A Rare Lower Extremity Intramuscular Lipoma With Heterotopic Ossification

Most lipomatous soft tissue tumors are benign with a low risk of metastasis. Intramuscular lipoma is a very rare subtype with a very high rate of recurrence. When detected late, the differentiation between intramuscular lipoma and liposarcoma on imaging remains challenging.

A 49-year-old male presented with a lipomatous, radiographically lucent, soft tissue lesion in the lower extremity causing occasional numbness and tingling and associated with intralesional calcifications on MRI. The patient underwent a marginal excision of the lesion, which relieved his symptoms. Pathology revealed a lipoma with heterotopic ossification.

Intramuscular lipomas are rare and underreported in the literature. When it is difficult to differentiate a lipoma from malignant liposarcoma, surgical intervention may be necessary. Long-term serial follow-ups are needed to assess for future recurrence.