Medical Imaging Analysis Report

I. Imaging Findings

The patient is a 27-year-old male, presenting with a right gluteal mass along with fatigue, fever, and general malaise. Based on the provided CT images, the following findings are noted:

• Pelvic region: A mass-like lesion is observed in the right gluteal soft tissue with a density slightly higher than that of muscle. Some heterogeneous density is noted, suggesting possible necrosis or hemorrhage within. The lesion appears relatively well-defined in some areas, but in certain parts, the boundary is indistinct, possibly involving adjacent fatty tissues.
• Abdomen: No obvious suspicious metastatic lesions in the liver parenchyma, but an enhanced CT scan is recommended for further evaluation.
• Chest: Multiple small nodules or lesions in the lungs, suggesting the possibility of pulmonary metastases. Correlation with pathology and clinical context is required for final determination.

Overall, the imaging findings suggest an aggressive soft tissue tumor in the right gluteal region, with suspicious metastatic lesions in the lungs.

II. Potential Diagnoses

Based on the clinical information (young adult male, gluteal mass, systemic symptoms) and imaging features (local mass, possible pulmonary metastasis), the following differential diagnoses can be considered:

1. Rhabdomyosarcoma: Given the patient’s age, the nature of the lesion, and the possible lung metastases—particularly the imaging and histological features (e.g., “pulmonary metastases” and “highly invasive”)—deep soft tissue involvement fits with rhabdomyosarcoma. The embryonal subtype is more common in children, while large tumors with pulmonary spread and high aggressiveness in a young adult may favor the alveolar subtype.
2. Other Soft Tissue Sarcomas (e.g., synovial sarcoma, undifferentiated pleomorphic sarcoma): These can also appear in young adults, often present with rapid growth and distant metastases. Definitive diagnosis requires pathological examination and immunohistochemistry.
3. Metastatic Tumors: If there is a history of a primary malignancy (e.g., a genitourinary or gastrointestinal origin), soft tissue metastases could occur. However, the patient currently does not have a known primary tumor, making this less likely.

III. Final Diagnosis

Taking into account the patient’s age, clinical presentation (right gluteal mass, fever, fatigue, etc.), imaging findings (local soft tissue lesion with suspected pulmonary metastases), existing literature, and pathological indications, the most likely diagnosis is:

Alveolar Rhabdomyosarcoma.

As this subtype generally carries a poorer prognosis and often presents with distant metastases in adults, further histopathological confirmation and molecular testing (such as checking for the FOXO1 gene translocation) are needed. If a biopsy has not been performed, a core needle biopsy or surgical resection followed by pathological examination is recommended to confirm the diagnosis.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategies

• Surgery: In early stages where complete resection is feasible, local surgical removal may be considered to reduce tumor burden, aiming for negative margins.
• Chemotherapy: Rhabdomyosarcoma is generally sensitive to chemotherapy, particularly the alveolar subtype. Chemotherapy is often a cornerstone of treatment to control systemic disease and potential micrometastases.
• Radiotherapy: For tumors that cannot be completely resected or have inadequate surgical margins, radiotherapy can help reduce local recurrence.
• Multidisciplinary Treatment: Due to the aggressiveness and high metastatic potential of adult alveolar rhabdomyosarcoma, a multidisciplinary approach—coordinating orthopedic surgeons, surgical oncologists, radiation oncologists, and medical oncologists—is essential for optimal outcomes.

2. Rehabilitation/Exercise Prescription

Rehabilitation should be tailored to the patient’s treatment phase (pre- and post-surgery, during chemotherapy or radiotherapy) according to individual conditions. Follow the FITT-VP principle:

• Frequency: Start with 2-3 sessions of basic physical training per week, gradually increasing to 3-5 times depending on overall condition and fatigue level.
• Intensity: Begin with low to moderate intensity exercise (e.g., light resistance, isometric muscle exercises), monitoring heart rate, blood pressure, and fatigue. Intensity should be reduced appropriately during chemotherapy or radiotherapy.
• Time: Initially 15-20 minutes per session, increasing gradually to 30 minutes or more as tolerated, closely monitoring the patient’s recovery.
• Type: Select exercises with minimal joint impact, such as walking, water-based exercises, or stationary cycling. If there is local functional limitation post-surgery, guided local muscle strengthening and range-of-motion exercises are recommended under a rehabilitation therapist’s supervision.
• Volume: Increase total exercise volume by combining each session’s duration with weekly frequency, adjusted according to the patient’s capacity.
• Progression: Gradually increase exercise intensity and volume as the patient’s physical condition and tumor control improve, ensuring safety while maintaining a reasonable challenge.

For patients who have recently undergone surgery or are undergoing chemotherapy and radiotherapy, closely monitor vital signs and blood parameters to avoid excessive fatigue or infection risk. Given the location of the lesion (gluteal region, pelvis), potential bone changes, and local tissue tolerance after radiotherapy, extra caution is advised during targeted exercises (e.g., local stretching, short brisk walks to promote circulation).

Disclaimer

This report is based on existing clinical and imaging data for reference purposes only and cannot replace in-person consultations or professional medical advice. If you have any questions or if the patient’s condition changes, please seek prompt medical attention or consult a specialist.