustrates the 6-year EFS |~|/files/powerpoints_images/node257239/Slide14.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>14</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257270">This illustrates the 6-year EFS </div></td>
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		<div id="div_15" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(15);">
			<span style="display:none;" id="span_15">This slide illustrates the treatment schema for all patients.  Patients with localized disease received standard PEB with cisplatin at a dose of 20 mg/m2/day x 5 days.  The advanced stage patients were randomly assigned to standard or HD-PEB.  As you can see, the only difference between these two arms is the cisplatin dose.|~|/files/powerpoints_images/node257239/Slide15.JPG|~|563|~|422|~|0</span>
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								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide15.JPG" id="image_15"/>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>15</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257272">This slide illustrates the treatment schema for all patients.  Patien...</div></td>
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			<span style="display:none;" id="span_16">There were 74 patients with stage II testicular and stage I-II ovarian tumors enrolled on the localized study and treated with surgical resection followed by 4-6 cycles of PEB.  This included 17 patients (median age of 20 months) with stage II testicular tumors, 41 patients with stage I ovarian tumors (median age 11.9 years) and 16 patients with stage II ovarian tumors (median age 10.7 years).|~|/files/powerpoints_images/node257239/Slide16.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>16</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257274">There were 74 patients with stage II testicular and stage I-II ovaria...</div></td>
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			<span style="display:none;" id="span_17">This slide reviews the study design for patients with advanced germ cell tumors.  That is following diagnosis, patients were randomized to standard of dose-intensive PEB.|~|/files/powerpoints_images/node257239/Slide17.JPG|~|563|~|422|~|0</span>
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								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide17.JPG" id="image_17"/>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>17</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257276">This slide reviews the study design for patients with advanced germ c...</div></td>
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			<span style="display:none;" id="span_18">299 patients with extracranial, advanced GCT were eligible for participation in the high-risk study.  The patients were diagnosed between FEB 1990-96, had a median age of 3.4 years.  183 were female and there were 134 gonadal and 165 extragonadal tumors.  The stage distribution included a 269 patients with stage  III or IV disease.Following surgery 150 patients were randomized to PEB while 149 were randomized to HD-PEB.  There was an equal distribution of primary sites by treatment.|~|/files/powerpoints_images/node257239/Slide18.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>18</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257278">299 patients with extracranial, advanced GCT were eligible for partic...</div></td>
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			<span style="display:none;" id="span_19">This slide illustrates the 6-year EFS |~|/files/powerpoints_images/node257239/Slide19.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>19</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257280">This slide illustrates the 6-year EFS </div></td>
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			<span style="display:none;" id="span_20">Multivariate Cox proportional hazard regression identified age > 12 years as the only significant prognostic factor for EFS with a risk of death 3.8 times higher in these patients as compared to patients < 12 years of age.  After adjusting for age, treatment was borderline significant for EFS.  In multivariate COX PH model for OS, the interaction of age and primary site was highly significant.  Patients > 12 with thoracic tumors had 5.9 times greater risk of death than patients < 12 years or patients with any other primary |~|/files/powerpoints_images/node257239/Slide20.JPG|~|563|~|422|~|0</span>
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														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>20</strong></td>
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														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257282">Multivariate Cox proportional hazard regression identified age > 12 y...</div></td>
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			<span style="display:none;" id="span_21">In conclusion, patients with stage I germ cell tumors represent a low-risk group.Patients with stage II-IV gonadal tumors appear to be an intermediate risk group with an excellent outcome following PEB.Patients with advanced extragonadal germ cell tumors are a higher-risk group.  In this group, age > 12 years is the most predictive factor for EFS.  There is a significant interaction between age and primary site suggesting that patients over 12 years with thoracic tumors are biologically different.|~|/files/powerpoints_images/node257239/Slide21.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide21.JPG" id="image_21"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>21</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257284">In conclusion, patients with stage I germ cell tumors represent a low...</div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_22" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(22);">
			<span style="display:none;" id="span_22">|~|/files/powerpoints_images/node257239/Slide22.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide22.JPG" id="image_22"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>22</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257286"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_23" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(23);">
			<span style="display:none;" id="span_23">Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, Bunin GR (eds).  Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1995, National Cancer Institute, SEER Program.  NIH Pub. No. 99-4649. Bethesda, MD, 1999. |~|/files/powerpoints_images/node257239/Slide23.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide23.JPG" id="image_23"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>23</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257288">Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, Bunin GR (...</div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_24" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(24);">
			<span style="display:none;" id="span_24">|~|/files/powerpoints_images/node257239/Slide24.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide24.JPG" id="image_24"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>24</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257290"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_25" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(25);">
			<span style="display:none;" id="span_25">|~|/files/powerpoints_images/node257239/Slide25.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide25.JPG" id="image_25"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>25</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257292"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_26" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(26);">
			<span style="display:none;" id="span_26">|~|/files/powerpoints_images/node257239/Slide26.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide26.JPG" id="image_26"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>26</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257294"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_27" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(27);">
			<span style="display:none;" id="span_27">|~|/files/powerpoints_images/node257239/Slide27.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide27.JPG" id="image_27"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>27</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257296"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_28" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(28);">
			<span style="display:none;" id="span_28">|~|/files/powerpoints_images/node257239/Slide28.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide28.JPG" id="image_28"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>28</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257298"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_29" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(29);">
