Leiomyosarcoma of the maxillary sinus presenting with epiphora: a case report.

Background: Leiomyosarcoma is an invasive malignancy that emerges primarily from smooth muscle and accounts for a small percentage of head and neck sarcomas. Its occurrence in the sinonasal region is extremely infrequent, and few cases have been documented in the literature. Owing to vague symptoms and common imaging characteristics, diagnosis can often be delayed or misinterpreted. Case presentation: We report a 57-year-old female patient who first visited the ophthalmology clinic with a complaint of epiphora and was misdiagnosed with a vascular tumor in the left maxillary sinus based on CT imaging; preoperative embolization was performed prior to surgical excision, and subsequent histopathology confirmed leiomyosarcoma. Postoperative imaging revealed hepatic metastases. Conclusion: This case highlights the diagnostic challenges of maxillary sinus leiomyosarcoma, particularly when patients present with uncommon symptoms such as epiphora. Imaging findings are often nonspecific and may be misinterpreted, as in our case. Accurate diagnosis is contingent on histology and immunohistochemistry. Prompt and complete surgical removal with tumor-free margins is challenging but crucial for local control. Postoperative radiotherapy or chemotherapy should be determined individually. Long-term follow-up data are needed to better define survival outcomes and refine treatment strategies for this challenging disease.