A rare case of acute arterial thrombosis revealing undifferentiated arterial leiomyosarcoma

Aortic leiomyosarcoma, a rare and elusive malignancy, presents diagnostic and therapeutic dilemmas due to its nonspecific symptoms and aggressive course. We report a unique case where the incidental discovery of arterial leiomyosarcoma occurred during acute cerebral infarction management. A previously healthy 58-year-old woman, initially presenting with severe neurological deficits indicative of acute ischemic stroke, underwent prompt recanalization therapy that resulted in successful restoration. Unexpectedly, a histopathological examination of the extracted thrombus revealed arterial leiomyosarcoma. The diagnostic process involved immunohistochemistry and contrast-enhanced computed tomography, confirming the presence of leiomyosarcoma originating from the ascending aorta. Given the patient's severe disability, a palliative care approach was chosen to prioritize comfort and quality of life. This case underscores the diagnostic potential of acute recanalization therapy for functional recovery as well as histopathological examination, shedding light on rare diseases. Further case accumulation is essential to refine treatment strategies and improve prognostic outcomes for vascular sarcomas.