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Bacon ER, Ihle K, Guo W, Egelston CA, Simons DL, Wei C, Tumyan L, Schmolze D, Lee PP, Waisman JR. Tumor heterogeneity and clinically invisible micrometastases in metastatic breast cancer-a call for enhanced surveillance strategies. NPJ Precis Oncol 2024; 8:81. [PMID: 38553598 PMCID: PMC10980766 DOI: 10.1038/s41698-024-00572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
The biology of metastatic breast cancer (MBC) is understudied, primarily due to the difficulty of procuring multiple samples from patients with oligometastatic breast cancer. We developed a rapid postmortem tissue procurement program that allows the collection and analysis of numerous metastatic lesions, subclinical locations, and potential pre-metastatic niches that fall within this scope. We conducted a rapid postmortem tissue collection study on 9 patients with MBC. Patients and their families consented to donate tissues immediately after death in an IRB-approved study. Various disease subtypes, progression histories, organ involvement, and final causes of death are reported. In patients with hormone receptor-positive (HR+) disease, estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 expression were heterogeneous across metastatic lesions within individual patients. Disease phenotype at the end of life trended toward complete loss of HR expression. Nearly all (n = 7) patients exhibited extensive tumor involvement of additional organs that had not been previously diagnosed clinically and were not retrospectively visible on recent imaging. Of these seven individuals, three included organs uncommonly associated with MBC: kidney, spleen, pancreas, and ovary. Finally, we identified clinically undetectable micrometastases in several organs uncommonly involved in MBC. Our findings raise several clinically relevant questions regarding the mechanisms of metastatic progression. Insights from this study argue for better surveillance strategies for monitoring MBC. We highlight the need to capture more accurate biomarker information in the context of heterogeneous disease and urge the consideration of treatment strategies that combine multiple targeted therapies.
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Affiliation(s)
- Eliza R Bacon
- The Center for Precision Medicine, City of Hope National Medical Center, Duarte, CA, USA.
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
| | - Kena Ihle
- The Center for Precision Medicine, City of Hope National Medical Center, Duarte, CA, USA
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Weihua Guo
- Department of Immuno-Oncology, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - Colt A Egelston
- Department of Immuno-Oncology, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - Diana L Simons
- Department of Immuno-Oncology, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - Christina Wei
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Lusine Tumyan
- Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Peter P Lee
- Department of Immuno-Oncology, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - James R Waisman
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
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2
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Bishnoi K, Agrawal K, Mishra SK, Purkait S. Uncommon Site of Metastasis: A Case Report of Breast Carcinoma Spreading to the Pancreas. Indian J Nucl Med 2024; 39:120-122. [PMID: 38989314 PMCID: PMC11232732 DOI: 10.4103/ijnm.ijnm_45_23] [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: 03/31/2023] [Revised: 05/08/2023] [Accepted: 05/29/2023] [Indexed: 07/12/2024] Open
Abstract
The metastatic lesions to pancreas are reported in various malignancies. However, pancreatic metastasis from breast cancer is rare and difficult to diagnose due to nonspecific symptoms and imaging findings. At the time of diagnosis, there may already be an associated widespread metastasis. In this case report, a woman in her forties with a history of breast cancer was found to have widespread metastases, including in the pancreas. The patient was treated with chemotherapy and hormonal therapy.
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Affiliation(s)
- Komal Bishnoi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sourav Kumar Mishra
- Department of Medical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suvendu Purkait
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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3
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Rossi C, Gallotti A, Messina A, Cobianchi L, Inzani F, Lucioni M, Vanoli A. Invasive lobular carcinoma metastasis to pancreas mimicking pancreatic signet ring cell carcinoma: A case report and systematic review of the literature. Pathol Res Pract 2024; 253:155049. [PMID: 38176311 DOI: 10.1016/j.prp.2023.155049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 01/06/2024]
Abstract
Metastasis to the gastrointestinal tract is a rare instance in the natural history of breast cancer, usually in association with lobular histology and widespread dissemination of disease. We report the case of a 74-year-old woman with a history of invasive lobular carcinoma presenting with a pancreatic metastasis mimicking a primary pancreatic adenocarcinoma; we also present a systematic review of the relevant literature. The presentation of pancreatic metastasis in the setting of breast cancer is unspecific, and histology is of paramount importance for a correct diagnosis; surgical metastasectomy could be of some benefit in the correct clinical setting.
