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s in thee s, theeclinic div andi/ icdivipa> how theepa>iws- with throwoma Fibro wilblpresent. Thee i> gowin thesi ases may at t-and pow v to i common d>endsdiv>ory,licati can> ulvexamin://ww shoule resultwin few aranv c of thesi t> s escaping promppl iagws-ro. O theealerteclinic divhas di/icrd that s-fillics-fiy, theeappropria> iagws-div approach rowusufilylstrav idforward.s="tiap>O theepossibility of a v> radiographs of the area of ints"est.  If a de i>ite iv c lesia rowseen on thee1 vw radiographs, i computrd tomographytscanlicati magwediv "esonv imaging scanlshoule b=lobtvw ed.  Theev>d>endsdiv>orylshoule b=lrearcord ararepsatrd with anlemphaga< on amily icatps"sonv> ca div>orylicattheesL ista Comsta Completa del T"view
M> to theekner aredayusufi,licatm> iws-s with ca , with only 0.007 to 0.3 % having acolli blicatlung carcinws-s"(50%), with theeblades", utrrus icatbrea-tlrespmasible r 25% of m> foll iagws-rowof primary t> daytil iv c m> s canlm> s as weillis to theeiv c of the eed (n> .). M> bl ell carcinws-wusufilylaffmcs iv c , less so thees ro -odd">,licatrarelylboth iv c icats ro -odd">.(7)caiv clas haveealso been reportrd to m> s of the s-rsalowin 23%, wherea- thee1ha gestacc unt r onlyl17% of the reportrd ases.(5) In theeseries reportrd by Healeyee/ al, 1982, theeendc 1ha gestof the toc i"e rare,(5) acc unting r less than 0.05% of albliv c m> t> s i"e di/icrd sa"lyl(11). Common com1 vw vowincludee iws-s and-uhaveepvw b= re anywradiographiv ch gestcanlbc datmcsea.(12) Clinicfi fdatures of m> eter c .(5) In a ase report on v>
bl ell carcinws-wto theeiig toc, throwpresenteatislinlenlarging subungufi no/dii that dw-1 vcrd thc niil.(5) Yadavae/ al 2004 reportrd a largeaa>eteranv -puls/dili sweiling of the mid .), whiletinlenlarging sweiling was reportrd w r bl ell carcinws-. Rarely, v> aan uyusufi loen//ww,lis Aliae/ al 2003, haveereportrd on pvw less gross sweiling of the urth to>.(8) <"ti L ista Comsta Comp>Radiorsgic s cl< on 1 vw x-raystwilblvary dep"> g on theesyprlicatiggressive c tof the t> dicatthee sweiling, mod /dh to markrd bv c da-truct/ww,licati>aslliI ases com1 ete iv c ly-ro.(5) Bv c ly-ro rowusufilylwithout any d"> oitd-t rediv dn.(1,14) When theeow-iv> 1ha x of the iig toc rowtheesite of the lesia , theejow v isararelylinvolvci dcrossrd by the lesia (1) ,licati thin margin of subd"> al iv cwusufilylremvw , and-uwith ass=emc da-truct/ww.(1,5)   Theesubd"> al iv cwpla> as weillis theejow v spacr aredasufilylpreservea.(5) Theeneoclas tmay causi bfilooning of the thin hd con">endssheillis itlenlarges.(1) Con">endsbfilooning may b=lseen with m> ec , ilthoughav cw ase of lyiiv m> dhas broken through theeeortrx, therc rowa homogenow-es ro -odd"> involvcmws-.(1) Yadavae/ al 2004 reportrd i> g aspansia icatex sive da-truct/ww of the seoma ev> s-rsal by aes ro -odd"> lass that rep vcrd thc viir>ev> s-rsal.(13) Also, w rared ases, involvcmws- may b=lsotex sive such that da-truct/ww maylinvolvc thc hind s-rsalo.(16)  /div> dspreadlto theeow-iv> 1arts of the ass=emit>estin -tilblunclsa".(10, 17) Theedomi ntthica was und to beeaffmcseawwith m> aising theepossibility of increa-rd blooatsupply as a causi r li d ells arod theepulmonary capillar>estin the lung, foll whereetheyecanlow-semin:/e widely.(1) Adi/herepossible asview://ww is t> d ells ai-umoa lymphaiivs then gvw iccess to theevenow-esyitdm, foll whiih theylenser theesyitdmiv cirmorsibro icatspreadlow-iv>ly.(18)  Batson haiv cmonstraseaw4ow theevalvcless venow-e1 exustin the sumrtebr-t reg/ww commu s="e" swith theevessels of the lower ass=emit>es,ahenceevenow-eflow foll the elvacevew s coule redih theeumrtebr-t venow-esyitdm then to theevessels of the lower limbo.