Gure 2). Sections of the mass revealed a proliferation of bland spindle cells arranged in a patternless fashion, with interweaving of collagen bundles and hyalinization. Numerous vessels and scattered mast cells were noted within the stroma. buy viagra onlinebuy cheap viagracheap generic viagrahttp://nationalityinworldhistory.net/bsh-women-viagra-for-sale-ao/cheap viagra onlinebuy cheap viagracheap viagrabuy viagra onlinebuy viagrageneric viagra online No areas of necrosis or degeneration were observed, and the mitotic index was less than 1 in 10 per high-power field. Immunoperoxidase stains revealed that the tumour cells were positive for cd34, bcl-2, and cd99. Findings were consistent with a pathologic diagnosis of solitary fibrous tumour. â â figure 2 â€‚ intraoperative findings revealed an approximately 12-cm pedunculated mass arising from a severely atretic right middle lobe: (a) immediately before wedge resection; and post-resection (b) superior and (c) inferior (staple line) borders. The patientâ€™s postoperative course was unremarkable, and she was discharged on postoperative day 4. 2. â€‚ discussion solitary fibrous tumours are rare, and usually benign, tumours derived from mesenchymal tissue. They commonly present as visceral pleural-based masses, but may arise from parietal pleura or be found in the mediastinum, lung parenchyma, or extrathoracic sites. There is no sex preponderance, and most cases are diagnosed later in life (60s). Common presenting symptoms include cough, shortness of breath, and chest pain. Patients may also be asymptomatic. These tumours may present with hypertrophic pulmonary osteoarthropathy or with hypoglycemia secondary to ectopic production of insulin-like growth factor. Definitive treatment typically requires complete excision with negative margins 1. Postoperatively, long-term follow-up is mandatory; recurrences have been reported up to 20 years post resection 2. The role of preoperative biopsy is controversial. In the correct clinical setting and with radiologic findings suggestive of resectability, biopsy is usually unnecessary 2. However, in our case, given an incidentally discovered mass with apparent invasion of the chest wall and diaphragm, preoperative biopsy assisted with operative planning for an anticipated wide local excision and possible chest wall and diaphragm resection and reconstruction. There is a theoretical risk (and an isolated case report) of tumour seeding along the biopsy tract 3. The use of a protective guide needle during image-guided biopsies (as was done in this patient) likely significantly lowers the risk of recurrent disease along the biopsy tract. However, it is prudent to postoperatively monitor patients for possible recurrences along the biops.
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