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TEACHING ATLAS OF MAMMOGRAPHY PDF

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Teaching Atlas of Mammography, 4th Edition () - Ebook download as PDF File .pdf), Text File .txt) or read book online. Teaching Atlas of Mammography. Editorial Reviews. From the Back Cover. The names Tabar and Dean are associated with In this fourth edition of the bestselling Teaching Atlas of Mammography, readers are again invited to share in the authors experience of analyzing and. The names Tabar and Dean are associated with high-quality mammography worldwide. In this fourth edition of the bestselling Teaching Atlas of Mammography.


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Teaching atlas of Mammography. Stuttgart. Thieme Verlag Svane G, Potchen EJ, Sierra A, Azavedo E. Stellate lesions. In: Patterson A. ed. Screening . Request PDF on ResearchGate | On Feb 1, , L Tabár and others published Teaching Atlas of Mammography. Teaching atlas of mammography. Laszlo Tabar, Peter B. Dean. × mm. Pp. + viii. Illustrated. Stuttgart: Georg Thieme Verlag. DM

Numerous microcalcifications are seen in the tumor. A soli- tary tumor is located in the lower half of the breast. High-power view of the lesion's periphery. Histology Cavernous hemangioma. Low-power photomicrograph of the lesion showing the typical structure of a cavernous hemangioma.

Analysis of the Tumor Form: The air out- lining the fine. Comment Well-trained technologists are familiar with the appearance of typical skin lesions and Fig. Two cases of warts. Most warts have a typical mammographic ap- pearance. The borders are sharply outlined with a multilobulated contour. A large tumor associated with coarse calcifications is seen in the upper outer quadrant. Physical Examination A freely movable tumor. In this case the calcifications indicate the diagnosis of a phyllodes tumor.

Histology Benign phyllodes tumor cystosarcoma phyllodes. Typical leaf-like phyllodes projec- tion of a duct-like structure into the lumen. There is no skin retraction. Comment Huge. MLO and CC projec- tions. Galactography may assist in the diagnosis. Analysis Location: Blood was expressed from the nipple during the mammographic examination. Galactography CC projection. There are several retroareolar tumors.

Seven months later the patient felt a lump in the lower half of the right breast. Mucinous and pap- illary carcinomas may have a low density at mammography. This sus- picion is strengthened by the fact that the tumor has developed within a short time in an year-old woman.

The mammogram was interpreted as normal. Repeat Mammography Fig. Microfocus magnification view in the MLO projection. The tumor arrows has no associated calcifications. No lymph node meta- stases. There are no associated calcifications. No lymph node metastases. CC view. Follow-up The woman died 5 years 10 months later from cerebral infarction at the age of 86 years.

There was no evidence of breast can- cer at the time of death.

Physical Examination The palpable tumor in the right breast is clinically malignant. Histology Well-differentiated ductal carcinoma. Specimen radio- graph. Microfocus magnification mammography in the CC and LM laterome- dial projections.

This can be obtained using ultrasound- guided core needle biopsy. No associated calcifica- tions. An oval-shaped lesion is located in the medial half of the breast. No further diagnostic proce- dures are necessary. There is a solitary tumor in the upper outer quadrant.

There are no associ- ated calcifications.

The presence of an air pocket best seen on the MLO projection suggests that the lesion protrudes from the skin surface Size: Clinical examination reveals a typical seba- ceous cyst. A ductal carcinoma of this size would have a much higher density.

Follow-up The woman was still alive 20 years later Fig. High-power magnification of the mucinous carcinoma near the tumor border. The combination of older age. Histology Mucinous carcinoma without axillary lymph node metastases. There was no evidence of breast cancer at the time of death. Lateromedial view with biopsy lo- calization plate. A solitary tumor is seen in the upper outer quadrant. No axillary lymph node metasta- ses. The hook localizes the tumor for biopsy.

Follow-up The woman died 16 years later from cardio- vascular disease.

These signs are characteristic of a mammo- graphically malignant tumor. Conclusion Fig. The high-density lesion has ill- defined borders. Ultrasonography confirms the mammographic findings. Cytology Malignant cells.

