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Sudo A, Oura S. A case of breast cancer developed in the chronic expanding hematoma cyst wall. Radiol Case Rep 2024; 19:5169-5173. [PMID: 39263521 PMCID: PMC11388040 DOI: 10.1016/j.radcr.2024.07.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/13/2024] Open
Abstract
No studies have reported breast cancer cases developed in the chronic expanding hematoma (CEH). Case presentation: A 47-year-old woman was referred to our hospital for the treatment of a large breast mass. Ultrasound showed that the tumor had an intra-cystic tumor pattern. Magnetic resonance imaging (MRI) of the mass component showed a hypo intense pattern on T1-weighted images, a mosaic pattern on T2 weighted images, and a faint enhancement on time-signal intensity images. Core needle biopsy pathologically showed connective tissue, hematoma, and hemosiderin laden macrophages neither with any mammary gland components nor with malignant cells. These image findings and the presence of hemosiderin laden macrophages led us to the diagnosis of CEH despite the lack of prior breast surgery. The large tumor size of the presumed CEH and its tendency for rapid growth made us attempt to treat the breast lesion with lumpectomy. Frozen section, however, revealed malignant cells in the hard part of the capsule, leading to the conversion of breast surgery from lumpectomy to nipple-preserving mastectomy. Postoperative pathological study showed that the tumor was composed of atypical cells growing in cribriform, tubular, and papillary fashions. In addition to the malignant cells, cyst wall of the CEH had abundant fibrosis and hemosiderin deposits. This is the first CEH case after no prior breast surgery, which had breast cancer within it. When a breast CEH is suspected, careful follow-up is imperative to avoid underestimating a possible concomitant breast cancer.
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Affiliation(s)
- Ayami Sudo
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada-city, OSAKA, 596-8522, Japan
| | - Shoji Oura
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada-city, OSAKA, 596-8522, Japan
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2
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Ozcan C, Dag A, Benli S, Tuncel F. Encapsulated papillary carcinoma of the breast clinicopathological features and management: Could sentinel lymph node biopsy be exempted? Asia Pac J Clin Oncol 2024. [PMID: 38886990 DOI: 10.1111/ajco.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/30/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Papillary lesions in the breast pose diagnostic and therapeutic challenges. Encapsulated papillary carcinoma (EPC) is a rare breast cancer. However, evidence-based guidelines are limited. For this reason, there is no complete clarity in diagnosis and treatment management, and there are insufficient studies in the literature. This study aimed to examine the necessity of sentinel lymph node sampling in the management of EPC, in line with patients' clinicopathological data. METHODS We retrospectively screened patients with EPC in our clinic between January 2012 and March 2022. We recorded and statistically evaluated patients' demographic, clinical, radiological, pathological, and treatment management. RESULTS Sixty-four patients with EPCs were identified. The final pathologic evaluation revealed that 19 patients (18.7%) had pure EPC, 27 patients (43.7%) had EPC with associated ductal carcinoma in situ and 18 patients (37.5%) had EPC associated with invasion. The mean age was 61 years, and two patients were male. Breast-conserving surgery was performed in 62 patients, and simple mastectomy was performed in two patients. Sentinel lymph node biopsy (SLNB) was positive in only one patient. Sixty-three patients with EPC were hormone receptor-positive, and one patient was triple-negative and was associated with invasion. None of the patients died, one had a local recurrence, and a mastectomy was performed. CONCLUSIONS The overall prognosis and long-term survival of patients with EPC were excellent. Our study and the current literature indicate that routine SLNB is overtreatment because surgical excision with negative margins is sufficient in EPC cases and lymph node metastasis is rare, even with an invasive component.
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Affiliation(s)
- Cumhur Ozcan
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Dag
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Sami Benli
- Department of Surgical Oncology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ferah Tuncel
- Department of Medical Pathology, Faculty of Medicine, Mersin University, Mersin, Turkey
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3
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Belonenko GA, Aksyonov AA, Sukhina NA, Aksyonova EG. The Use of Pneumocystography for Navigation of Stereotaxic Core-needle Biopsy in Complex Breast Cysts: Case Report. Kurume Med J 2024; 69:265-269. [PMID: 38233178 DOI: 10.2739/kurumemedj.ms6934011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Complex breast cysts (CBC) are characterized by a high (up to 31.0%) oncological potential and the need for a biopsy. In some clinical situations, navigating a biopsy using mammography (MG), ultrasound (US), endoscopy, and magnetic resonance imaging (MRI) may be difficult. The first case of stereotaxic core-needle biopsy (sCNB) under pneumocystography (PCG) guide is presented.
