Giant Compressive Intramuscular Lipoma of the Calf Presenting as Tibial Nerve Neuralgia After Traditional Massage: A Case Report

Introduction. Giant intramuscular lipoma is a rare benign tumor. Because of its deep location, it may cause nerve compression and raise concern for an atypical lipomatous tumor. We report a giant lipoma of the soleus muscle complicated by tibial nerve neuralgia after traditional massage and briefly describe the clinical, imaging, surgical and histological findings. Clinical examination, ultrasonography, operative findings and histology were reviewed in this single case observation. Case presentation. A 58-year-old female farmer with no medical history presented with a left calf swelling that had slowly enlarged over five years. After one month of traditional massage consisting of repeated deep manual pressure and kneading applied locally to the calf, she developed neurogenic pain radiating to the foot, associated with plantar paresthesia and a positive Tinel sign. Ultrasonography showed a heterogeneous calcified mass measuring 15 × 7 × 4 cm within the soleus muscle. A marginal en bloc resection was performed with release of the posterior tibial neurovascular bundle and neurolysis. Histology confirmed a benign lipoma. Conclusion. Traditional massage may have hypothetically decompensated chronic tibial nerve compression related to the lipoma. Complete excision with neurolysis led to rapid neurological improvement, with no clinical recurrence at six months; longer follow-up remains recommended.