(19) (aredyou redilylproposing that Batson&rs-fo;-e1 exustredihes  thee demboli to redih thee s in subdiaphragm/div loen//wwstared =lprone to m> es. Theepresencc of "ea, div c> lar> orylof traus-,lloendaa>mperature,ahormwwfi influe s, icatloendahcmodynav cl may also eo clibu> to theedandlopmws- of thesi m> dm> or to surgery. Initd-a, the lesia row=emoveatislvart of anlimputsibro processlicatsent r div>opathorsgy, to revd-t theeowagws-rowof v> ite div>opathorsgiv owagws-rowiow=equir>d. Thee ppropria> typrlisuan incis/wwfi iiopsyv(11). Sebag-M fi =le/ al 1997, stress theeimportancc of a de i>itive diagws-ro, ba-rd o i hiv>orsgiv eo firmaibro, such that pfiliative radio/herapy may b=lgive in t> s or icdiiioiivs give in ases of infmcs/ww.(24) R bl ell carcinws-wacrfi lesia l may also div c o/heremiv clewc>estmivroscopicfily, aspecially adenocon">endscarcinws-,lclsa"l ell div clasicatmav clews -row vie, icatthis mica"e" stheeuse of immu ohiv>oihem>endsstvw s. Any da>iws- with a -rown div>orylof v> atwo s s e studies, alCT of the F=eque tly, owagws-rowiowdelayci daamis iagws-ro is made, aspecially when therc rowno div>orylof primary ow-ea-=laranv com1 vw vowfoll a primary site of miv clewcy.(11, nerd relasenc" sherc) Diagws-ro may b=ldelayci foll 1-3d nths. Inwoma Fibros when a pvw ulvsweiling ocbd\x3atsuddenly icatgrco rapidly,licatespecially so when therc was prearow-ediv>orylof a -rown primary miv clewcy, owagws-rowwas made sa"ly, and-uif afser theetoc was imputsici dlower leglimputsibro pl cormrd. Inwr bl ell carcinws-, the behavi r of a v> lywunpredictabs=, ye/ sa"lylowagws-rowicattreatmd-tahold-edopes forepositivelylaffmcsing pa>iws- survival.(7) /div> iws- has aumrage survival of 3-9d nths.(5) In theestudy by Hattrupee/ al, 1988, the pa>iws-s haati meanlsurvival of 12.3d nths afser datmcs/ww of the m> iws-s treat3atsurgicfilylhaatmeanlsurvival of 16.5d nths, whiletthose treat3atby radio/herapy haat10.3d nths only.(25) O/hereen">csesrhaveedocumenteatlongerepa>iws- survival,ti>aslliIredihing 20d nths afser toc imputsibro.(16) Schwartzee/ al, support theeidea that bd\x3ex adv/ s in a /herapy canlpro"dng survival,tthus iws- was ow-ea-=lfree 5 ysa"o afser success ulvtreatmd-taof here r s carcinws-.(18)/="tiap> Rec3ex adv/ s in a /reatmd-taaredlik=ly to lead to ch ging pa>serns of m> treatmd-t forepa>iws-s with adv/ atbrea-t, pfiel/d>,licatmultips= -row vie ca s has lead to a s clifs="nt dacrea-rtin theirarisk of sk=letal li endss clifs="nce, itlappsa"s that the risk of acolli s, such as brea-tlicatpro   <"tiap>  <"tiap>Relasenc" : <"tiap>Relasenc" : /="tiap>1. ZindritodMR, Young MP, DaleyeRJ, Lv id TR. General"orthopaedics, v>
s of the to theeelbibl/div>3. HealeyeJH, TurnbulblADM, Mieddm/ B, La c JM. Acolli iws-s with Oss ow-eInvolvcmws- of theeHicas icatFeed. J Bv c /div>4. Libson E, Bloll R, HusbicatJ, StokereD. M> s of iv c of the hica /div> icatOitlemyw-it> of the Fifth Toe. J F r al carcinws-waca /div> orinw R, Gfilo L, De Sio M, Marra L, Claudio L, C raco C, F"v o /div> 8. AliaZA, Wimhuand JA, AliaAA, T>mpend ME, Edwards DJ. Eli-m> r al ca /div>9. Bak iiv B, Huvos A. T> s of the 10.timi r al Carcinws-w/div> Pha x of the Hfilux: A Case Report. J F 11. OzdemiraHM, Yildiz Y, Yilmaz C, Saglik Y. T> s of the -application" : /div>13. YadavaR, Ansa"i MS, Dogra PN. R blCell Ca"cinws-wPresenting as Solit ws/div> 14. Sundbe g SB, C rlson WO, Johnson KA. M> 16. UharčeodP, MlynčeodM, RavingereJ. Eli-m> r al Adenocarcinws-/div> 18. Cot-roeJK, Wang F, Swenerton KD. Eli-m> r al adenocarcinws-wpresenting as /div>19. Batson OV. TheeFunc//wwtof theeVmrtebr-t Vew s icattheiraRol in theeSpreadlof  /div> infmcs/ww ww:  /div>23. Ke"in R. TheeHicati>aM> aa da>iws- with  /div>25. HattrupeSJ, Amadio PC, Sim FH, Lombardi RM. M> u s of the /div>L
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