Medical Analysis Report

1. Imaging Findings

Based on the provided CT and MRI images, there is a localized expansile, osteolytic lesion in the 7th thoracic vertebra (D7). Partial sclerosis is seen around the margins of the lesion. The CT images show a low-density area in the vertebral body with eccentric destruction, and the cortical bone is locally thinned or slightly bulging. On MRI, the affected region shows mixed signals. In T1-weighted images, signals are predominantly low to intermediate, and in T2-weighted images, some regions show relatively low signal along with a certain soft tissue component, consistent with the characteristic “relatively low T2 signal” often seen in some GCTs. No obvious large paravertebral soft tissue mass is observed, but a slight soft tissue bulge is noted around the vertebral margin. Surrounding vertebrae and the posterior elements do not show any significant destruction, and there is no evident scoliosis or kyphotic deformity.

2. Possible Diagnoses

1. Giant Cell Tumor of Bone (GCT):
   • Commonly occurs in young to middle-aged adults, typically presenting as an expansile osteolytic lesion.
   • On imaging, the sacrum is frequently involved, but thoracic vertebrae can also be affected, often with a soft tissue component.
   • On MRI, T2 signals are often relatively low or mixed, which is somewhat characteristic.
2. Metastatic Tumor:
   • The thoracic spine is a common site for metastases; lesions may be multiple or associated with a known primary tumor.
   • On CT, they can present as osteolytic or mixed destructive lesions. Clinical history and additional imaging are needed to support this diagnosis.
3. Aneurysmal Bone Cyst (ABC):
   • Sometimes coexists with giant cell tumors or can be difficult to differentiate from them.
   • Expansile bone destruction can be seen, and the cystic cavity may show septations or fluid-fluid levels.
4. Other benign bone tumors or tumor-like lesions (e.g., osteoid osteoma or enchondroma):
   • They usually have more typical morphological features such as calcification or bony proliferation.
   • They do not fully match this case’s imaging features and are therefore relatively less likely.

3. Final Diagnosis

Taking into account the patient’s age (35 years), clinical presentation (persistent back pain for 3 months with no obvious trauma or other systemic symptoms), imaging findings (eccentric osteolytic lesion in D7 vertebra with partial sclerosis and predominantly low T2 signal on MRI), and pathological examination (biopsy confirmed giant cell tumor), the final diagnosis is:

Giant Cell Tumor of Bone (GCT) in the 7th Thoracic Vertebra (D7).

4. Treatment Plan and Rehabilitation

Treatment Strategy:

• Surgical Treatment: For spinal GCT, surgical resection is often recommended. Common approaches include en bloc resection of the affected segment (e.g., total vertebral body resection in this case) or curettage with bone grafting and internal fixation. If there is significant soft tissue involvement, the resection margins and reconstruction requirements need to be adjusted accordingly.
• Adjuvant Therapies: Depending on intraoperative findings and pathological grading, possible options include:
  • Preoperative or postoperative radiotherapy (for cases with residual disease or where complete resection is difficult).
  • Selective arterial embolization (helpful for lesions with abundant blood supply to reduce bleeding and shrink the tumor mass).
  • Chemotherapy or targeted therapy (e.g., denosumab) may be considered in the treatment plan for GCT on a case-by-case basis.

Rehabilitation and Exercise Prescription: Postoperative rehabilitation should be carried out cautiously to maintain spinal stability and gradually restore motor function.

• Early Rehabilitation:
  • Within 1-2 weeks post-surgery, rest in bed and gentle position changes are mainly recommended. Protect the surgical site and consider bracing with a thoracolumbar support if advised by the physician.
  • Under medical guidance, begin deep breathing exercises and mild lower limb strength training with protective bracing to prevent thrombosis.
• Intermediate Rehabilitation (2-6 weeks post-surgery):
  • Once bone healing advancement is confirmed, begin small-range exercises for back, core, and other muscle groups, focusing on light to moderate isometric or resistance training.
  • Avoid excessive spinal rotation or flexion to reduce stress on internal fixation and lower the risk of reinjury.
• Late Rehabilitation (6 weeks post-surgery and beyond):
  • Based on follow-up imaging and clinical healing evaluation, gradually increase exercise volume and intensity. Low-impact aerobic activities (e.g., swimming or stationary cycling) can be initiated.
  • Develop a program for strengthening the core muscles and improving balance, adhering to the FITT-VP principle (Frequency, Intensity, Time, Type, Volume, Progression) 2-3 times per week, gradually increasing exercise volume and difficulty.
  • If necessary, receive individualized functional training under the guidance of a professional rehabilitation team to maintain spinal stability and optimize recovery of daily and work abilities.

5. Disclaimer

This report is intended solely for reference based on the available information. It cannot replace in-person consultations or professional medical advice. For actual diagnosis and treatment plans, please consult a specialist physician or orthopedic oncologist who can make final decisions based on the patient’s individual condition and the latest medical guidelines.