Microfocus magnification in the CC projection. Physical Examination A solitary. Follow-up The woman died 7 years and 8 months later from myocardial infarction. No mammographic abnormality is seen. Second screening examination at the age of 60 years. The benign differential diagnostic option is a papilloma. A tumor is seen high up in the axillary portion of the breast.

Histology Lymphoma in both the breast and the iliac fossa. It is a mammographically malignant tumor. Nor- mal mammogram. Two years later the patient presented with a 2-month history of a mass in the axillary portion of the right breast and a mass in the right iliac fossa. No associated calcifications were demonstrable. Follow-up The woman was still alive 18 years later at the age of 84 years. Physical Examination Benign tumor. Histology Benign phyllodes tumor.

Ultrasound can easily differentiate between the two. Solid tumors should be subjected to microscopic diagnosis. Detail of Fig.

Low-power view showing the leaf. Physical Examination Inspection: Follow-up The patient was placed on oral antibiotics. Comment An inflammatory carcinoma and a huge re- troareolar abscess could both produce this clinical picture.

En- larged axillary lymph nodes. Ultrasound is not the primary diagnostic procedure of choice since necrosis. Mammography of the left breast after puncture and air insufflation: Ultrasound- guided needle puncture can establish the correct diagnosis. It is associated with nipple retraction and skin thickening over the areola and lower portions of the breast.

Left breast heavier than right. MLO and CC projection. Repeat mammography in the MLO projec- tion Fig. Puncture 60 mL of pus was aspirated. The patient is febrile. Cytology Inflammatory cells. Cystic degeneration of a medullary cancer with a thin rim of viable tumor tis- sue. There is an oval-shaped tumor in the upper inner quadrant with no associ- ated calcifications. Physical Examination 2 cm freely movable tumor in the upper inner quadrant of the right breast.

The infe- rior and anterior wall of the cyst is sharp. Needle biopsy is recom- mended. Ab- scess? Inflamed cyst? There is a tripolar mitosis arrow. The very high proliferation rate of the tumor cells is demonstrated by immu- nohistochemical staining for Ki antigen. No malignant cells.

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Tumor in the cyst wall? Histology Medullary cancer in a 2-cm segment of the wall of a cyst. Typical histologic picture of a me- dullary carcinoma with poorly differenti- ated cancer cells and intense lymphoplas- Fig.

Follow-up The patient died 16 years 5 months later of metastatic breast carcinoma at the age of 52 years. Histology Multiple malignant melanoma metastases. Analysis of the Larger Tumor Form: Physical Examination There is a hard. MLO projection shows two oval-shaped tumors near the chest wall. There is a solitary tumor 4 cm from the nipple.

Histology Partly ductal. Photographic enlargement of the spot compression view of the tumor. The pectoral muscle ap- pears to be infiltrated. There is a patholog- ically enlarged lymph node in the axilla. Failure to drain pus with a large-bore needle should heighten the suspicion of malignancy. How- ever. A large. The ancillary method of choice is ultra- sound-guided needle aspiration. MLO and CC projec- tions after puncture.

Conclusion Abscess with a thick irregular wall. Histology Abscess. Magnification Immersion Radiography of the Left Hand Radiographic changes in the soft tissues and bone.

Atlas of Mammography

Nor- mal breast. Enlarged axillary lymph nodes bilaterally. Comment When the axillary lymph nodes are en- larged and breast disease can be ruled out with certainty by physical examination. She was called back for further examination of the finding in the axillary regions of the mammograms. Physical Examination No abnormalities in the breasts. Histology Mucinous carcinoma. Physical Examination Freely movable tumor below the nipple.

The low-density radiopaque appearance on the mammogram can be explained by the high mucinous content. No axillary lymph Fig. Mucinous car- cinoma is also difficult to detect with ultra- sound.

Teaching Atlas of Mammography

Mammographic picture of pa- thologically enlarged axillary lymph nodes in a year-old woman with chronic lym- phatic leukemia. Two weeks later. Comment As this case demonstrates. For this rea- son. A solitary tumor is seen 6 cm from the nipple. The resolving hematoma still ob- scures the tumor. Histology Benign intraductal papilloma. Fine Needle Biopsy Fig. Cytology Fig. Mammogram following fine nee- dle aspiration biopsy shows the typical ap- pearance of a hematoma.

