True smooth muscle neoplasms of the wall of digestive tract are rare, in particular in the stomach, and the benign ones are prevalent. We report a case of gastric leiomyosarcoma (LMS) that we observed, diagnosed to a 71 years-old man, with important comorbidities, who had already underwent the amputation of the right lower limb. In consequence of the discovery of anaemia and melaena he underwent an endoscopy of the upper GI tract and CT scan, which showed the presence of a neoformation of the gastric wall, but because of the thrombosis of the common iliac artery and the occurrence of the clinical picture of critical ischaemia, at first the patient underwent the amputation of the left lower limb e only then an intervention of atypical gastroresection. Despite the neoplastic infiltration of the resection margins and the impossibility to undertake an adjuvant chemotherapy, the follow-up at 6, 12 and 28 months did not show a recurrence of the disease that remained in phase of clinical remission
