Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided cross-sectional MRI images, a soft-tissue mass or space-occupying lesion is observed in the right shoulder region (including the shoulder joint and surrounding soft tissues). The lesion presents a marked abnormal soft-tissue density/signal that may involve the local bone structure. Given the anatomical complexity of this area, the lesion is closely adjacent to the surrounding muscles and joint capsule. Specific features include:

• The lesion is located near the right shoulder joint, showing a soft-tissue swelling or mass with an ill-defined boundary.
• The local bone may display uneven signals, suggesting potential bony destruction or cortical involvement (further confirmation needed).
• There may be enhancement or necrotic areas within or around the soft-tissue lesion, requiring contrast-enhanced sequences and other imaging planes to confirm.
• The overall lesion signal significantly differs from the surrounding shoulder muscle tissue, indicating space-occupying characteristics.

II. Potential Diagnoses

Considering the patient's basic clinical history (hepatocellular carcinoma, previously treated with transcatheter arterial chemoembolization), the following possibilities should be considered for the soft-tissue mass or destructive bony lesion in the shoulder:

1. Hepatocellular carcinoma (HCC) bone metastasis: Although bone metastasis is relatively uncommon in HCC, it must be taken into account in advanced or recurrent cases. For lesions with obvious soft-tissue masses, bone destruction, and pain, bone metastasis is the primary differential diagnosis.
2. Primary bone or soft-tissue sarcoma: If the lesion is not directly related to the existing HCC, it could be a primary sarcoma in the shoulder/proximal humerus region, such as osteosarcoma or soft-tissue sarcoma. These tumors can manifest as aggressive destruction and mass formation.
3. Other metastatic tumors: If the patient has multiple lesions or any other tumors, metastasis from another primary site should be ruled out, especially when encountering a single focal destructive lesion.
4. Benign or subacute lesions (e.g., giant cell tumor of bone, aneurysmal bone cyst, etc.): Although less common than malignant lesions, benign tumors or cystic lesions in the shoulder area must also be excluded. However, given the clinical context here, a benign lesion is less likely.

III. Final Diagnosis

In light of the patient's age (76 years), history of hepatocellular carcinoma, and the aggressive bone or soft-tissue lesion appearance on MRI accompanied by local shoulder pain, the most likely diagnosis is:

“Hepatocellular carcinoma bone metastasis (involving the right shoulder bone and soft tissues)”

Further diagnostic confirmation is recommended through:

• Evaluating serum tumor markers (e.g., AFP).
• Contrast-enhanced MRI or CT of the shoulder to determine lesion extent.
• Bone scan (or PET-CT) to assess for systemic skeletal metastases.
• Biopsy to obtain histological evidence confirming whether the lesion is an HCC metastasis.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy:
   • Tumor-specific management: If confirmed as HCC bone metastasis, consider local radiotherapy, palliative resection, or combined radiochemotherapy to relieve pain and control local progression.
   • Systemic therapy: Continue assessing the liver condition, and consider combining HCC-targeted therapies, immunotherapy, or other systemic chemotherapy as needed.
   • Supportive therapy: Pain management (oral or topical analgesics) and bone-protective agents (bisphosphonates or osteoclast inhibitors) to prevent further bone destruction or fracture.
   • Surgical indications: If there is significant local pain or a high risk of bone destruction, surgical fixation or decompression may be considered to prevent pathological fracture and improve quality of life.
2. Rehabilitation/Exercise Prescription (Gradual Progression):
   • Within the tolerable range of pain and bone stability, gentle shoulder and upper limb activities such as pendulum exercises and assisted stretching are recommended to maintain joint mobility.
   • Initial stage: 2–3 times per week, 10–15 minutes per session of light upper limb stretching and range-of-motion exercises, avoiding excessive load.
   • Intermediate stage: When symptoms are stable and approved by a physician, gradually increase to 20–30 minutes per session, with low-resistance exercises using resistance bands. Movements should be slow and avoid exacerbating pain.
   • Later stage: If the lesion is effectively controlled or upon clearance by a physician and rehabilitation specialist, progressively add strength training with small weights (1–2 kg) or machine-assisted workouts, 3–4 times per week.
   • Throughout, closely monitor pain, fatigue, and bone stability. If marked discomfort (increased pain, joint swelling, limited mobility) occurs, seek medical advice promptly.
3. Precautions:
   • Patients with bone metastases should be alert to the risk of pathological fractures; proper safety and correct posture are crucial during exercise.
   • If there is compromised cardiopulmonary or liver function, consult relevant specialists before creating an individualized exercise plan.
   • Physical therapy, nutritional support, and psychological counseling are recommended throughout to improve treatment outcomes and quality of life.

V. Disclaimer

This report provides a preliminary medical analysis based on the provided information and is for reference only. It cannot replace an in-person consultation or professional medical advice. If you have any questions or if your symptoms worsen, please consult a specialist or visit a hospital promptly.