Microfocus magnification view. Further differential diagnosis follows that Fig. The radiolucent part corresponds to the hi- lus of this intramammary lymph node.

A solitary lesion is seen in the upper half of the breast. No further procedures are indicated. Analysis of the Lesion Fig. A cm long. Analysis of the Calcifications Location: There are associated calcifications.

No evidence of ma- lignancy. Physical Examination An elongated. Solitary tumor. Cytology Benign epithelial cells. Spot compression microfocus magnification view of the tumor.

CC projec- tion. A soli- tary tumor is seen in the central portion of the breast with no associated calcifications. Spot-microfocus magnification images in the MLO Fig. The circular. Mammography and Ultrasound Fig. Details of the MLO Fig. The hand-held ultrasound im- ages demonstrate both an intracystic tumor the cystic component shows through transmission and.

The intracystic growth is an 11 mm grade 1 in situ papillary carcinoma. Large format thin-section low- Fig. The thin. Comment The diagnostic workup of intracystic breast Fig. Large-format thin-section low- power magnification showing both the in- tracystic papillary cancer and the adjacent invasive ductal carcinoma. Imaging can demonstrate the presence of an intracystic growth. Large-format thin-section inter- mediate-power magnification histology im- ages demonstrating the invasive ductal car- cinoma Fig.

Cases such as this one with an adjoining comet-tail sign are more likely to be malignant. Alpha-smooth-muscle actin stain demonstrating the lack of myoepithe- lial cells within the papillary structures. Ultrasound-guided fine needle aspiration biopsy: Ultrasound image of the solitary.

Fine Needle Aspiration Biopsy Fig. No associated calcifications are demonstrable. A solitary. The rarely seen liposarcoma is radiopaque sound Fig. The excised tumor and fat cells of varying sizes. Comment Fig. Preoperative hand-held ultra. Ultra- sound examination with ultrasound-guided needle biopsy provides excellent differen- tial diagnosis. There is a tumor in the medial half of the breast. Detailed mammogram in the CC projection.

Follow-up The patient died 2 years and 8 months later of metastatic breast carcinoma.

The tumor is ER and PR positive. Ultrasound examination reveals a cystic tumor with intracystic growth. Large-section histology images of the cyst containing several intracystic tumors. A large solitary. This mammographic situ or invasive carcinoma. The Malignant-type calcifications are com.

Radial scars vary in ap- This is the typical picture of inva. These are the graphic images that are diagnostic: The most typical mammographic appearance of breast carci- noma is a stellate lesion. Each view may thus the spicules. Skin changes may also with periductal elastosis. Spot compression microfocus magni- fication views are of great value in evaluat- ing these mammographic signs. Architectural distor- tion without a central tumor mass is a less common sign of malignancy.

A ra-. Its perception requires familiarity with the full variety of normal breast parenchymal structure and an understanding of how pathologic pro- cesses produce distortion. Perception of these lesions may be difficult. Although mammographic differentiation of breast carcinoma from other stellate lesions may be highly accurate.

Each is associated with its own characteristic surrounding radiating struc- ture. XXI Diagrammatic illustration of invasive ductal carcinoma: A collagen. Analysis of the central portion may show Fig. They occasionally contain in picture.

Architectural dis- tortion without a central tumor mass may be caused by a number of malignant or be- nign diseases. This may Fig. Higher-reso- lution magnification mammography im- ages may reveal a small central tumor mass not seen in the initial mammo- graphic images.

Comment The mammographic appearance of the small. Architectural distortion without a central tumor mass may also be caused by the fol- lowing diseases: Ultrasound examination assists in the differential diagnosis because the center of a radial scar shows cystic dilatation of the proliferating ducts.

Certain subtypes of breast cancer are characterized by for- mation of new. The mammo-. XXII Illustration of the mammographic appearance of a radial scar. Due to the absence of E-cadherin. Complete surgical these lesions are associated with cancer in — localized skin thickening and retraction removal and thorough histological exami- situ or tubular carcinoma.

Relevant patient history tectural distortion on the mammogram re- tions in these cases are the so-called contributes to the diagnosis.

