D in 1989 by gerald and rosai who described a distinct type of small round blue cell tumor with a predilection for serosal surfaces such as the peritoneum and the tunica vaginalis that affected mostly caucasian males in the second or third decade of life. buy viagra online 1 dsrct is generally associated with aggressive features and a poor prognosis. Tumor cells co-express epithelial, mesenchymal and neuronal markers and are thought to originate from a mesothelial or submesothelial progenitor cell with the potential to undergo multilineage differentiation. Because of this, dscrt is also called "mesothelioblastoma". To date more than two hundred cases have been described in the medical literature. Dsrct exhibits a male predominance of 90%, and 85% of patients are caucasian. generic viagra without presciption usa Median age at diagnosis has been reported as 14, 19 and 25 years of age in different series. natural alternatives to viagra for women 1-4 several treatment modalities are used including surgery, radiotherapy and chemotherapy. Unfortunately, these modalities frequently do not provide a durable response, and the prognosis for patients with dsrct remains poor. safe take 2 viagra pills Despite aggressive therapy, 3-year overall survival has been estimated at 44% and the 5-year survival rate remains around 15%. 5 figure 1 clinical manifestations in most cases, dsrct presents as an abdominal mass with peritoneal and omental implants. Associated symptoms may include crampy abdominal pain, weight loss and constipation. generic viagra online The most common presentation is bulky abdominal disease present in a young adult, often males. buy cheap viagra Other reported sites of disease include pleura, ethmoid sinuses, scalp, hand, posterior cranial fossa, pancreas, ovary, paratesticular and kidney. Symptoms related to extra-abdominal tumors vary, and include scoliosis, chronic sinusitis, and pain. viagra coupon Erectile dysfunction has also been described. 1-3,5-9 dsrct is regional; the major bulk of these tumors is intraabdominal. cheap viagra online Liver metastases are common at diagnosis and relapse; other distant sites include lymph nodes, lung and bones. Interestingly, dsrct has been documented as an incidental finding during a cesarean section. Another peculiar sign on presentation is known as a "sister mary joseph nodule," which is an occasionally painful lump in the umbilicus secondary to metastatic cancer in this location (figure 1). 10,11 more than 40% of patients have distant metastases at the time of diagnosis, mostly located in the liver, lungs, and lymph nodes (figure 1). viagra jetlag Diagnosis and pathological findings imaging studies are often suggestive but non-specific. safe take 2 viagra pills Abdomen ct usually demonstrates bulky, heterogeneous masses located in the abdomen and pelvis with a peritoneal componen.