Background: Bladder leiomyosarcoma is an extremely rare non-urothelial malignancy, accounting for less than 0.1% of all bladder tumors. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and the absence of standardized treatment protocols. Case presentation: We report the case of a 61-year-old woman who presented with hematuria, dysuria, and suprapubic pain. Imaging revealed a large, locally invasive bladder mass, and histopathological examination following transurethral resection confirmed leiomyosarcoma. The patient underwent radical cystectomy with resection of adjacent bowel segments and urinary diversion. Histology showed a high-grade leiomyosarcoma (pT3N0) with extensive necrosis and a high mitotic index. Two months postoperatively, peritoneal dissemination was detected. Systemic chemotherapy with dacarbazine and doxorubicin initially led to the regression of metastases, but disease progression occurred within months, including lung, liver, and bone metastases. Palliative radiotherapy and second-line chemotherapy were initiated. As of now, 16 months have elapsed since surgery. Conclusions: This case underscores the aggressive clinical course of bladder leiomyosarcoma despite multimodal therapy and the urgent need for individualized management strategies. Given its rarity, this case contributes to the limited literature and highlights the importance of vigilant follow-ups and further studies to establish evidence-based treatment protocols.

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic neoplasm with low malignant potential, most commonly occurring in young patients. Although this condition is more frequently diagnosed in adults, it accounts for approximately 8–12% of all pancreatic tumors in children. The diagnosis of SPN is challenging due to its often asymptomatic nature, with tumors typically remaining undetected until they reach a considerable size of 5–7 cm. Furthermore, some patients may present with nonspecific symptoms, which can complicate the diagnosis. The treatment of choice is formal pancreatic resection, during which the tumor is radically removed. Although the long-term prognosis for SPN is generally favorable, postoperative complications such as pancreatic fistulas are common. Treatment of these complications may require antibiotic therapy and drainage of peripancreatic fluid collections. This article presents a clinical case in which a 15-year-old girl was incidentally diagnosed with a solid pseudopapillary carcinoma located in the tail of the pancreas, and underwent formal pancreatic resection. We discussed the importance of close postoperative monitoring and the potential causes of postoperative complications.