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37-y.o male with HME and knee pain. Axial T1, T2 and STIR MRI slices at popliteal region. Large cartilaginous cap and possible compression of the popliteal artery by osteochondroma. MRA was performed to evaluate popliteal A. pseudoaneurysm (large arrow). Pathology specimen obtained from the cartilagenous cap showed increased cellularity suggestive of malignant degeneration. Operative care was planned
Ewing sarcoma: age: 2-20, uncommon in black patients. 2nd m/c highly malignant bone neoplasm in children that typically arises from
medullary cavity (Round cell tumors). Key symptom: bone pain that may mimic infection (ESR/CRP/WBC) Considered PNET
Key Rad Dx: aggressive moth-eaten/permeative lucent lesions in the shaft of long bones with large soft tissue invasion/typical onion skin
periostitis. May produce saucerisation
May affect flat bones. May appear as sclerotic in 33%. Early lung mets (25-30%) bone-to-bone mets
Poor prognosis if delayed Dx. Imaging steps: 1st step x-rad, MRI is v. important followed by biopsy. CXR/CT PET-CT
Rx: combined rad-chemo, operative.
Malignant fibrous histiocytoma (MFH) reclassified as Pleomorphic Undifferentiated Sarcoma (PUS) is the m/c S.T. sarcoma. MFH is
aggressive biologically with poor prognosis
M>F (1.2:1) 30-80 with peak in a 6th decade. 25-40% of all adults sarcomas m/c extremities. Retroperitoneum next (worst prognosis d/t late Dx and large growth w/o symptoms)
Clinically: painful, hard mass typically about the knee or thigh. Histology: poorly differentiated/undifferentiated malignant fibroblasts, myofibroblasts and other mesenchymal cells
Imaging: MRI is the modality of choice with T1, T2, T1+C. Typically appears as aggressive heterogeneous mass intermediate to low signal on T1 and high signal on T2 with areas of necrosis and enhancement on T1+C. May
appear misleadingly encapsulated w/o true capsule
Management: operative with radiation and chemotherapy. Tumour depth is crucial for prognosis. 80% 5-year survival if <5cm deep in ST and 50% if >5-cm deep in ST.
Synovial sarcoma: common malignant ST neoplasm esp. in younger patients or older children/adolescents. M/C found in knee area
Clinically: can present slowly as palpable mass in the extremity often ignored d/t slow growth
Imaging is the key: radiography may reveal ST. density/mass. Some synovial sarcomas may show calcification and mistaken for Myositis Ossificanse or heterotopic bone formation
MRI with T1,T2 and T1+C are Dx modality of choice. Other modalities: US, CT are non-specific
DDx: MFH
Management: operative, chemo-radiation
Prognosis: variable depending on size, invasion, metastasis
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Welcome to El Paso's Premier Wellness and Injury Care Clinic & wellness blog, where Dr. Alex Jimenez, DC, FNP-C, a board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those found on this site and our family practice-based chiromed.comΒ site, focusing on restoring health naturally for patients of all ages.
Our areas of chiropractic practice include Β Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.
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We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.
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We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please feel free to ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900.
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Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License # TX5807
New Mexico DC License # NM-DC2182
Licensed as a Registered Nurse (RN*) in Texas & MultistateΒ
Texas RN License # 1191402Β
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Masters in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
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