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Back with a Vengeance: Microvascular Tumor Embolism

      Imaging studies could not capture the source of a 70-year-old woman's pulmonary hypertension and dyspnea. Nine years earlier, she had undergone breast-conserving surgery with axillary nodal dissection, adjuvant chemotherapy, and radiation for cancer of the right breast. At that time, the diagnosis was Stage IIA (pT1cN1aM0). The 1.2-cm tumor was categorized as invasive micropapillary carcinoma, hormone receptor-positive, and human epidermal growth factor receptor 2-negative, and she had 3 positive axillary lymph nodes. Her mammogram and chest X-ray results had been reported as normal as recently as 1 year prior to the present admission. The values of the serum tumor markers cancer antigen 15-3 and carcinoembryonic antigen, at 356 U/mL and 10.4 ng/mL, respectively, were elevated 1 month prior to the present admission. Yet, she had no noticeable signs of recurrence.
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