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Eals a hypocellular proliferation of small spindle cells with little cytoplasm in a bed of dense collagen, fig 6. This process infiltrated bundles of normal appearing skeletal muscle. Figure 6a and 6b: representative sections of the incisional biopsy of the right chest wall mass. 6a. The biopsy is made up of dense collagen with small spindle and angular cells with scant cytoplasm. 6b. This process surrounds normal tissues including fat, and skeletal muscle (sm) as shown here. Immunohistochemistry reveals that the spindle cells are positive for cd-34 and vimentin, and negative for s-100 and actin, fig 7. Figure 7. Immunohistochemical stains were obtained. As seen above, cd34 (hematopoetic stem cells, hematopoietic progenitor cells, and endothelial cells), and vimentin (mesenchymal cells) stains were positive, as shown by the brown cells, while s-100 (central and peripheral nervous tissue), and actin (smooth or striated muscle) staining was negative in this mass. This pattern is consistent with a gardner fibroma. Desmoid fibromatosis is a monoclonal fibroblastic proliferation that develops from musculoaponeurotic structures. As seen above, desmoid fibromatosis is made up of spindle-shaped cells in a collagenous matrix with nuclei that lack the pleomorphic, atypical, and hyperchromatic characteristics that suggest malignancy. Desmoid fibromatosis is a benign disease in that it does not metastasize, but it is quite locally invasive, and has a predilection for recurrence. Recurrence rates in the literature range from 30%-80%. Although desmoid fibromatosis has a high recurrence rate, over 90% are eventually eradicated, and it is very rare that one dies as a direct result of desmoid fibromatosis. The factors that determine the risk for recurrence include age at presentation, location of the tumor, and the ability to obtain a negative surgical margin. where can i buy viagra online cheap viagra online buy generic viagra online buy cheap viagra viagra online cheap viagra in canada generic viagra without a doctor viagra for sale cheap generic viagra viagra without a doctor prescription As the age at presentation decreases, the 10 year recurrence rates increase. For patients over age 40 and patients from 31-40 years of age the recurrence rate is 25%. The rate increases to 35% in patients between the ages 21-30, and to 45% in patients younger than age 20. Desmoid fibromatosis presenting in the extremities have a higher recurrence risk than those presenting on the trunk. Combining the location of the lesion, and whether a negative margin was achieved at resection gives the following recurrence rates at 10 years. Lesions presenting on the trunk with a negative microscopic surgical margin have a low 18% recurrence rate. Extremity lesions with a negative margin or trunk lesions with a positive margin have an intermediate recurrence rate of 48%. And extremity lesions with a positive margin have the highest recurrence rate of 83%. Obviously, obtaining a negative surgical margin is important in treating this process. The tumor often lacks a capsule or even a psuedocapsule, and can have non-palpable finger-like projections into and along normal muscle bundles and fascial planes making the intrao.  

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