Descriptionstructure should be Case report information:Patient hit his left ankle to the side of the door 5-6 weeks No pain at the time Developed 4 week history of ankle swelling and was started on gout management No weight loss, no lethargy, no lack of appetite, no fever Doesnt drink alcohol Smoke 4-5 per day PMH Hypothyroidism Gout Stroke On examination Left ankle swelling Tender Tender on palpation of medial malleolus Range of movement ok, but limited due to pain Sensation intact Pulses intact Denies any calf pain Bloods WCC 7.6 CRP 8.1 Urate 384 MRI At the medial malleolus there is a large heterogenously enhancing mass lesion measuring approximately 47x62x55 mm, with marked destruction of the medial malleolus are seen on the plain films. The lesion extends into the medial gutter of the tibiotalar joint. The posterior tibialis tendon passes through the inferior margin of the lesion. The adjacent tibial plafond shows quite florid marrow oedema. No subperiosteal collection or sinus tract is evident. Further similarly enhancing soft tissue mass lesions are seen within the soleus muscle belly, within the deep flexors extending anteriorly and in the peroneal muscles at the level of the proximal to mid fibula. No cortical destruction is seen of the shafts of the tibia or fibula. There is some increased signal at the mid to lower fibular diaphysis. Conclusion: Appearances are those of an aggressive process, chondrosarcoma seems unlikely given multiple soft tissue lesions in the lower leg.Needle biopsy, deep soft tissue tumour, left ankle: high grade spindle cell sarcoma (grade 3) with features favouring a malignant peripheral nerve sheath tumour.Case report should focus on malignant peripheral nerve sheath tumor of Ankle with grade 3 spindle cell sarcomaI will add images myself

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