Gastrocnemius-soleus intramuscular lipoma misinterpreted as hemangioma: a rare case report

Intramuscular lipomas (IMLs) are rare, comprising less than 1% of all lipomas, and typically arise in large proximal muscles. Their occurrence in the calf is extremely uncommon and may mimic vascular or malignant lesions on imaging.

A 45-year-old female presented with an 8-month history of dull pain in the left calf. MRI suggested a hemangioma. Surgical excision was performed, and histopathology confirmed an intramuscular lipoma. The patient recovered without complications and reported full symptom resolution.

IMLs in distal sites like the calf are rare and challenging to diagnose due to imaging overlap with hemangiomas and liposarcomas. MRI aids evaluation, but histopathology remains the gold standard. Surgical excision is curative, and biopsy may be omitted in select small, radiologically benign lesions to avoid contamination.

IMLs should be considered in the differential diagnosis of painful intramuscular masses, even in atypical locations. Accurate diagnosis and complete excision ensure favorable outcomes.