Es of an epithelioid angiosarcoma. buy viagra overnight delivery The tumour was predominantly well differentiated with smaller areas showing poorly differentiated tumour cells. The tumour was excised completely but the closest posterior margin was only 1 mm. Following referral to our institution, postoperative radiotherapy was delivered to the chest wall using a single 8 mev electron field, delivering 40 gy in 15 fractions over 3 weeks followed by an electron boost to the scar of 10 gy in 4 fractions. A staging ct thorax and abdomen at this time showed no evidence of distant metastases. buy viagra canada Figure 1: an ulcerated bruise-like lesion in the left breast, consistent with the typical appearance of a breast angiosarcoma. Unfortunately, in may 2006, the patient presented to the clinic with symptoms of shortness of breath and a chest radiograph revealed multiple lung metastases. viagra canada A subsequent ct scan showed multiple bilateral lung nodules considered too numerous to consider metastectomy. viagra prescription label Due to the patient's poor general fitness, she was not a candidate for chemotherapy but was kept on regular follow-up. viagra online with price Over the next few months, she developed symptoms of disease progression and the repeated chest x-rays showed an increase in the size and number of lung nodules (figure 2). Physical examination at that time also revealed multiple new subcutaneous nodules on her scalp consistent with metastatic skin deposits. much does viagra cost cvs As these nodules were not causing her any symptoms, no palliative treatment was offered at that time. Figure 2: chest radiograph showing multiple lung metastases. buy viagra online legally She was reviewed again in the clinic in december 2007 and commented that the scalp nodules had regressed. On clinical examination, the subcutaneous scalp nodules were no longer palpable and a subsequent chest x-ray showed a reduction in the number and size of lung nodules. buy viagra cheap The patient denied taking any nonprescribed medication or dietary change leading to the conclusion that this represented a spontaneous regression (figure 3). canadian online pharmacy generic viagra Figure 3: repeat chest radiograph performed three months later showing a significant reduction in size and number of lung metastases. 3. Discussion primary sarcoma of the breast is a rare malignant tumour which accounts for approximately 0. 04% of all breast tumours [2]. It typically presents as a palpable breast mass and the highly vascular nature of these tumours often produces a bluish discoloration of the overlying skin. The discoloration is often initially mistaken for bruising, thereby delaying diagnosis. viagra prescription label The primary treatment is surgical excision, which often requires a simple mastectomy in order to obtain wide margins. A routine axillary dissection is not indicated as lymphatic spread is uncommon (although more. generic viagra usa Ernst Fischer

 

tumblr

flow chart

 

mail(at)ernstfischer.com