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Affiliation(s)
- Chiara Rossi
- Department of Molecular Medicine, University of Pavia, Unit of Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Anna Gallotti
- Unit of Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alessia Messina
- Department of Molecular Medicine, University of Pavia, Unit of Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Unit of General Surgery, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Frediano Inzani
- Department of Molecular Medicine, University of Pavia, Unit of Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Lucioni
- Department of Molecular Medicine, University of Pavia, Unit of Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
| | - Alessandro Vanoli
- Department of Molecular Medicine, University of Pavia, Unit of Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
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4
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Okamoto T. Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer. World J Gastroenterol 2022; 28:985-1008. [PMID: 35431494 PMCID: PMC8968522 DOI: 10.3748/wjg.v28.i10.985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/03/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku 104-8560, Tokyo, Japan
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5
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Mor AG, Das S, Joshi SP, Chaudhari VA, Desai S. Metastatic Lobular Carcinoma of the Male Breast Masquerading as a Pancreatic Head Mass, a Diagnostic Dilemma—Rare Case and Literature Review. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractMale breast cancer comprises of 1% of all and invasive lobular carcinomas (ILC) are even rarer in males. ILC are known to have unusual metastatic sites. We report a case of a 51-year-old male diagnosed with breast cancer, who presented with a recurrent chest wall nodule and icterus after 24 months of disease-free interval. On further investigations, he was found to have pancreatic head mass associated with conjugated hyperbilirubinemia suggestive of obstructive jaundice and a left parasternal soft tissue recurrence. A self-expandable metallic stent was inserted for recurrent cholangitis. Biopsy from the chest wall nodule was recurrence of ILC and pancreatic head mass was suspected to be either a second primary or an isolated pancreatic head metastasis of ILC on imaging. In either case surgical resection if operable and localized was planned. However, on staging laparoscopy, the patient was found to have mild ascites and multiple peritoneal nodules, which on biopsy proved to be metastases from ILC. Patient was treated with second-line hormonal therapy with luteinizing hormone-releasing hormone agonist and an aromatase inhibitor. ILC may present with unusual sites of metastasis leading to diagnostic dilemma. A high index of suspicion of metastases and appropriate biopsies can help one embark upon the most appropriate plan.
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Affiliation(s)
- Akash G. Mor
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Subhasree Das
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shalaka P. Joshi
- Department of Surgical Oncology, Breast Services, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vikram A. Chaudhari
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sangeeta Desai
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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6
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Wong YM, Jagmohan P, Goh YG, Putti TC, Ow SGW, Thian YL, Pillay P. Infiltrative pattern of metastatic invasive lobular breast carcinoma in the abdomen: a pictorial review. Insights Imaging 2021; 12:181. [PMID: 34894297 PMCID: PMC8665916 DOI: 10.1186/s13244-021-01120-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
Invasive lobular carcinoma (ILC) has a greater tendency to metastasize to the peritoneum, retroperitoneum, and gastrointestinal (GI) tract as compared to invasive carcinoma of no special type (NST). Like primary ILC in the breast, ILC metastases are frequently infiltrative and hypometabolic, rather than mass forming and hypermetabolic in nature. This renders them difficult to detect on conventional and metabolic imaging studies. As a result, intra-abdominal ILC metastases are often detected late,
with patients presenting with clinical complications such as liver failure, hydronephrosis, or bowel obstruction. In patients with known history of ILC, certain imaging features are very suggestive of infiltrative metastatic ILC. These include retroperitoneal or peritoneal nodularity and linitis plastica appearance of the bowel. Recognition of linitis plastica on imaging should prompt deep or repeat biopsies. In this pictorial review, the authors aim to familiarize readers with imaging features and pitfalls for evaluation of intra-abdominal metastatic ILC. Awareness of these will allow the radiologist to assess these patients with a high index of suspicion and aid detection of metastatic disease. Also, this can direct histopathology and immunohistochemical staining to obtain the correct diagnosis in suspected metastatic disease.
