Medical Analysis Report

1. Imaging Findings

The patient is a 31-year-old female who has experienced right hip pain for approximately 4 months. The imaging data includes X-ray plain films and MRI. The overall imaging features are as follows:

• X-ray: On the proximal right femur or around the acetabulum, there is bone destruction presenting as “geographic” or irregular osteolytic lesions with ill-defined margins, suggesting a wide range of destruction and an unclear transition zone, consistent with an invasive lesion. Local cortical destruction and a possible soft tissue mass are also visible.
• MRI: On both T1- and T2-weighted images, there are multiple cystic or fluid signal areas within the lesion. Some areas show higher signal intensity, suggesting the presence of hemorrhage or necrosis within the cystic cavities. Internal septations and enhancing soft tissue components along the lesion margin are observed. The interface with surrounding muscles or soft tissue planes is not very clear, indicating possible tumor extension into the soft tissues.
• Pathological Appearance (Intraoperative or Specimen Example): Hemorrhagic cystic cavities and necrotic components are observed, with tumor cells and osteoid formation present in the periphery or within the septations.

2. Potential Diagnoses

Based on the patient’s age, lesion location, and imaging characteristics, the following diagnoses or differential diagnoses are considered:

1. Teleangiectatic Osteosarcoma (T-OSA)
   This subtype of osteosarcoma features multiple cystic spaces containing blood or necrotic tissue. It accounts for approximately 4.5%–11% of all osteosarcomas. Imaging often shows extensive bone destruction, cystic or hemorrhagic signals, and peripheral solid tumor enhancement. It commonly occurs in adolescents or young adults, which aligns with this case.
2. Aneurysmal Bone Cyst (ABC)
   Also presents as a multiloculated, cystic lesion containing blood-filled cavities, but typically lacks prominent malignant tumor components. The peripheral or septal enhancement is not as pronounced as in malignant tumors, and the degree of bone destruction is generally less severe. Commonly found in adolescents or young adults.
3. Conventional Osteosarcoma
   A common subtype of osteosarcoma, usually presenting with bone destruction, a soft tissue mass, and malignant osteoid formation. However, large-scale cystic and hemorrhagic changes are less apparent compared to the teleangiectatic type.

3. Final Diagnosis

Considering the patient’s age (31 years old), history of right hip pain, imaging findings (hemorrhagic and necrotic cystic cavities, peripheral tumor enhancement, and significant bone destruction), and pathological features (malignant spindle cells and osteoid formation in the cyst wall and septations), the most likely diagnosis is Teleangiectatic Osteosarcoma (T-OSA).

If a complete biopsy has not yet been performed, further pathological evaluation and related laboratory tests (e.g., tumor markers, blood panel) are recommended for final confirmation.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategy

• Neoadjuvant Chemotherapy: Standard treatment for osteosarcoma includes preoperative neoadjuvant chemotherapy to reduce tumor size and target potential micrometastases.
• Surgical Resection: Depending on the extent of the lesion and involvement of surrounding tissues, wide resection, limb-salvage surgery, or amputation may be performed. In teleangiectatic osteosarcoma, thorough resection is required along with function preservation, which may involve bone grafting or joint reconstruction.
• Postoperative Adjuvant Chemotherapy: Chemotherapy is continued after surgical resection to consolidate treatment outcomes and reduce the risk of recurrence.
• Regular Follow-up and Imaging: Monitoring for tumor recurrence or distant metastasis is crucial, especially checking common metastatic sites such as the lungs and liver.

4.2 Rehabilitation and Exercise Prescription

The primary goals of postoperative rehabilitation include preventing limb disuse, improving muscle strength and joint range of motion, promoting functional recovery, and maintaining daily activity capacity. Below is an example program based on the FITT-VP principle:

• Early Rehabilitation (1–4 weeks after surgery)
  • Under medical supervision, perform passive or small-range active movements of the affected limb, avoiding excessive load.
  • Bedside isometric exercises for lower limb muscles (e.g., quadriceps contractions) 2–3 times per day, 5–10 minutes each time.
• Intermediate Rehabilitation (4–12 weeks after surgery)
  • Once the surgical site is stable, gradually increase joint range-of-motion exercises, such as active hip and knee movements, gentle stretching, and low-intensity resistance training.
  • With appropriate protective devices or supports, begin partial weight-bearing exercises to gradually restore walking ability.
  • Perform 3–4 sessions per week, 20–30 minutes each, adjusting based on pain and swelling.
• Late Rehabilitation (12 weeks or longer)
  • Gradually increase weight-bearing and functional training, including sit-to-stand exercises, stair climbing, and resistance training, generally 3–5 sessions per week.
  • When joint stability and bone healing are confirmed, consider low-impact aerobic exercises such as swimming or cycling to enhance cardiopulmonary function and muscle strength.
  • Extend training sessions to 30–45 minutes, increasing intensity based on follow-up evaluations.
• Individual Considerations:
  • Closely monitor the progress of bone healing and soft tissue recovery. If severe pain, swelling, or discomfort occurs, consult your physician promptly.
  • If the patient has insufficient cardiopulmonary function or other underlying conditions, adjust training intensity and frequency under specialist guidance.

Disclaimer

This report provides reference analysis and should not replace an in-person consultation or the opinion of a professional physician. Specific treatment and rehabilitation plans should be determined by a multidisciplinary team of physicians and rehabilitation specialists, tailored to the patient’s actual condition.