Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided MRI images of the lower limb, the following observations are noted:

1. Tumor/Local Soft Tissue Condition: In the distal anterior compartment of the calf, there is an abnormal soft tissue lesion appearing as low signal on T1-weighted images and relatively high signal on T2-weighted images. The lesion has partially unclear boundaries and presents heterogeneous signal changes, suggesting possible mixed tissue or necrotic areas.
2. Tendons and Musculature: The anterior compartment tendons show signal increase and localized thickening, consistent with tendinitis or tendon pathology; surrounding soft tissues also show some degree of edema or effusion signals.
3. Adjacent Structures: The joint alignment is acceptable, with no obvious bone destruction observed on the articular surfaces. The local bone cortex shows no significant abnormal signal changes, and there is no clear evidence of new bone formation or fracture.

II. Potential Diagnoses

Given the patient’s history of lower limb leiomyosarcoma surgical resection and the current imaging findings, the following diagnoses should be considered:

1. Local Recurrence of Leiomyosarcoma: Leiomyosarcoma in the limbs is prone to local recurrence, especially after surgery and local radiotherapy. The appearance of a new soft tissue mass or abnormal signal warrants high suspicion for recurrence.
2. Tendon Pathology Related to Postoperative or Radiation Changes: Localized tendon signal enhancement and synovial reaction are common after surgery or radiation damage. Based on the lesion’s morphology and imaging features, tendon pathology such as tenosynovitis or tendon thickening should be considered.
3. Other Soft Tissue Tumors or Proliferative Lesions: Such as liposarcoma or fibrosarcoma. However, the patient has a known history of leiomyosarcoma, making other tumors less likely by comparison.

III. Final Diagnosis

Taking into account the patient’s age, medical history (prior leiomyosarcoma resection), and MRI findings, the most likely diagnosis is:

• Local Recurrent Leiomyosarcoma Combined with Anterior Compartment Tendon Pathology.

Further confirmation may require pathological biopsy or imaging follow-up to distinguish between simple tendon lesions and a locally recurrent tumor.

IV. Treatment Options and Rehabilitation Plan

Based on the above diagnostic considerations, treatment and rehabilitation should be individualized:

1. Surgical Intervention: If histological biopsy or further evaluation confirms tumor recurrence, another surgical resection may be necessary, aiming for complete excision of the lesion while preserving limb function.
2. Radiotherapy and Chemotherapy: In postoperative or recurrent leiomyosarcoma cases, chemotherapy and/or local radiotherapy may be considered. The specific regimen depends on the pathological grade, tumor size, and extent of invasion.
3. Conservative Management of Tendon Pathology:
   • Local Physical Therapy: If there is no active tumor, modalities like heat application and ultrasound therapy can be considered to promote local blood flow and reduce inflammation.
   • Medication: When needed, oral or topical non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate pain and inflammation.
   • Exercise Rehabilitation: Implement progressive stretching and mild strengthening exercises targeting the anterior compartment muscles.
4. Rehabilitation and Exercise Prescription (FITT-VP Principle):
   • Frequency: 3–5 sessions per week are recommended. Adjust according to the patient’s overall condition and ongoing tumor treatment.
   • Intensity: Begin with low to moderate intensity to avoid exacerbating local pain or tissue damage.
   • Time: 20–30 minutes per session, which can be divided with rest intervals. Extend the duration gradually based on recovery progress.
   • Type: Prefer low-impact activities such as seated or partial weight-bearing ankle plantar-flexion and dorsiflexion exercises. Resistance training can be assisted with elastic bands.
   • Progression: Increase load or session time gradually as pain subsides and muscle strength improves. If there is a possibility of tumor recurrence, consult with a specialist before advancing training intensity.
   • Volume & Individual Condition: Consider the patient’s bone status and cardiopulmonary function. If significant pain, swelling, or fatigue occurs, reduce or discontinue exercises promptly.

Disclaimer: This report is based solely on the available medical history and imaging data for reference purposes and does not replace an in-person consultation or professional medical advice. For any questions or worsening symptoms, please seek medical attention promptly. The final diagnosis and treatment plan must be determined in conjunction with clinical presentation, laboratory tests, pathological results, and specialist evaluations.