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Affiliation(s)
- G A Belonenko
- Department of Surgery, Faculty of Postgraduate Education, Donetsk National Medical University
| | - A A Aksyonov
- Department of Minimally Invasive Interventions of the National Cancer Institute
| | - N A Sukhina
- Department of Radiology, Faculty of Postgraduate Education, Donetsk National Medical University
| | - E G Aksyonova
- Department of Fundamental Medicine ESC "Institute of Biology and Medicine" T. Shevchenko National University
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4
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Zhang J, Maimone S, Cornell L, Komforti MK, Letter H. Encapsulated papillary carcinoma of the breast: A case report. Radiol Case Rep 2023; 18:1738-1742. [PMID: 36915606 PMCID: PMC10006301 DOI: 10.1016/j.radcr.2023.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 03/02/2023] Open
Abstract
Breast malignancies diagnosed from screening mammography most commonly present as a new or enlarging lesion at the time of diagnosis. We present the unusual case of an encapsulated papillary carcinoma that demonstrated decreasing size on mammogram over several subsequent years. We review the unique imaging and histologic findings of papillary carcinoma that make this imaging conundrum possible.
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Affiliation(s)
- Joe Zhang
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224 USA
| | - Santo Maimone
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224 USA
| | - Lauren Cornell
- Department of Hematology/Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224 USA
| | - Miglena K Komforti
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224 USA
| | - Haley Letter
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224 USA
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5
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An intriguing journey of encapsulated apocrine papillary carcinoma of the breast. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Encapsulated Apocrine Papillary Carcinoma (EAPC) of the breast are very rare tumors. They usually present as a cystic mass with mural nodule in women aged 44–84 years. Affected patients may be asymptomatic or complain of breast swelling, or nipple discharge. Mammographic features are nonspecific. The tumor appears as a high-density round or oval mass with circumscribed or spiculated margins on mammography. On Ultrasonography (US) a classical lesion appears as predominantly cystic mass with intracystic solid papillary projections and area of vascularity within it. Contrast Enhanced Breast MRI helps to further characterize the lesion by showing intense contrast enhancement in early phase along with washout curve. Histological features of these tumors are similar to those of classical encapsulated papillary neoplasm, in that myoepithelial cells are absent within the papillary structures and at the periphery of the cyst. They show variable degree of cytological atypia and mitotic activity. Such tumors consist of abundant granular eosinophilic cytoplasm and large nuclei with prominent nucleoli and are androgen receptor positive. However, a multidisciplinary approach is crucial for diagnosis and tissue histology is essential to suitably formulate treatment guidelines. Surgical excision is the preferred treating option for these tumors. Little consensus is available about local radiation and adjuvant therapy for the treatment of such tumors, yet they have been reported to have good prognosis.
Case presentation
This rare case report describes the intriguing journey towards the diagnosis of an encapsulated intracystic apocrine papillary carcinoma in a 52-year-old premenopausal female who presented with palpable breast swelling in left breast. The patient underwent mammography, breast ultrasound and breast MRI concluding it to be a BIRADS 4A lesion. Then the patient was subjected to trucut core biopsy and finally surgical excision was performed. On Histopathology this lesion was diagnosed as encapsulated apocrine papillary carcinoma with androgen receptor positivity and triple negative hormonal status. At present patient is on regular follow-up.
Conclusions
Encapsulated intracystic apocrine papillary carcinoma has a favorable prognosis with low recurrence rate and excellent long-term survival regardless of its invasive nature. Therefore, we present this rare entity to highlight the importance of radiological and histopathology findings in its diagnosis.
