The mesentery is a common site of metastasis from gastrointestinal, pancreatic, and biliary cancers. Primary mesenteric cancers are rare and usually mesenchymal and benign. Mesenteric leiomyosarcoma is a rare, malignant smooth muscle sarcoma with an incidence of 1:350000. It usually arises from the vasculature of the mesentery. The ileum of the small bowel is the most common site of origin. Due to its low incidence, preoperative diagnosis is difficult. This is a report of a 71-year-old woman who presented with several months of a lower abdominal mass and recent onset of associated abdominal discomfort. An earlier colonoscopy 8 months previously was unremarkable. A recent abdominal and pelvic computed tomography scan revealed a necrotic mass in the central mesentery. She underwent surgical resection of the mass to include the overlying segment of the small intestine and had an uneventful convalescence. Mesenteric leiomyosarcoma is a rare tumor that is diagnosed based on histological examination with immunohistochemistry. As a result, there is minimal information on its clinical presentation, pathology, and treatment
