Angiofibrolipoma of the Calf
A 9-year-old boy presented with a history of right calf swelling noticed since birth which was slowly increasing in size. The swelling became painful about a year prior to presentation. He had no preceding history of trauma or fall. There was history of weight loss that was first noticed at the age of 7 years though weight loss was not marked. There was no pain from other parts of the body. There was no history of bone pain, jaundice, abdominal pain, chest pain or cough to suggest a metastatic lesion. There was no history of similar swelling in the siblings or parents. At presentation, essential findings were those of a young boy that was not pale, anicteric, with no significant lymph node enlargement. Musculoskeletal examination showed a 18×32 cm firm mass involving the upper 2/3 of the right leg posteriorly extending from the popliteal fossa down to the gastrosoleus junction with a punched out scar at the site of the previous incisional biopsy; which had been done prior to been planned for definitive management. The edges were poorly defined and tender on deep palpation. There was no clinical vascular deficit. Mid calf circumference on the right limb was 44 cm and 24 cm on the left. The mass was fixed to the underlying structure. The child maintained the ankle in an attitude of plantar-flexion. Attempt at standing plantigrade or placing the foot plantigrade resulted in pain, he therefore walked on his toes. Plain radiograph revealed a soft tissue mass at the posterior aspect of the right leg with no bone involvement ().\nHematological parameters were within normal limits. Incisional, with later excisional biopsy were done. The excision was a marginal excision. Intra-operative findings were: i) a mass approximately 15×9×4 cm arising from the two heads of the gastronemius muscle at its origin in the popliteal fossa; ii) a yellowish-pink mass closely related to the posterior tibial artery at its origin in the fossa, the mass had to be dissected and removed piecemeal around the neurovascular bundle to prevent injury; iii) the soleus muscle had to be stripped off the gastronemius and the latter was detached at the gastrosoleus junction; iv) the cut surface of the mass was solid and yellowish with numerous ecchymotic patches ().\nHistology showed fibrocollagenous tissue composed of adipose tissue and numerous thinwalled and congested vascular vessels. Also seen were chronic inflammatory cells, mainly lymphocytes and plasma cells. No evidence of malignancy seen in all the sections examined. Findings were consistent with angiofibrolipoma ().