Mammography to small oil cysts are seen in the central will greatly facilitate the treatment plan- screening has brought attention to this portion. Calcification type calcifications Case A prevalence of 0. The combination of patient history. Chapter VI. The occurrence of this cancer-imi. Fat necrosis fol. The older the lesion. When may be associated with either of these Although the definitive diagnosis of archi- present.

The presence quires histologic examination. The characteristic ative differentiation between malignant mented. The larger the tumor mass.

When they extend to the skin or areolar region they cause retraction and local thickening. The presence of a central tumor mass with associated spicules is typical of malignant stellate tumors. It is recommended that radiologists refer to this case while analyzing other stel- late lesions. The spicules are dense and sharp.

No axillary metastases. Overview of the tumor with stain- ing for elastic fibers Mammogram Physical Examination No palpable tumor. MLO projec- tion. Histology Infiltrating ductal carcinoma. Cases 58—85 Mammography Fig. First screening study. A small tumor shadow is seen at coordinate A1.

Follow-up The woman died 1 year and 11 months later from pulmonary embolism. Specimen photograph. The tumor is seen at coordinate A1. Magnification view in the MLO projection. First screening examination. Follow-up The woman died 8 years and 5 months later from colon cancer.

A stellate tumor is seen in the upper inner quadrant. At the time of death. Maximum dia- meter 7 mm. Conclusion This tumor has the typical mammographic appearance of a malignant stellate breast tumor: Centrally located, large 5 cm dia- meter stellate tumor.

The nipple and areola are retracted. The skin is thickened and re- tracted over the lower and outer portions of the breast. Comment This is an illustrative example of an ad- vanced stellate malignant breast tumor with a large central tumor mass and radiat- ing spicules that retract the areola and skin.

The tumor in- filtrates the lymph vessels. Right breast, CC projection. Right a and left b breasts, Fig. Right breast, microfocus magnifi- MLO projections. Compare the lower halves cation view, MLO projection. Compare of the right and left breasts.

In the lower half Fig. Observe how the of the right breast there is architectural dis- lesion has a different appearance in each A year-old asymptomatic woman. First tortion centered at coordinate A1. Conclusion This mammographic appearance is typical Fig. The diagnosis is supported by the lack of palpatory findings.

No further diagnostic procedures are indicated. In fact, needle biopsy is contraindicated see p. The next step should be open surgi- cal biopsy followed by careful histologic ex- amination. A large area with architectural distortion is seen 4 cm from the nipple.

The mammographic appearance of the lesion changes with the projection. The two hollow, benign-type calcifications are not associated with the lesion. Analysis An invasive ductal carcinoma of this size would have a large, solid central tumor mass. Instead, there are central radiolucen- Fig. The radiating structure consists of long, thick, drooping linear densities inter- vening with radiolucencies. The mammo- graphic image is unlike the straight specu- lations of an invasive breast cancer.

Unlike large breast cancers, this lesion was not pal- pable, nor was there skin thickening or re- traction. Conclusion Typical mammographic and clinical picture of a radial scar. Complete surgical removal is recommended without preoperative needle biopsy see p.

Operative specimen photograph. Comment An invasive ductal carcinoma similar in size to Cases 61—64 would be palpable and would have a large, dense, homogeneous central tumor mass dominating the picture compare Case 60 with Cases 61— Left breast, detailed view of the MLO projection. There is a large radiating structure in the upper half of the breast. Analysis Best from the Microfocus Magnifi- cation Views No solid tumor center is demonstrable in this radiating structure.

The radiating struc- ture consists of thick collections of linear Fig. Alternating with them are radiolucent linear structures parallel to these strands.

Comment Even with such a large, superficial lesion, no tumor could be palpated. This supports the diagnosis of a radial scar. Right breast, MLO projection.

A Fig. The radiating structure is seen at coordinate A1. Right breast, enlarged view of the lateromedial LM projection. Analysis No solid tumor center. The appearance of the lesion changes remarkably with the pro- jection. The radiating structure consists of thick linear radiopaque densities alternat- ing with linear translucencies.

Complete surgical removal is the treatment of choice. Overview of the tumor. Spot microfocus magnification im- age in the CC projection. Detailed view of the tubular carci. Histology Tubular carcinoma. Conclusion This is a typical mammographic picture of a small infiltrating carcinoma: Ultrasound-guided core biopsy a single shot through the lesion provides sufficient preoperative information for treatment planning.