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6
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Athanasiou A, Khomsi F, de Joliniere B, Feki A. Encapsulated Papillary Carcinoma: A Case Report and Review of the Literature. Front Surg 2022; 8:743881. [PMID: 35187043 PMCID: PMC8854492 DOI: 10.3389/fsurg.2021.743881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Papillary neoplasms are a distinct assemblage of breast lesions whose main characteristic is the presence of fibrovascular cores which are surrounded by epithelial cells. Papillary lesions are of heterogenous nature, with similar clinical behavior and histomorphologic characteristics. Their biological patterns, however, can be quite different. According to the World Health Organization (WHO) (2019), breast tumors have been recently classified into five subdivisions of papillary neoplasms. They are namely: intraductal papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma (EPC), solid-papillary carcinoma and invasive papillary carcinoma. Despite the papillary architecture being easily recognized, histological variations are diagnostically challenging. The presence or absence of myoepithelial cells in the papillary cores can distinguish the malignant from the benign lesions respectively. EPC is a rare, histologically unique carcinoma type whose main characteristic is a thick fibrous capsule at the periphery and a prolific cell structure with fibrovascular stalk support. A characteristic feature is the absence of myoepithelial cells at the surrounding thick fibrous capsule. Usually, EPC maintains a slowly developing tumor despite the absence of myoepithelial cells. An EPC case presents diagnostic difficulties since it bears close resemblance to malignant and benign papillary breast lesions. Upon a clinical and radiological evaluation, EPC commonly appears as a benign lump. In mammography, the tumor is frequently found in a retroareolar position as a well-defined mass. On the other hand, in an ultrasound, the tumor will appear as a cystic lesion characterized by solid components. The clinical picture of EPC is usually an asymptomatic benign mass which at times can be felt through auto-palpation or screening mammography. A bloody nipple discharge is regarded as a common symptom. We report a case of an EPC of a 81-year-old woman who presented with a mass in the left breast.
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Affiliation(s)
- Aikaterini Athanasiou
- Department of Obstetrics and Gynecology, Fribourg Cantonal Hospital Chemin des Pensionnats, Villars-sur-Glâne, Switzerland
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Zheng X, Li F, Xuan ZD, Wang Y, Zhang L. Combination of shear wave elastography and BI-RADS in identification of solid breast masses. BMC Med Imaging 2021; 21:183. [PMID: 34852775 PMCID: PMC8638471 DOI: 10.1186/s12880-021-00702-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the value of quantitative shear wave elastography (SWE) plus the Breast Imaging Reporting and Data System (BI-RADS) in the identification of solid breast masses. METHODS A total of 108 patients with 120 solid breast masses admitted to our hospital from January 2019 to January 2020 were enrolled in this study. The pathological examination served as the gold standard for definitive diagnosis. Both SWE and BI-RADS grading were performed. RESULTS Out of the 120 solid breast masses in 108 patients, 75 benign and 45 malignant masses were pathologically confirmed. The size, shape, margin, internal echo, microcalcification, lateral acoustic shadow, and posterior acoustic enhancement of benign and malignant masses were significantly different (all P < 0.05). The E mean, E max, SD, and E ratio of benign and malignant masses were significantly different (all P < 0.05). The E min was similar between benign and malignant masses (P > 0.05). The percentage of Adler grade II-III of the benign masses was lower than that of the malignant masses (P < 0.05). BI-RADS plus SWE yielded higher diagnostic specificity and positive predictive value than either BI-RADS or SWE; BI-RADS plus SWE yielded the highest diagnostic accuracy among the three methods (all P < 0.05). CONCLUSION SWE plus routine ultrasonography BI-RADS has a higher value in differentiating benign from malignant breast masses than color doppler or SWE alone, which should be further promoted in clinical practice.
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Affiliation(s)
- Xue Zheng
- Pediatric Hospital Ultrasound Department, Cangzhou Central Hospital, Cangzhou, Hebei Province, China.
| | - Fei Li
- Department of Pulmonary and Critical Care Medicine (PCCM) Ward II, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Zhi-Dong Xuan
- Department of Ultrasound III, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Yu Wang
- Pediatric Hospital Ultrasound Department, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Lei Zhang
- Department of Clinical Laboratory, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
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Nuñez DL, González FC, Ibargüengoitia MC, Fuentes Corona RE, Hernández Villegas AC, Zubiate ML, Vázquez Manjarrez SE, Ruiz Velasco CC. Papillary lesions of the breast: a review. BREAST CANCER MANAGEMENT 2020. [DOI: 10.2217/bmt-2020-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Papillary breast lesions are rare breast tumors that comprise a broad spectrum of diseases. Pathologically they present as mass-like projections attached to the wall of the ducts, supported by fibrovascular stalks lined by epithelial cells. On mammogram they appear as masses that can be associated with microcalcifications. Ultrasound is the most used imaging modality. On ultrasound papillary lesions appear as homogeneous solid lesions or complex intracystic lesions. A nonparallel orientation, an echogenic halo or posterior acoustic enhancement associated with microcalcifications are highly suggestive of malignancy. MRI has proven to be useful to establish the extent of the lesion. Core needle biopsy is the gold standard for diagnosis. Surgical excision is usually recommended, although treatment for papillomas without atypia is still controversial.