			<span style="display:none;" id="span_29">|~|/files/powerpoints_images/node257239/Slide29.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide29.JPG" id="image_29"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>29</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257300"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_30" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(30);">
			<span style="display:none;" id="span_30">|~|/files/powerpoints_images/node257239/Slide30.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide30.JPG" id="image_30"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>30</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257302"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_31" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(31);">
			<span style="display:none;" id="span_31">|~|/files/powerpoints_images/node257239/Slide31.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide31.JPG" id="image_31"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>31</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257304"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_32" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(32);">
			<span style="display:none;" id="span_32">|~|/files/powerpoints_images/node257239/Slide32.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide32.JPG" id="image_32"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>32</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257306"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_33" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(33);">
			<span style="display:none;" id="span_33">|~|/files/powerpoints_images/node257239/Slide33.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide33.JPG" id="image_33"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>33</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257308"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_34" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(34);">
			<span style="display:none;" id="span_34">|~|/files/powerpoints_images/node257239/Slide34.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide34.JPG" id="image_34"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>34</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257310"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_35" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(35);">
			<span style="display:none;" id="span_35">|~|/files/powerpoints_images/node257239/Slide35.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide35.JPG" id="image_35"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>35</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257312"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_36" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(36);">
			<span style="display:none;" id="span_36">|~|/files/powerpoints_images/node257239/Slide36.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide36.JPG" id="image_36"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>36</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257314"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_37" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(37);">
			<span style="display:none;" id="span_37">|~|/files/powerpoints_images/node257239/Slide37.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide37.JPG" id="image_37"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>37</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257316"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_38" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(38);">
			<span style="display:none;" id="span_38">|~|/files/powerpoints_images/node257239/Slide38.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide38.JPG" id="image_38"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>38</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257318"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_39" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(39);">
			<span style="display:none;" id="span_39">|~|/files/powerpoints_images/node257239/Slide39.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide39.JPG" id="image_39"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>39</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257320"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_40" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(40);">
			<span style="display:none;" id="span_40">|~|/files/powerpoints_images/node257239/Slide40.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide40.JPG" id="image_40"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>40</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257322"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_41" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(41);">
			<span style="display:none;" id="span_41">|~|/files/powerpoints_images/node257239/Slide41.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide41.JPG" id="image_41"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>41</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257324"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_42" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(42);">
			<span style="display:none;" id="span_42">|~|/files/powerpoints_images/node257239/Slide42.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide42.JPG" id="image_42"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>42</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257326"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_43" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(43);">
			<span style="display:none;" id="span_43">|~|/files/powerpoints_images/node257239/Slide43.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide43.JPG" id="image_43"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>43</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257328"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_44" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(44);">
			<span style="display:none;" id="span_44">|~|/files/powerpoints_images/node257239/Slide44.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide44.JPG" id="image_44"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>44</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257330"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_45" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(45);">
			<span style="display:none;" id="span_45">|~|/files/powerpoints_images/node257239/Slide45.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide45.JPG" id="image_45"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>45</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257332"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_46" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(46);">
			<span style="display:none;" id="span_46">|~|/files/powerpoints_images/node257239/Slide46.JPG|~|563|~|422|~|0</span>
			<table cellspacing="0" cellpadding="0" border="0" align="right" width="294px">
				<tbody>
					<tr height="62px">
						
						<td width="36%" class="image_tag" style="cursor:hand;">
							<div style="overflow:hidden;height:61px;width:105px">
								<img height="79" width="105" border="0" src="/files/powerpoints_images/node257239/Slide46.JPG" id="image_46"/>
							</div>
						</td>
						<td class="image_tag_desc" width="64%">
							<table cellspacing="0" cellpadding="0" border="0" align="center" width="99%" class="table172X62" >
								<tbody>
									<tr>
										<td valign="top">
											<table cellspacing="0" cellpadding="0" border="0" align="center" width="96%">
												<tbody>
													<tr>
														<td width="94%" align="left"><strong>Image</strong></td>
														<td width="6%"><strong>46</strong></td>
													</tr>
													<tr>
														<td height="42" valign="top" colspan="2" align="left" text-align="left"><div id="imagedesc_257334"></div></td>
													</tr>
												</tbody>
											</table>
										</td>
									</tr>
								</tbody>
							</table>
						</td>
					</tr>
				</tbody>
			</table>
		</div>
	</td>
</tr>
<tr height="68px">
	<td align="center" valign="bottom" height="68px" colspan="2">
		<div id="div_47" style="height: 68px; width: 300px; padding-top: 6px; cursor:hand;" class="cont_ents" onclick="fill_imagedetails(47);">
			<span style="display:none;" id="span_47">|~|/files/powerpoints_images/node257239/Slide47.JPG|~|563|~|422|~|0</span>
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														<td width="6%"><strong>49</strong></td>
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Germ Cell Tumors, Hepatoblastoma and Retinoblastoma

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