No axil- lary metastases. Physical Examination No palpable tumor in the breasts. A stellate tumor is seen 6 cm from the nip- ple in the lateral half of the breast. Follow-up The patient died 6 years and 9 months later from acute myocardial infarction. Physical Examination No history of trauma.

MLO projection: The tumor was excised in toto. Although the mammographic picture is characteristic of a radial scar.

There appears to be a hole in the center of the lesion cor- responding to the radiolucent center of the lesion on the mammogram. In addition. Note the thick radiating tissue strands.

Comment The benign lesion and benign-type calcifi- cations are unrelated to each other. Analysis of the Calcifications Distribution: Right breast same case 6 months later.

Follow-up The woman died 8 years later of septicemia. A palpable tumor has developed at the site of operation.

At the time of death there was no evidence of breast cancer. This case was reoperated before the advent of percutaneous core needle biopsy.

Histology Traumatic fat necrosis. There is a large radiating structure in the upper inner quadrant of the breast. This radiating structure Fig. Analysis The radiating structure consists of collec- tions of thick.

No history of trauma. Histology Radial scar sclerosing duct hyperplasia. The associated calcifications are unusually large. Spot magnification view. At the center of the large lesion. CC pro- jection. Conclusion This large region of architectural distortion did not cause skin changes. The mammographic image is consistent with a radial scar.

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Physical Examination A hard. A large radiating structure is seen at the site of operation. Analysis Center of the lesion Fig. The patient requested surgical removal of the cyst. The radiating structure is smaller. History of repeated aspirations from a large cyst in the right breast. The large circular lesion in the medial half of the breast corresponds to a cyst. Histology Foreign body granuloma. The history may help in differen.

Analysis Central portion of the architectural distor- tion: History of right breast surgery 25 years earlier. The appearance of the tumor changes with the projection Radiating structure: The skin retraction and the thick scar at the site of operation had remained unchanged for many years.

There is architec- tural distortion in the lower outer quadrant. MLO and detailed view of the CC projection. A small tumor is seen at coordinate A1 in these four mammograms.

Only the tumor. Follow-up The woman died 13 years later from myo- cardial infarction. Mammo- graphically malignant tumor. Analysis Central tumor mass with long radiating spi- cules. There was no evidence of breast cancer. No associated calcifications. No axillary lymph node metastases. A Comment There are a number of other radiopaque. The spicules are short. The Fig. Conclusion A palpable tumor was noted in the lateral cations. Mammographically malignant tumor. Spot compression with micro.

Right and left breasts. Best on the spot compression views. At coor. There are no associated calcifi. Stellate tumor with a central tumor mass. MLO pro. The tumor can be detected on the MLO projection by oblique masking.

Retraction of the posterior parenchymal border on the CC projection Fig. At coordinate A1 there is a small stellate tumor with no associated calcifications. Operative specimen. MLO pro- jections. CC and LM projections. Comment This case represents a problem in percep- tion. Follow-up The woman was still alive 21 years later at the age of 92 years. Spot compression microfocus magnification views. Normal right breast.

There are coarse calcifica- screening study. First tralateral breast. The calcifications With knowledge of the mammogram. Typical mammographic appearance of a Physical Examination Fig. The cation view. There is a stel- breast parenchymal contour protrudes at late tumor with a distinct central mass. Asymptomatic year-old woman. The tumor. No stellate malignant tumor. Follow-up The patient was still alive 20 years later.

Detailed view of the spiculated contour.

More than half of the nuclei express receptor positivity through brown staining. The spicules contain grade 1 ductal carcinoma in situ. Overview of the tumor using an immunohistochemical stain for estrogen re- ceptors. Follow-up First to the so-called desmoplastic reaction con- screening study.

The mographically malignant. Histology nective tissue proliferation in the vicinity of Infiltrating ductal carcinoma. Chapter II p. Physical Examination 10 mm. No palpable tumor in the breasts. The woman was still alive 19 years later. Oblique masking helps reveal Small. Mammography with no evidence of breast cancer. A small tumor is seen at coordinate A1 in the upper outer quadrant of the left breast. Mammographic diagnosis: A small.