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Affiliation(s)
- Denny Lara Nuñez
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Candanedo González
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa Ibargüengoitia
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Mariana Licano Zubiate
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos Casian Ruiz Velasco
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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9
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Bonnet SE, Carter GJ, Berg WA. Encapsulated Papillary Carcinoma of the Breast: Imaging Features with Histopathologic Correlation. JOURNAL OF BREAST IMAGING 2020; 2:590-597. [PMID: 38424859 DOI: 10.1093/jbi/wbaa068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 03/02/2024]
Abstract
Encapsulated papillary carcinoma (EPC) is a rare, clinically indolent breast malignancy most common in postmenopausal women. Absence of myoepithelial cells at the periphery is a characteristic feature. Mammographically, EPC typically presents as a mostly circumscribed, noncalcified, dense mass that can have focally indistinct margins when there is associated frank invasive carcinoma. Ultrasound shows a circumscribed solid or complex cystic and solid mass, and occasional hemorrhage in the cystic component may produce a fluid-debris level; the solid components typically show intense washout enhancement on MRI. Color Doppler may demonstrate a prominent vascular pedicle and blood flow within solid papillary fronds. Encapsulated papillary carcinoma can exist in pure form; however, EPC is often associated with conventional ductal carcinoma in-situ and/or invasive ductal carcinoma, no special type. Adjacent in-situ and invasive disease may be only focally present at the periphery of EPC and potentially unsampled at core-needle biopsy. In order to facilitate diagnosis, the mass wall should be included on core-needle biopsy, which will show absence of myoepithelial markers. Staging and prognosis are determined by any associated frankly invasive component, with usually excellent long-term survival and rare distant metastases.
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Affiliation(s)
- Sarah E Bonnet
- Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Gloria J Carter
- Magee-Womens Hospital of UPMC, Department of Pathology, Pittsburgh, PA
| | - Wendie A Berg
- Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
- University of Pittsburgh School of Medicine, Department of Radiology, Pittsburgh, PA
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10
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Hassan Z, Boulos F, Abbas J, El Charif MH, Assi H, Sbaity E. Intracystic papillary carcinoma: clinical presentation, patterns of practice, and oncological outcomes. Breast Cancer Res Treat 2020; 182:317-323. [PMID: 32462260 DOI: 10.1007/s10549-020-05680-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intracystic/encapsulated papillary carcinoma remains a poorly understood disease of the breast with a little amount of reports that describe it. It shares features with DCIS and IDC and predominantly affects postmenopausal women. This study aims to evaluate the clinical presentation, treatment, and outcomes in IPC patients managed at our institution. METHODS We retrospectively pooled twenty-eight IPC patients' medical records at our institution. Descriptive analysis of clinicopathological characteristics, approach, and outcomes was done along with a quantitative statistical analysis. RESULTS Cases were divided into three groups: isolated IPC, IPC associated with DCIS, and IPC associated with Invasive Carcinoma. Treatment modalities varied according to the IPC type and its associated components. All patients presented with a palpable mass. Immunohistochemical staining revealed that all isolated IPCs were ER and PR positive and HER2 negative. Lymph node dissection proved necessary only in IPC associated invasive carcinoma. Irregular borders and lobulations, among others, were found on non-invasive core biopsies that turned out to be associated with invasion on surgical pathology. All patients were alive after a median follow-up time of 23 months when the study was over with no reports of recurrence. CONCLUSION IPC cases and treatment approaches at our institution appear similar to the available literature and confirm the excellent prognosis among IPC. Even more, further studies into the key features such as BMI, family history, and radiological findings are necessary for a potential algorithm that could assess for risk of finding invasion in surgical pathology and subsequently the need for axillary/sentinel lymph node biopsy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Chemotherapy, Adjuvant
- Female
- Follow-Up Studies
- Humans
- Mammary Glands, Human/pathology
- Mammary Glands, Human/surgery
- Mastectomy
- Medical History Taking
- Middle Aged
- Neoplasm Invasiveness/diagnosis
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Prognosis
- Retrospective Studies
- Sentinel Lymph Node/pathology
- Sentinel Lymph Node Biopsy
- Treatment Outcome
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Affiliation(s)
- Zeina Hassan
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Phase 1 - Surgery Specialty Clinics - 4th Floor, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pathology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Jaber Abbas
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Phase 1 - Surgery Specialty Clinics - 4th Floor, Beirut, Lebanon
| | - Mohamad Hadi El Charif
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Phase 1 - Surgery Specialty Clinics - 4th Floor, Beirut, Lebanon
| | - Hazem Assi
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Eman Sbaity
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Phase 1 - Surgery Specialty Clinics - 4th Floor, Beirut, Lebanon.
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