Background: Primary leiomyosarcoma of the breast is an exceptionally rare malignant neoplasm, accounting for less than 1% of all breast sarcomas. Due to its rarity, diagnosis and management present both clinical and pathological challenges. Reporting such cases contributes to the growing understanding of tumor behavior, optimal surgical management, and prognostic outcomes. Case Presentation: We report the case of a 67‑year‑old female who presented to Military Cancer Center in September 2025 with a progressively enlarging, firm, painless mass in the left breast. Imaging suggested a hypoechoic oval lesion posterior to left nipple suspicious for malignancy, and subsequent core biopsy revealed spindle cell tumor with smooth muscle differentiation raising the possibility of leiomyosarcoma. The patient underwent wide local excision with clear surgical margins. Histopathological analysis confirmed the diagnosis of primary leiomyosarcoma of the nipple areola complex, with immunohistochemical staining positive for smooth‑muscle actin, desmin, and BCL-2. Postoperative recovery was uneventful, with no evidence of local recurrence or distant metastasis was detected at 6‑month follow‑up. Ethical Considerations: Written informed consent for publication of clinical information and images has been obtained from the patient. All identifying details will be anonymized to protect patient confidentiality. Conclusion: This case highlights the diagnostic complexity and management considerations in primary breast leiomyosarcoma. Documenting such rare presentations is essential to enhance clinical awareness and guide future management strategies.
Saleh M. Habahbeh1*, Alia M. Hajjat2, Faris Y. Al-Azzam1, Ahmad Abdul Majed Al-Maqableh1, Ahmad A. Kofahi1, Muthanna Ababneh1 (Mon,) studied this question.