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Affiliation(s)
- Ying Mei Wong
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore.
| | - Pooja Jagmohan
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | - Yong Geng Goh
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | - Thomas Choudary Putti
- Department of Pathology, National University of Singapore, National University Hospital, Kent Ridge Road, Singapore, 119074, Singapore
| | - Samuel Guan Wei Ow
- Department of Hematology-Oncology, National University Cancer Institute and Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | - Premilla Pillay
- Department of Diagnostic Imaging, National University Hospital, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
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7
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Nagao A, Noie T, Horiuch H, Yamada H, Momiyama M, Nakajima K, Satou S, Satodate H, Nara S, Harihara Y. Long-term survival after pancreatic metastasis resection from breast cancer: a systematic literature review. Surg Case Rep 2021; 7:39. [PMID: 33534098 PMCID: PMC7859131 DOI: 10.1186/s40792-021-01124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background Patients with advanced-stage breast cancer often demonstrate pancreatic metastases. However, pancreatic metastases resection from breast cancer has been rarely performed, with only 20 cases having been reported to date. Case presentation A 49-year-old woman presented to our hospital in September 2003 with complaints of uncontrollable oozing from her left breast tumor. Computed tomography revealed a left breast tumor approximately 9.3 cm in diameter as well as heterogeneously enhanced solid mass lesions with necrotic foci in the pancreatic tail and body, up to 6.2 cm, which were radiologically diagnosed as pancreatic metastases from breast cancer. An emergent left simple mastectomy was performed to control bleeding. After epirubicin and cyclophosphamide hydrate treatment failed to improve her condition, the pancreatic metastases responded to weekly paclitaxel treatment, but eventually regrew. The patient underwent distal pancreatectomy with splenectomy, left adrenalectomy, partial stomach resection, and paraaortic lymph nodes excision in December 2004 after no other metastasis was confirmed. Furthermore, she received radiation therapy for left parasternal lymph node metastasis 6 months later. The patient recovered well. Consequently, she has no evidence of disease > 15 years after pancreatectomy. Conclusions This is the first reported case of pancreatectomy for pancreatic metastases from breast cancer, which was simultaneously diagnosed. Patients with no metastasis other than resectable pancreatic metastases and breast cancer and who possess some sensitivity for chemotherapy may benefit from pancreatectomy.
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Affiliation(s)
- Atsuki Nagao
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Tamaki Noie
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | - Hajime Horiuch
- Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Haruyasu Yamada
- Department of Radiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masashi Momiyama
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Kentaro Nakajima
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Shouichi Satou
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Hitoshi Satodate
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Satoshi Nara
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Yasushi Harihara
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
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8
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Kouhen F, Chihabeddine M, Squali M, Allaoui M, Bouzidi AA, Errafiy N, Ismaili N. Metastasis to the pancreas: a rare site for secondary malignancy of breast cancer (a case report). Pan Afr Med J 2020; 37:260. [PMID: 33598075 PMCID: PMC7864279 DOI: 10.11604/pamj.2020.37.260.25228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/09/2020] [Indexed: 11/11/2022] Open
Abstract
Breast cancer is the most frequent invasive cancer in women and the second cause of death by cancer in women after lung cancer. It causes metastases especially to bones, liver and lungs. Pancreatic metastases from a primary breast neoplasm are rare and unusual, occurring in less than 3% of the cases. There have been only 28 cases described in the literature. This paper adds one more case to the published literature. We present a case of pancreatic metastasis of the breast in a 64-year-old female and a discussion based on a review of the literature.
