Primary adrenal leiomyosarcoma

Primary adrenal leiomyosarcoma is an extremely rare soft tissue tumour arising from the smooth muscle of adrenal vascular structures, with approximately 50 reported cases worldwide. The tumour typically presents with non-specific symptoms and does not produce hormones, often leading to a delayed diagnosis. It is usually identified on CT or MRI, but definitive diagnosis requires histopathology and immunohistochemistry. We describe the case of a young woman in her early 30s who presented with epigastric and left flank pain and was subsequently found to have a large adrenal mass. She underwent surgical resection and remains recurrence-free 13 months postsurgery.