Primary Omental Leiomyosarcoma With Pulmonary Metastases: A Case Report of Surgical Management and Chemotherapy Response.

Primary omental leiomyosarcoma is an extraordinarily rare tumor, with only a limited number of cases reported in the medical literature. Early surgical intervention appears to be a key determinant in the successful treatment of this malignancy, although more cases are needed to establish a standardized approach for optimal management. Leiomyosarcomas originating from the omentum present unique diagnostic challenges due to their rarity and often nonspecific clinical and radiologic findings. The complexities of diagnosing and managing this condition are compounded in rural areas where access to advanced diagnostic tools and specialists is limited. Leiomyosarcomas appear on abdominal computerized tomography (CT) as heterogeneous solid masses with cystic areas that enhance with contrast. While imaging can suggest the diagnosis, histopathology is required for confirmation. These tumors are highly aggressive, and complete surgical resection is the only definitive treatment, with resectability depending on peritoneal implants or metastasis. Other treatments, such as chemotherapy, radiation, and embolization, have variable success. Liver metastasis is the most common and a poor prognostic factor. Despite alternative therapies, surgery remains the best option for long-term survival. This case not only highlights the rarity and diagnostic challenges of omental leiomyosarcoma but also underscores the importance of timely referral to specialized centers. It further emphasizes the need for comprehensive diagnostic evaluations and personalized treatment plans tailored to the unique characteristics of each patient. Addressing these challenges through early intervention and targeted therapies is crucial to improving outcomes for patients with rare malignancies like omental leiomyosarcoma.