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+We present a case of leiomyosarcoma of the colon whose first manifestation was a pulmonary metastasis. The patient was a 74-year-old woman with a history of chronic obstructive pulmonary disease and hysterectomy with double adnexectomy and subsequent brachytherapy for endometrial adenocarcinoma 5 years ago. She consulted for dyspnoea of 2 months' evolution, without associated cough, haemoptysis or general syndrome.
+Blood tests were normal. Chest X-ray and chest CT scan revealed a right parahilar mass measuring 5 x 3 cm. A biopsy of the mass was taken by bronchoscopy showing a mesenchymal tumour with positive imnunohistochemistry for vimentin and negative for c-KIT compatible with leiomyosarcoma.
+
+An extension study was performed with gastroscopy, colonoscopy and abdominopelvic CT scan, which was negative. With a diagnosis of primary leiomyosarcoma of the right lung, a right pneumonectomy was performed, confirming the histology of leiomyosarcoma in the surgical specimen.
+One month after the right pneumonectomy, the patient presented with abdominal pain with nausea, vomiting and episodes of rectorrhagia. Colonoscopy showed a polylobulated mass with a neoplastic appearance in the ascending-blind colon and abdominal CT scan with dilatation of the small bowel loops showing a doughnut-shaped image at the level of the terminal ileum-blind ileum compatible with intestinal invagination with a probable underlying tumour lesion.
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+Emergency surgery was performed, revealing small bowel obstruction due to invagination of the terminal ileum at the level of the tumour in the cecum. A right hemicolectomy was performed.
+Histopathological study of the surgical specimen showed that it was a leiomyosarcoma measuring 6 x 4 x 2.8 cm, affecting the mucosa, submucosa, muscle and serosa with a high number of mitoses (more than 10 mitoses per 10 high magnification fields) and immunohistochemistry positive for actin and vimentin and negative for c-KIT. This finding demonstrates that the LMS had its origin in the colon and the lung tumour was metastatic.
+During this second postoperative period, the patient again presented respiratory complications and died one month after abdominal surgery.
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+