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Affiliation(s)
- Fadila Kouhen
- Mohammed VI University of Health Sciences (UM6SS), Department of Radiotherapy, International University Hospital Sheikh Khalifa, Casablanca, Morocco
| | - Meriem Chihabeddine
- Mohammed VI University of Health Sciences (UM6SS), Department of Radiotherapy, International University Hospital Sheikh Khalifa, Casablanca, Morocco
| | - Mohammed Squali
- Mohammed VI University of Health Sciences (UM6SS), Department of Medical Oncology, International University Hospital Sheikh Khalifa, Casablanca, Morocco
| | - Mohammed Allaoui
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Department of Pathology, Military Hospital Mohammed V, Rabat, Morocco
| | - Abderrahmane Al Bouzidi
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Department of Pathology, Military Hospital Mohammed V, Rabat, Morocco
| | - Nadia Errafiy
- Mohammed VI University of Health Sciences (UM6SS), National Reference Laboratory (LNR), Casablanca, Morocco
| | - Nabil Ismaili
- Mohammed VI University of Health Sciences (UM6SS), Department of Medical Oncology, International University Hospital Sheikh Khalifa, Casablanca, Morocco
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9
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S Prakash P, Lee JWK, Tang SW, Iau PTC. A rare case report of recurrent metastatic breast cancer mimicking primary pancreatic cancer. Int J Surg Case Rep 2020; 77:446-449. [PMID: 33395823 PMCID: PMC7691437 DOI: 10.1016/j.ijscr.2020.10.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022] Open
Abstract
Secondary pancreatic tumors are rare, of which a breast primary is extremely uncommon. Invasive lobular carcinoma is the commonest breast cancer histological subtype metastasizing to the pancreas. Imaging characteristics can usually adequately differentiate secondary from primary pancreatic tumors. Pancreatic metastasectomy offers reasonably good long-term survival rates and can even be curative in selected cases.
Introduction Secondary pancreatic tumors are rare, of which a breast cancer primary is extremely uncommon. To our knowledge, we present the 14th case reported worldwide and first from Singapore of lobular breast cancer metastasizing to the pancreas. Presentation of case A 53-year-old woman presented with painless obstructive jaundice, weight loss over 1.5 months and a 2 cm right breast mass. She had left breast Invasive Lobular Carcinoma (ILC) treated 5 years prior with wide local excision, adjuvant radiotherapy and hormonal therapy. She had elevated bilirubin, liver enzymes and Cancer Antigen (CA) 19–9. Imaging found 3 right breast nodules, left axillary lymphadenopathy, biliary dilatation with an ampullary mass, and bone metastases. Breast nodule biopsies confirmed ILC but ampullary mass cytopathology was inconclusive. Frozen section of the mass during exploratory laparotomy showed metastatic ILC; a triple bypass surgery was done and chemo-endocrine therapy commenced. Discussion ILC is the commonest type of breast carcinoma in cases with pancreatic metastases, usually recurring after long disease-free intervals, and widely metastatic at presentation. Imaging characteristics help differentiate secondary from primary pancreatic tumors. Radiological features and history of an extra-pancreatic cancer suffice in suspecting pancreatic metastases. Despite limited surgical experience, it is well accepted that pancreatic metastasectomy offers reasonably good long-term survival rates, quality of life and can even be curative in highly selected cases. Conclusion This case is an interesting case because it highlights the diagnostic dilemma involved in the rare entity of breast cancer metastatic to the pancreas, and summarizes its diagnosis and management.
