Nasopharyngeal Leiomyosarcoma: Diagnostic Challenges and Management of a Rare Head and Neck Sarcoma.

Leiomyosarcoma (LMS) is a rare, smooth-muscle malignancy and an uncommon sinonasal tumor, often diagnosed at a late stage due to non-specific symptoms and complex anatomy. We report an 82-year-old man with a two-month history of facial pain, epistaxis, and right-sided hearing loss. Imaging and endoscopic evaluation showed a friable mass involving the posterior nasal cavity and nasopharynx. Biopsy confirmed a giant cell-rich spindle cell LMS. He underwent endoscopic resection with positive margins. Postoperative complications and comorbidities delayed the initiation of adjuvant radiation therapy. Rapid local recurrence soon rendered the tumor unresectable, with extension into the hard palate and oropharynx. Clinical decline precluded further therapeutic interventions, and the patient died six months after the initial onset of symptoms. This case report documents the aggressive nature of primary nasopharyngeal LMS and its propensity for early recurrence. Complete resection with negative margins is critical but often limited by anatomy. Adjuvant radiation therapy may improve local control in margin-positive disease, although the evidence is largely retrospective. Early recognition and timely multidisciplinary treatment are essential in the management of this disease.