Medical Imaging Analysis Report

Patient Information: Male, 78 years old, chief complaint of right shoulder pain (for about 3 months), and a relatively hard mass palpable in the right shoulder region.

I. Imaging Findings

Based on the provided X-ray, CT, and MRI images, there is a mixed osteolytic-osteoblastic lesion in the right clavicle area, with uneven bone density, and a “radiating” or “sunburst” type periosteal reaction. The shape of the clavicle is destroyed, and there is a notable soft tissue mass extending beyond the bone. A similar lesion is observed in the right pelvic (iliac) region. The overall imaging appearance suggests an aggressive lesion.

II. Differential Diagnosis

1. Primary malignant bone tumor (e.g., osteosarcoma): The classic “sunburst” periosteal reaction is commonly seen in osteosarcoma. Although most osteosarcomas occur in younger patients, they can also appear in older patients (e.g., secondary to Paget’s disease). However, osteosarcoma is often associated with severe pain, and specific tumor markers (e.g., PSA) are usually not elevated.
2. Metastatic bone tumor: In elderly patients with aggressive bone destruction and accompanying soft tissue masses, metastatic lesions must be considered. Prostate cancer commonly exhibits osteoblastic metastases, and with the patient’s significantly elevated PSA (118.00 ng/mL), prostate cancer bone metastases are highly likely. Breast cancer can also present various degrees of osteoblastic metastases, but it is relatively less common in this context, and PSA typically does not elevate in breast cancer.
3. Infectious lesion (osteomyelitis): Aggressive bone destruction can be seen in chronic osteomyelitis, but it is often accompanied by clear clinical signs of infection (fever, redness, elevated inflammatory markers), which do not align well with this case.
4. Other causes of bone lesions: Such as rare post-traumatic periosteal reactions or uncommon bone tumors. However, these generally do not present with obvious “multifocal” or “suspected metastatic” features, making them less likely in this case.

III. Final Diagnosis

Considering the patient’s age, symptoms, imaging findings (mixed osteoblastic-osteolytic lesions with radial periosteal proliferation, soft tissue mass), and laboratory results (significantly elevated PSA), along with the pathological confirmation from a soft tissue biopsy of the clavicle, the most likely diagnosis is metastatic prostate cancer.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy

• Endocrine Therapy (Androgen Deprivation Therapy): Metastatic prostate cancer often responds well initially to androgen deprivation therapy (GnRH agonists or antagonists, surgical castration, etc.).
• Radiation Therapy: For lesions causing severe pain or posing a high risk of fracture, radiotherapy can be considered to relieve pain and stabilize the lesion.
• Bone Protection Therapy: Use of bisphosphonates (e.g., zoledronic acid) or RANKL inhibitors (e.g., denosumab) can help reduce skeletal-related events.
• Surgical Intervention: If a lesion results in fracture or severe structural damage, orthopedic surgery (internal fixation or resection and reconstruction) may be indicated to facilitate functional recovery.

2. Rehabilitation/Exercise Prescription Recommendations

Given the presence of bone metastases, bone fragility and fracture risk increase. Rehabilitation should be carried out cautiously under the guidance of specialists and physical therapists, with a gradual and individualized approach. Suggested key points include:

• Frequency: 3-4 sessions of low-load training per week, with adequate rest days in between.
• Intensity: Start with low-intensity exercises, such as light resistance training or simple limb movements in seated or supine positions; avoid excessive weight-bearing or explosive movements.
• Time: Begin with 15-20 minutes per session and gradually increase to 30 minutes according to tolerance and clinical status.
• Type: Primarily protective active exercises, simple stretching, and range-of-motion practice; gentle aerobic exercises (e.g., seated cycling or slow walking with precaution) may be added, ensuring fall prevention.
• Progression: Increase training load based on the patient’s subjective feedback and objective indicators (pain scale, fatigue level, bone scan or imaging follow-up). If significant pain or fatigue occurs, adjust the intensity and training plan promptly.
• Proper Core Training: Where safe, core stability exercises may help maintain posture and reduce the risk of falls.

Throughout the training process, closely monitor the patient’s cardiopulmonary status and pain level to ensure safety and efficacy.

V. Disclaimer

This report is based on the current imaging and clinical information for reference only and cannot replace in-person medical consultation or professional medical advice. If you have any questions or changes in condition, please seek prompt medical evaluation. Follow-up treatment and rehabilitation should be directed by a specialist’s assessment and recommendations.