Integrative diagnostic approach in a rare case of primary thyroid leiomyosarcoma with distant metastasis: a case report and literature review

When TLS initially presents with benign-appearing ultrasound and FNA findings, misdiagnosis may easily occur. This case highlights the importance of early integration of histopathological and molecular evaluation for progressive thyroid lesions. The co-occurrence of <i>NF1</i> and <i>BCORL1</i> mutations, along with <i>TP53</i> and <i>TERT</i> promoter alterations, may underlie the tumor's aggressive biological behavior and supports the incorporation of molecular subtyping strategies in TLS management.