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Answer: Calcific myonecrosis mimicking an invasive soft-tissue neoplasm

Discussion
The differential diagnosis of calcific myonecrosis includes malignant tumors that undergo calcification, such as epithelioid sarcoma, synovial sarcoma, and soft-tissue osteosarcoma. A history of trauma to the extremity with ischemia or neurological injury seems to be a prerequisite for the development of calcific myonecrosis.
Calcific myonecrosis typically presents as an enlarging mass in the anterolateral aspect of the leg. It may present as a slowly enlarging mass in the anterior compartment, months or years after an episode of blunt trauma. The history or physical appearance may suggest that the involved muscles in the compartment sustained ischemic damage as a result of the initial injury. Plain radiographs are usually diagnostic, with the lesion appearing as a fusiform, peripherally calcified soft-tissue mass. However, in isolated cases, such as the one described here, the presence of extensive fibular destruction may be highly suggestive of an invasive soft-tissue neoplasm.

Reference:
Zohman, G.L.; Pierce, J.; Chapman, M.W.; Greenspan, A.; and Gandour-Edwards, R.: Calcific myonecrosis mimicking an invasive soft-tissue neoplasm. J. Bone and Joint Surg., 80-A: 1193-97, August 1998.

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