Follow-up Fig. Analysis Lace-like radiating structure. The tumor can mor is seen at coordinate A1. There is a stellate lesion at coordi. Infiltrating ductal carcinoma. Comment nate A1 in the right breast. First Form: Enlarged view in the Histology mediolateral projection. There was No palpable tumor in the breasts.

Mammography Mammographically malignant tumor. The smaller the stellate tumor. Follow-up tions The woman died 12 years later from myo- Physical Examination Size: Analysis The tumor is lo. Conclusion The overlying dense parenchyma obscures the tiny central tumor mass.

At co- ordinate A1 there is parenchymal distortion. The long. Follow-up The woman was still alive 19 years later. Operative specimen radiograph. There is architectural distortion located centrally.

A tion view in the CC projection. Analysis No definite central tumor mass is demons- trable on the preoperative mammograms. The asymmetric density is seen at coordinate A1. A Analysis Form: Physical Examination A No palpable tumor in the breasts. Normal right mammogram. The nonspecific asymmetric density corresponds to a tiny.

At coordinate A1 in the left breast there is a small. The lesion is seen at coordinate A1. Spot magnification view of the tu- mor in the MLO projection.

Follow-up The patient returned to her native country. Analysis Best on the Spot Compression View Stellate tumor with a central tumor mass surrounded by numerous spicules. Follow-up The patient died 4 years later. Mam- mographically malignant tumor. Histology Infiltrating ductal carcinoma with axillary lymph node metastases. A Mammography Fig. Low-power view of the invasive tumor. There is architectural distortion at coordinate A1.

XIXa at coordinate A1. Sus- picious for malignancy. There is parenchymal contour retraction see Fig. No associated calci- fications are seen. Analysis Instead of a solid. The associated calcifications are very faint. The radiating structure is formed by alternating radiopaque and ra- diolucent linear structures. No associated malignancy. A ra- diating structure is seen 8 cm from the nip- ple in the upper half of the breast.

CC projection: Radial scar sclerosing duct hyper- ture is located at coordinate A1. Analysis Comment The radiating structure lacks a central tu.

No cation view. A year-old asymptomatic woman. This lesion is difficult to perceive and also Physical Examination mor mass. Oblique masking. There are no associated calcifica. Conclusion jections. At coordinate A1. The occupies most of the right breast. Right a and left b breasts. The right breast is smaller than the left because of a large. There are nipple—areola complex and skin overlying coarse.

Hand-held ul- breast. Photographic magnification of tions. Neither a distinct tumor mass nor trasound f: The large architectural distortion the upper half of the right breast with the drastically alters the appearance of the right architectural distortion e. Right c and left d CC projec. Ultrasound-guided g core bi- opsy.

First mammography examination. There is an asymmetric density with slight architectural distortion in the upper outer quadrant rectangles. Neither skin changes nor nipple discharge were ob- served. Microfocus magnification views of the asymmetric density on the LM c and CC d projections.

Histology showed grade 1 and 2 carcinoma in situ. Specimen radiographs of large- bore needle biopsy containing calcifications. Innumerable powdery and crushed stone-like calcifications are seen within the density.

Operative specimen radiograph with the architectural distortion and micro- calcifications h. Specimen radiograph with the architectural distortion. Specimen radiograph o shows a cluster of discernible calcifications. The corresponding large thick-section subgross. Details of a specimen radiograph slice containing two clusters of discernible microcalcifications.

Low-power microphotograph of tightly packed cancer-filled duct-like struc- tures characteristic of neoductgenesis. The corresponding histology slide shows that some of the microcalcifications are localized within the acini of an ex- tremely distended TDLU. No sign of invasion was demonstrable. The first mammogram at age 64 outer quadrant. First examination. The malignant diagnostic options are Two consecutive mammography screening A nonspecific asymmetric density with ar.

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Rozhkova and A.Breast Cancer: A ra- diating structure is seen 8 cm from the nip- ple in the upper half of the breast. Observe how the of the right breast there is architectural dis- lesion has a different appearance in each A year-old asymptomatic woman. Select Rating 1 2 3 4 5. Innu- merable calcifications of varying form. IXa Schematic presentation of the devel.

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