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Affiliation(s)
- Prajwala S Prakash
- Division of Breast Surgery, University Surgical Cluster, National University Health System (NUHS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - James Wai Kit Lee
- Division of Breast Surgery, University Surgical Cluster, National University Health System (NUHS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Siau Wei Tang
- Division of Breast Surgery, University Surgical Cluster, National University Health System (NUHS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Philip Tsau Choong Iau
- Division of Breast Surgery, University Surgical Cluster, National University Health System (NUHS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
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10
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R Perez A, Paolo A Zamora H. Solitary pancreatic metastasis from a primary breast carcinoma: A case report. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2020. [DOI: 10.5348/100085z04ca2020cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Apodaca-Rueda M, Chaim FHM, Garcia MDS, de Saito HPDA, Gestic MA, Utrini MP, Callejas-Neto F, Chaim EA, Cazzo E. Solitary pancreatic metastasis from breast cancer: case report and review of literature. SAO PAULO MED J 2019; 137:201-205. [PMID: 29116313 PMCID: PMC9721236 DOI: 10.1590/1516-3180.2017.0144260617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Pancreatic metastases from primary malignant tumors at other sites are rare, constituting about 2% of the neoplasms that affect the pancreas. Pancreatic metastasis from breast cancer is extremely rare and difficult to diagnose, because its clinical and radiological presentation is similar to that of a primary pancreatic tumor. CASE REPORT A 64-year-old female developed a lesion in the pancreatic tail 24 months after neoadjuvant therapy, surgery and adjuvant radiation therapy for right-side breast cancer (ductal carcinoma). She underwent distal pancreatectomy with splenectomy and left adrenalectomy, and presented an uneventful outcome. The immunohistochemical analysis on the surgical specimen suggested that the lesion originated from the breast. CONCLUSION In cases of pancreatic lesions detected in patients with a previous history of breast neoplasm, the possibility of pancreatic metastasis should be carefully considered.
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Affiliation(s)
- Márcio Apodaca-Rueda
- Medical Student, Faculdade de Medicina da Pontificia Universidade Católica de Campinas (PUC-Campinas), Campinas (SP), Brazil
| | - Fábio Henrique Mendonça Chaim
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Milena da Silva Garcia
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Helena Paes de Almeida de Saito
- MD. Assistant Lecturer, Oncology Unit - Department of Internal Medicine, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Martinho Antonio Gestic
- MD, MSc. Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Murillo Pimentel Utrini
- MD, MSc. Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Francisco Callejas-Neto
- MD, MSc. Assistant Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Elinton Adami Chaim
- MD, MSc, PhD. Full Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Everton Cazzo
- MD, PhD. Adjunct Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
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12
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Koufopoulos N, Goudeli C, Pigadioti E, Balalis D, Manatakis DK, Antoniadou F, Korkolis DP. Synchronous Colonic Adenocarcinoma and Metastatic Lobular Carcinoma in a Colectomy Specimen: A Rare Finding. Cureus 2018; 10:e3207. [PMID: 30405983 PMCID: PMC6205883 DOI: 10.7759/cureus.3207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Invasive lobular carcinoma is the second-most-common subtype of invasive breast carcinoma. Its metastatic pattern is different compared to invasive carcinoma—no special type. It metastasizes more often to the gastrointestinal tract, peritoneum, pleura, and ovaries. The extrahepatic gastrointestinal tract metastases occur mostly in the stomach and small intestine and less often in the colon and rectum. We present a case description of an 87-year-old woman admitted to our hospital with hematochezia, abdominal discomfort, fatigue, and weight loss. A colonoscopy revealed an exophytic tumor of the sigmoid colon. Metastatic disease was not found in imaging studies. A low anterior resection was performed. The pathologic examination revealed a collision tumor consisting of a poorly differentiated adenocarcinoma of the colon and metastatic lobular carcinoma. The diagnosis was challenging due to the lack of a previous history. Also, the diffuse architectural pattern and signet ring cells found may be in primary signet ring carcinoma of the colon as well as in carcinomas from other anatomical sites. Immunohistochemistry was helpful in making the diagnosis. A review of the literature revealed that this is the fourth case of metastatic breast carcinoma coexisting with colonic adenocarcinoma.
