Pancreatic Tail Leiomyosarcoma With Hepatic Metastases: Diagnostic and Therapeutic Challenges: A Case Report.

Primary pancreatic leiomyosarcoma (PLMS) is a rare malignant tumor accounting for less than 0.1% of all pancreatic neoplasms and often presents at an advanced stage with distant metastases or local invasion. Clinical symptoms are nonspecific, including gastrointestinal discomfort, abdominal pain, or distension, which frequently leads to delayed diagnosis. We report a 53-year-old woman with persistent abdominal distension, bloating, and central discomfort, in whom imaging revealed a 7.5 cm mass in the pancreatic tail with multiple liver metastases, encasement of the splenic arteries, and no direct invasion of the spleen or adjacent adrenal gland; her family history was notable for hematological, breast, and pancreatic cancers. Due to its rarity, aggressive metastatic behavior, and lack of standardized therapy, PLMS presents significant diagnostic and treatment challenges. This case highlights the importance of recognizing pancreatic leiomyosarcoma as a distinct clinical entity and contributes to the limited literature guiding its management.