High-grade leiomyosarcoma of the hard palate in a geriatric patient: A case report and review of diagnostic and surgical considerations

Introduction: Leiomyosarcoma (LMS) is a rare, highly aggressive malignant mesenchymal tumor derived from smooth muscle cells. While common in the uterus and retroperitoneum, its primary occurrence in the oral cavity is exceptionally rare, posing significant diagnostic and therapeutic challenges, particularly in elderly patients with multiple comorbidities.
Case Presentation: We report the case of a 78-year-old male, hypertensive and diabetic, presenting with a progressively enlarging, ulcerated lesion of the hard palate evolving over five months. Preoperative imaging demonstrated an invasive mass with palatine bone erosion. Initial biopsy suggested a smooth muscle tumor of uncertain malignant potential (SmTUMP), but definitive histopathological analysis following radical surgical excision confirmed a high-grade leiomyosarcoma. The patient underwent an infrastructure maxillectomy with clear margins followed by adjuvant chemotherapy.
Conclusion: Oral leiomyosarcoma is a lethal malignancy that mimics benign smooth muscle tumors or more common carcinomas. In the geriatric population, metabolic comorbidities such as diabetes and hypertension necessitate a tailored multidisciplinary approach to manage surgical risks and adjuvant toxicity. Radical resection remains the mainstay for achieving local control and improving survival outcomes.