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Affiliation(s)
| | - Christina Goudeli
- Department of Gynecology, "Saint Savvas" Cancer Hospital, Athens, GRC
| | - Eleni Pigadioti
- Department of Pathology, "Saint Savvas" Cancer Hospital, Athens, GRC
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Zammit A, James D, Van Rooyen PH. Metastatic lobular breast carcinoma to the pancreas: a case report. J Surg Case Rep 2018; 2018:rjy111. [PMID: 29977508 PMCID: PMC6007369 DOI: 10.1093/jscr/rjy111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/26/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022] Open
Abstract
We report a case of a 72-year-old female, with an extensive breast cancer history, who presented with abdominal pain to her general practitioner. Cross-sectional imaging demonstrated a lesion in the head of pancreas, which was not amenable to curative resection. Percutaneous biopsy was obtained, which demonstrated metastatic lobular breast cancer. This rare case highlights how previous medical histories may assist in final pathological diagnosis.
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Affiliation(s)
- Andrew Zammit
- Department of General Surgery, Hervey Bay Hospital, Queensland, Australia
| | - Daniel James
- Department of Pathology, Royal Brisbane and Women's Hospital, Queensland, Australia
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14
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Liu F, Vermesh O, Mani V, Ge TJ, Madsen SJ, Sabour A, Hsu EC, Gowrishankar G, Kanada M, Jokerst JV, Sierra RG, Chang E, Lau K, Sridhar K, Bermudez A, Pitteri SJ, Stoyanova T, Sinclair R, Nair VS, Gambhir SS, Demirci U. The Exosome Total Isolation Chip. ACS NANO 2017; 11:10712-10723. [PMID: 29090896 PMCID: PMC5983373 DOI: 10.1021/acsnano.7b04878] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Circulating tumor-derived extracellular vesicles (EVs) have emerged as a promising source for identifying cancer biomarkers for early cancer detection. However, the clinical utility of EVs has thus far been limited by the fact that most EV isolation methods are tedious, nonstandardized, and require bulky instrumentation such as ultracentrifugation (UC). Here, we report a size-based EV isolation tool called ExoTIC (exosome total isolation chip), which is simple, easy-to-use, modular, and facilitates high-yield and high-purity EV isolation from biofluids. ExoTIC achieves an EV yield ∼4-1000-fold higher than that with UC, and EV-derived protein and microRNA levels are well-correlated between the two methods. Moreover, we demonstrate that ExoTIC is a modular platform that can sort a heterogeneous population of cancer cell line EVs based on size. Further, we utilize ExoTIC to isolate EVs from cancer patient clinical samples, including plasma, urine, and lavage, demonstrating the device's broad applicability to cancers and other diseases. Finally, the ability of ExoTIC to efficiently isolate EVs from small sample volumes opens up avenues for preclinical studies in small animal tumor models and for point-of-care EV-based clinical testing from fingerprick quantities (10-100 μL) of blood.
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Affiliation(s)
- Fei Liu
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
- Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Sciences, Wenzhou, Zhejiang 325001, China
| | - Ophir Vermesh
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Vigneshwaran Mani
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Tianjia J. Ge
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Steven J. Madsen
- Department of Materials Science and Engineering, Stanford University, Stanford, California 94304, United States
| | - Andrew Sabour
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - En-Chi Hsu
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Gayatri Gowrishankar
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Masamitsu Kanada
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Pharmacology & Toxicology, and Institute for Quantitative Health Science and Engineering (IQ), Michigan State University, East Lansing, Michigan 48824, United States
| | - Jesse V. Jokerst
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of NanoEngineering, University of California, San Diego, La Jolla, California 92093, United States
| | - Raymond G. Sierra
- Stanford PULSE Institute, SLAC National Accelerator Lab, Menlo Park, California 94025, United States
- Hard X-ray Department, LCLS, SLAC National Accelerator Lab, Menlo Park, California 94025, United States
| | - Edwin Chang
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Kenneth Lau
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Kaushik Sridhar
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Abel Bermudez
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Sharon J. Pitteri
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Tanya Stoyanova
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
| | - Robert Sinclair
- Department of Materials Science and Engineering, Stanford University, Stanford, California 94304, United States
