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Abstract Background Primary thyroid leiomysosarcoma is a rare and aggressive disease which represents 0.014% of primary thyroid cancers. It confers a diagnostic conundrum, due to difficulty to make a preoperative diagnosis of thyroid leiomyosarcoma and to differentiate it from anaplastic thyroid carcinoma. Case presentation We herein report a rare case of primary thyroid leiomyosarcoma. A 48-year-old male presented with history of anterior neck swelling for the past 2 months. Computed tomography (CT) neck showed hypodense nodule at the right thyroid lobe with calcification causing tracheal deviation, with intratracheal extension at 1st and 2nd tracheal rings and presence of lung metastases. The histopathology analysis yield high grade spindle cell neoplasm suggestive of sarcoma. Immunohistochemistry showed that neoplastic spindle cells were positive for smooth muscle actin, vimentin, caldesmon while no reactivity was reported for thyroglobulin, calcitonin, thyroid transcription factor-1, S-100, CD45, CD 5, and cytokeratins. Patient had undergone tracheostomy and chemotherapy but he succumbed to death 1 month after completion of chemotherapy. Conclusion Primary thyroid leiomyoarcoma is a very rare and aggressive disease. The treatment ranging from surgery, adjuvant radiotherapy and chemotherapy, with high recurrence rates.

A 12-year-old boy was referred to our ENT clinic with an incidentally discovered left supraclavicular mass that was suspected to be malignant. He was asymptomatic and had no prior illnesses. Neck examination found a fixed, hard, non-pulsatile, and non-tender mass measuring 2 cm in diameter in the left supraclavicular fossa. Rest of the ENT assessment, chest and upper limb neurovascular examinations were unremarkable. The patient’s full blood count was within the normal range. A plain chest radiograph was taken as part of the work-up.