Medical Imaging Analysis Report

1. Radiological Findings

Based on the patient’s provided X-ray and MRI images of the right lower leg, a localized lesion can be observed within the anterior cortical region of the mid-tibia:

• X-ray Findings: A lucent lesion with unclear boundaries can be seen in the cortical layer of the mid-tibia. There are areas of sclerotic patches or mildly increased density, and the lesion appears somewhat elongated. No obvious invasive signs or “onion skin” periosteal reaction is noted.
• MRI Findings: The lesion appears relatively hypointense on T1-weighted images and hyperintense on T2-weighted images, suggesting composition primarily consisting of soft tissue or fluid. On contrast-enhanced images, varying degrees of enhancement can be seen in the lesion, with possible thinning or even partial destruction of the cortex, along with a small bulging signal in the surrounding soft tissue.

No obvious large soft tissue mass is detected, but the tibial cortex shows some degree of destruction or recession. Overall, the findings suggest a focal lesion originating from the tibial cortex.

2. Potential Diagnoses

Based on the patient’s age, location of the lesion, and its radiological features, the following conditions are considered:

1. Adamantinoma
   Typically seen in adolescents or young adults, most often occurring in the cortical layer of the tibia. It grows relatively slowly but is locally invasive. X-rays often show a lytic lesion in the cortex, and MRI typically shows low signal on T1, high signal on T2, and heterogeneous enhancement, consistent with the characteristics of this case.
2. Fibrous Dysplasia
   Common in adolescents, with fibro-osseous changes that can occur in the cortex or medullary canal. On X-ray, it often presents a “ground-glass” appearance. Although varying bone density changes may appear, the prominent cortical involvement and localized destruction in this case are not typical for fibrous dysplasia.
3. Osteoid Osteoma/Osteoblastoma or Fibro-osseous Profilative Lesions
   These lesions can create localized lysis surrounded by a sclerotic rim. However, osteoid osteoma often presents with notable night pain relieved by NSAIDs and is more commonly located in the pedicles of vertebrae or metaphyses of long bones. The prolonged course and the apparent mass in this case make these possibilities less likely.

3. Final Diagnosis

Considering the patient’s age (14), the lesion location (anterior cortex of the mid-tibia), imaging findings (lytic lesion with local sclerosis, low signal on T1, high signal on T2, enhancement on MRI, long clinical history, and progressively worsening pain), and the common histological feature of epithelial cell nests with positive cytokeratin staining, the most likely diagnosis is:

Adamantinoma.

To confirm the diagnosis, a biopsy or surgical pathology is required.

4. Treatment Plan and Rehabilitation Program

Adamantinoma is a low-grade malignant tumor with locally invasive characteristics. The primary treatment is complete surgical resection (en bloc or wide excision) to minimize the risk of recurrence. Chemotherapy or radiotherapy is generally not used unless in special circumstances where individualized treatment may be considered.

• Surgical Treatment: For localized lesions, curettage and grafting or bone transplantation can be performed. In cases of extensive lesions or significant structural damage, a segmental resection with reconstruction is necessary. Post-operatively, close follow-up is crucial to monitor for local recurrence.
• Rehabilitation and Exercise Prescription:
  1. Early Postoperative Phase (Weeks 1–3): Focus on rest and reducing swelling of the affected limb; perform simple isometric quadriceps exercises. Avoid weight-bearing or intense activities to prevent muscle strength decline and joint stiffness.
  2. Mid-Rehabilitation Phase (Weeks 4–8): As bone healing and tissue repair allow, gradually increase weight-bearing on the affected limb. Partial weight-bearing exercises can be done with a brace or crutches, combined with range-of-motion exercises and low-intensity strength training. Schedule training 3–4 times per week, about 30 minutes each session, adjusting according to patient tolerance.
  3. Late Rehabilitation Phase (Week 8 and Beyond): Once imaging and clinical evaluation confirm good bone healing at the lesion site, progress to full weight-bearing walking and moderate strength exercises, such as cycling or walking in water. Increase frequency to 4–5 times per week, alternating different types of exercises to improve joint stability and muscle strength.
  4. Advanced Exercise Progression: Track local pain, swelling, and functional status. Gradually increase exercise intensity (transition from low-intensity to moderate/high-intensity resistance exercises) and extend exercise duration (20 → 30 → 40 minutes). Ensure a gradual progression from non-weight-bearing to partial then full weight-bearing to prevent reinjury.

Special Note: Since the patient is an adolescent with bones still developing, postoperative monitoring of bone healing and potential recurrence is essential. Any new onset of pain or swelling should prompt immediate medical review.

Disclaimer: This report is intended as a reference for medical imaging and rehabilitation information and cannot replace in-person consultation or the diagnosis and treatment advised by a qualified physician. In case of any concerns or sudden changes, please seek specialist advice or visit a hospital promptly.