Ts may also occur within the vertebral bodies, they need to be differentiated from chordoma. buy cheap viagra Systemic metastases to the regional lymph nodes, lung, liver, and bone occur in up to 25% of cases. Macroscopy on gross examination, chordomas are generally soft and appear to be well encapsulated. viagra canada Lobulations are apparent on cut section, and the tumor usually has a bluish gray color with extensive gelatinous translucent areas that are focally cystic and hemorrhagic. mais eficaz viagra ou viagra Grossly, the tissue may suggest a chondrosarcoma or even a mucinous carcinoma. Microscopy microscopic examination reveals a characteristic arrangement of tumor cells separated into lobules by fibrous septa of different thicknesses. buy viagra The tumor cells are of various sizes and shapes, arranged in both cords and sheets, with an eosinophilic cytoplasm associated with both extracellular and intracellular mucin that may be minimal or abundant. viagra online The intracellular vacuoles may be very prominent and displace the nucleus to one edge, producing the so-called "physaliphorous cell". viagra discount Synopsis  bone destruction  characteristic lobulated, firm blue gray tissue mass, with focal hemorrhage and cystification  nests and cords of tumor cells with abundant eosinophilic cytoplasm separated by lakes of mucoid tissue.  large mucoid foci are present;  in these mucoid areas, cords of eosinophilic cells may be present  large variegated and vacuolated cells characteristic of chordoma (physaliphorous cells) immunochemistry the tumor cells express both s-100 protein and epithelial markers. buy viagra canada Differential diagnosis  chondrosarcoma approximately one third of spheno-occipital chordomas contain a significant chondroid component, and these lesions can easily be confused with chondrosarcomas, especially with chondrosarcomas having a predominantly myxoid structure.  notochordal rest on occasion, a large notochordal rest in a vertebral body may be discovered as an incidental finding on mri. generic viagra no prescription In such a case, the differentiation from a chordoma may be a problem, although in a chordoma, there is generally a lytic lesion seen on radiographic imaging, whereas this has not been the case with the notochordal rests, which have been reported to be more often associated with bony sclerosis. Microscopically, notochordal rests lack myxoid extra. viagra canada online pharmacy no prescription