Medical Imaging Analysis Report

I. Radiological Findings

Based on the provided CT and MRI images, the following are noted:

• Cervical/Upper Thoracic Region: A soft tissue mass is visible in the paravertebral and deep neck regions, with relatively clear boundaries and no significant invasive destruction of adjacent trachea or major blood vessels. Some images reveal a history of cervical spine surgical fixation devices.
• Lungs: Multiple solid small nodules are seen in both lung fields, widely distributed with small diameters, consistent with benign/low-aggressive metastatic lesions.
• Pelvis and Abdomen: A solid mass is found in the pelvic cavity, roughly spherical or ovoid in shape, demonstrating mild to moderate enhancement in certain areas. A localized solid nodule is observed in the abdominal wall. Overall, no obvious ascites or significant invasion of the bowel, liver, or other organs is noted.
• Skeleton: Localized changes in bone density or abnormal lesions are visible in the cervical and lumbar vertebrae, but no widespread osteolytic or destructive changes. Some lesions exhibit bone expansion or localized defects, potentially consistent with benign infiltration from a smooth muscle origin.
• Ultrasound Images (Suspected Abdominal Wall Nodule): A solid mass with relatively clear boundaries and heterogeneous internal echoes.

These imaging findings, in combination with clinical pathological results (smooth muscle tumor features), suggest multiple smooth muscle tumor lesions or “benign dissemination”-type changes throughout the body.

II. Potential Diagnoses

1. Benign Metastasizing Leiomyoma (BML):

   Considering the patient’s likely history of uterine leiomyoma (fibroids), histopathologically confirmed as smooth muscle tumors, along with similar “metastatic” lesions in the lungs and bones, typically presenting with well-defined margins and slow growth—lacking the severe destructive or invasive traits of malignancies—BML is the primary consideration.

2. Leiomyosarcoma Metastases:

   Compared to BML, leiomyosarcoma usually appears more aggressive and destructive on imaging, often with local tissue destruction and frequent necrosis or hemorrhage. A comprehensive assessment of pathology and imaging is needed to exclude this possibility.

3. Multiple Metastatic Tumors (Lung Nodules or Bone Metastases):

   Common solid tumors, such as breast, lung, and kidney cancers, can present with multiple metastases to the lungs and bones. However, given the patient’s histopathology results and possible uterine fibroid history, a smooth muscle origin is more likely.

III. Final Diagnosis

Considering the patient’s age, smooth muscle tumor pathology, the distribution of widespread nodules as seen on imaging, and literature reports on Benign Metastasizing Leiomyoma (BML), the most likely diagnosis is:

Benign Metastasizing Leiomyoma (BML)

If any diagnostic uncertainties remain, further immunohistochemistry, genetic testing, or close follow-up observations of the lesions may be used for confirmation.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy

• Endocrine Therapy: Since BML is often thought to be associated with estrogen levels, measures to suppress or reduce estrogen (e.g., using GnRH agonists or monitoring post-menopausal status) may be considered.
• Surgery/Interventional Therapy: For large solitary or oligometastatic lesions, surgical resection or minimally invasive ablation can be undertaken to alleviate local symptoms or compression. Pathological examination of the removed lesions can further clarify the diagnosis.
• Follow-up Observation: If lesions remain relatively stable, regular radiological follow-up is advised to monitor tumor size and count.
• Adjuvant Therapy: Symptomatic treatment (e.g., pain management, nutritional support) may be provided. In cases of significant bone involvement or fracture risk, bisphosphonates, vitamin D, and calcium supplements may be used to improve bone density.

2. Rehabilitation and Exercise Prescription

Given potential multiple skeletal lesions, the need to manage estrogen levels, and considerations for post-surgical recovery, a personalized and gradual exercise program is recommended to protect bones and maintain muscle strength:

• Exercise Type: Use low-impact aerobic exercises (e.g., brisk walking on flat terrain, elliptical trainer, swimming) and light-to-moderate resistance training (resistance bands or light weights), avoiding high-impact activities that place undue stress on the spine or bones.
• Frequency (F): 3–5 sessions per week, individualized according to the patient’s capacity.
• Intensity (I): Work at a moderate intensity by subjective perception (Borg Rating of Perceived Exertion at about 11–13), avoiding excessive fatigue or aggravation of joint/bone pain.
• Time (T): Start with 15–20 minutes per session. As the patient’s tolerance increases, gradually extend the duration to 30–45 minutes.
• Type (T): Focus on flexibility training and core stabilization, supplemented by resistance exercises to maintain or slightly improve muscle strength.
• Volume/Progression (V/P): Reassess patient tolerance and symptoms every 2–4 weeks. If the patient adapts well, make slight increments in total exercise time or training load.
• Special Considerations: If there is fragility in the bones or spinal instability, exercises should be conducted under the guidance of professional rehabilitation therapists or trainers to ensure safe and proper form during any weight-bearing activities.

Disclaimer: This report is based on available data and serves as a reference for medical analysis. It does not replace in-person consultations or professional medical advice. Specific diagnosis and treatment should be determined by a specialist in conjunction with the patient’s actual condition.