Leiomyosarcomas of the vascular system (vLMSs) are rare tumors that commonly originate from large proximal and central veins. Pancreatic metastasis is rare for sarcomas, and surgical excision with large margins is the treatment of choice. We present a case of a 32-year-old female with primary vLMS originating from the distal crural veins and local invasion of the fibula. A prior open biopsy site was suboptimal. The patient was treated with neoadjuvant chemotherapy and radiotherapy, followed by surgery. The follow-up radiological imaging showed pancreatic head metastasis, which is also an extremely rare site for vLMS.