| | - Viswam S. Nair
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Medicine, Stanford University, Stanford, California 94304, United States
| | - Sanjiv S. Gambhir
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Materials Science and Engineering, Stanford University, Stanford, California 94304, United States
- Department of Bioengineering, Stanford University, Stanford, California 94304, United States
- Corresponding Authors: ,
| | - Utkan Demirci
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Department of Radiology, School of Medicine, Stanford University, Stanford, California 94304, United States
- Corresponding Authors: ,
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Kliiger J, Gorbaty M. Metastasis to the pancreas and stomach from a breast cancer primary: a case report. J Community Hosp Intern Med Perspect 2017; 7:234-237. [PMID: 29046750 PMCID: PMC5637649 DOI: 10.1080/20009666.2017.1369379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022] Open
Abstract
A 60-year-old female with an unknown family history initially presented with signs and symptoms concerning for gastrointestinal cancer. Regular breast cancer screening and subsequent work-up around this time demonstrated the presence of T2N1 stage II triple positive ductal adenocarcinoma of the left breast. Follow-up imaging for her gastrointestinal symptoms demonstrated a 3.5 cm solitary mass in the pancreas and diffuse thickening of the stomach wall. Biopsies of the gastrointestinal lesions were identified as metastatic foci of the breast cancer primary. Breast cancer metastases to the stomach and to the pancreas are both very rare events. Of the breast cancer primaries that do metastasize to the gastrointestinal system, it is unusual for the primary to be ductal adenocarcinoma. The rapid succession of diagnosing the primary source of breast cancer simultaneously with its metastases is also unusual. Timely identification and appropriate management of these rare metastases was made possible due to routine breast cancer screening.
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Affiliation(s)
| | - Mayer Gorbaty
- Medical Oncology, Northwest Hospital, Randallstown, MD, USA
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Sun X, Zuo K, Huang D, Yu B, Cheng Y, Yang W. Pancreatic metastasis from invasive pleomorphic lobular carcinoma of the breast: a rare case report. Diagn Pathol 2017; 12:52. [PMID: 28693516 PMCID: PMC5504649 DOI: 10.1186/s13000-017-0641-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
Background Invasive pleomorphic lobular carcinoma (PLC) is an aggressive subtype of invasive lobular carcinoma of the breast, which has its own histopathological and biological features. The metastatic patterns for PLC are distinct from those of invasive ductal carcinoma. In addition, pancreatic metastasis from PLC is extremely rare. Case presentation We report a rare case of a 48-year-old woman presenting with clinical gastrointestinal symptoms and pancreatic metastasis of PLC. The pancreatic tumor was composed of pleomorphic tumor cells arranged in the form of solid sheets and nests and as single files, with frequent mitotic figures, nucleolar prominence, high nuclear to cytoplasmic ratio and loss of cohesion. The malignant cells were positive for p120 (cytoplasmic) and GATA3 and negative for estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, E-cadherin, gross cystic disease fluid protein 15 and mammaglobin, which indicated a lobular carcinoma phenotype of the breast. Conclusions To the best of our knowledge, this is one of the few reported cases in the literature of pancreatic metastasis of invasive lobular carcinoma of the breast, of which the definitive diagnosis was obtained only after surgery. Rare metastasis sites should be considered, particularly, when a patient has a medical history of PLC.
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Affiliation(s)
- Xiangjie Sun
- Department of Pathology, Fudan University Shanghai Cancer Center, No.2 building, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ke Zuo
- Department of Pathology, Fudan University Shanghai Cancer Center, No.2 building, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Dan Huang
- Department of Pathology, Fudan University Shanghai Cancer Center, No.2 building, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Baohua Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, No.2 building, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yufan Cheng
- Department of Pathology, Fudan University Shanghai Cancer Center, No.2 building, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, No.2 building, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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17
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Motos Micó JJ, Velasco Albendea FJ, Barrera Casallas C, Quijano Moreno SL, Rosado Cobián R. Metástasis ampular por carcinoma lobulillar de mama. Cir Esp 2016; 94:e45-7. [DOI: 10.1016/j.ciresp.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 11/26/2022]
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