Medical Analysis Report

I. Radiological Findings

Based on the provided X-ray, CT, and MRI images, combined with the patient’s notable mass in the right groin (inguinal region) and associated vascular and nerve compression symptoms, the following major radiological features are observed:

• Multiple bony outgrowths: Exophytic bony prominences are visible in multiple locations, including the bilateral proximal femurs, humeri, distal radii and ulnae, and both proximal and distal tibiae and fibulae. These show continuity of the cortex and medulla with the parent bone, consistent with multiple osteochondromas (exostoses).
• In the pelvic region (especially near the right iliac bone or pubic symphysis), a large, irregularly shaped bony mass is visible. Meanwhile, cartilaginous or calcified signals can be seen in the local soft tissue, suggesting an enlarged cartilaginous component. Certain areas show prominent enhancement in soft tissues.
• On MRI, the cartilaginous cap demonstrates low-to-intermediate signal on T1 and high signal on T2, with septal-like enhancement, indicating proliferative or possibly malignant cartilaginous tissue; additionally, compression signs on adjacent vessels and nerves are observed.
• In some images, even after the closure of the nearby growth plates, the bony exostoses continue to grow and the cartilaginous cap thickens (in some measures close to or exceeding 2 cm). In adults, this is an important sign of malignant transformation.
• Compression of lower extremity veins leads to restricted venous return, causing stasis (i.e., “venous dysfunction”), and the large tumor mass further compresses the surrounding tissues.

II. Potential Diagnoses

Based on the above radiological findings and the patient’s history, the following diagnoses or differential diagnoses should be considered:

1. Secondary Chondrosarcoma
   • The patient has a history of multiple osteochondromas (often termed Hereditary Multiple Exostoses, HME). Continuous growth of the local bony outgrowth after growth plate closure and marked thickening of the cartilaginous cap are typical patterns of malignant transformation.
   • An MRI showing a cartilaginous cap thicker than 2 cm or locally heterogeneous enhancement with a soft-tissue component suggests a tendency toward malignant change.
2. Simple enlargement of osteochondroma
   • Osteochondromas (exostoses) themselves can often be multiple. However, if there is no obvious soft-tissue component or significant thickening of the cartilaginous cap, they generally remain benign.
   • Because the patient already exhibits neurovascular compression symptoms and pain, along with radiological signs of a thickened cartilaginous cap, a simple benign enlargement is less likely.
3. Other cartilaginous lesions
   • Including other subtypes of chondrosarcoma, but given the patient’s history of HME and the typical osteochondroma configuration, secondary chondrosarcoma arising from osteochondroma is the most common concern.

III. Final Diagnosis

Taking into account the patient’s age, history of HME (multiple hereditary exostoses), clinical presentation (continuous growth of exostoses, compression of vessels and nerves causing pain and stasis), and imaging features (marked thickening of the cartilaginous cap and appearance of a soft-tissue mass), the most likely diagnosis is:

“Malignant transformation of multiple osteochondromas (Hereditary Multiple Exostoses) — Secondary Chondrosarcoma”

If there is still any uncertainty, a biopsy of the lesion can be performed for final confirmation.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy

• Surgical treatment: For lesions that show malignant transformation or cause significant symptoms (vascular or nerve compression), complete surgical resection of the tumor with negative margins is usually required to reduce the risk of recurrence.
• Perioperative evaluation: Preoperative MRI is necessary for precise localization and to assess the tumor extent, while also noting the course of blood vessels and nerves to formulate a detailed surgical plan.
• Auxiliary testing (pathology): Intraoperative or postoperative pathological examination of the specimen is essential to confirm the tumor’s malignancy grade. If needed, radiotherapy or other adjuvant therapies may be considered (although for low-grade chondrosarcoma, surgery alone is often sufficient, and routine chemo/radiation is not common).
• Follow-up and monitoring: Because of the risk of malignant transformation in HME, regular MRI/CT follow-ups are recommended (some guidelines suggest once a year) to detect any new lesions or progression of existing ones as early as possible.

2. Rehabilitation/Exercise Prescription

During both the preoperative and postoperative periods, individualized rehabilitation and exercise guidance should be given based on the patient’s skeletal condition and cardiopulmonary function, as follows:

• Preoperative phase:
  • If the pain and the mass do not severely limit activity, low-impact exercises can be performed, such as seated or supine limb range-of-motion training, to maintain joint flexibility and basic muscle strength.
  • Avoid high-impact activities or those that may cause fractures or further soft-tissue damage, such as running, jumping, or heavy weightlifting.
• Early postoperative phase:
  • Based on the extent of resection and medical advice, start with non-weight-bearing or partial weight-bearing exercises, such as walking with a walker or crutches.
  • After the surgical site has healed and stabilized, gradually introduce light weight-bearing exercises and joint range-of-motion training (e.g., straight leg raises, quadriceps contraction exercises) to restore muscle strength.
• Progressive exercise program (FITT-VP principle):
  • Frequency: Light to moderate intensity activities 3-5 times per week.
  • Intensity: Depending on patient recovery, initially keep the target heart rate at about 30%-50% of the maximum heart rate, gradually progressing to 50%-70%.
  • Time: Start with approximately 15-30 minutes per session, increasing to 45 minutes or more as tolerated.
  • Type: Prefer low-impact activities such as swimming, stationary cycling, elliptical training, or walking in water to reduce stress on lower limb bones and joints.
  • Progression: As disease control improves and fitness increases, gradually increase weight-bearing and exercise volume. Under the guidance of physicians and therapists, incorporate small-weight, higher-repetition resistance training to enhance muscle strength.
  • Volume/Pattern: Adhere to a gradual progression, regularly monitor pain and limb functionality, and avoid sudden, large increases in exercise volume.
• Safety Precautions:
  • Closely observe changes in pain or swelling at the surgical site. Seek prompt medical evaluation if any abnormal symptoms (severe pain, redness, signs of infection, etc.) occur.
  • For patients at risk of skeletal fragility or who have undergone extensive resections, begin exercise with protective measures to prevent falls and other injuries.

Overall, the rehabilitation plan should be carried out progressively under the guidance of sports medicine or orthopedic rehabilitation professionals, in coordination with surgical and oncological follow-up.

Disclaimer: This report is for reference only, based on the existing medical history and imaging studies. It does not replace in-person medical consultation or professional medical diagnosis and treatment advice. If you have any further questions or if your condition changes, please seek medical attention promptly.