A previously healthy 51-year-old female presented with gradually worsening, 10/10 non-radiating epigastric abdominal pain associated with nausea, bilious vomiting, and weight loss. Computed tomography (CT) of the abdomen with intravenous contrast showed a large 10.7 × 9.5 cm exophytic mass in the antrum/body of the stomach (Figure 1A). An upper endoscopic evaluation revealed a large fungating, infiltrative, and ulcerated mass in the gastric body (Figure 1B). Histopathology of the biopsied mass was notable for spindle cells with a fascicular pattern, moderate nuclear atypia, abundant eosinophilic cytoplasm, and numerous mitotic figures. Immunohistochemistry analysis revealed that the tumor was diffusely positive for smooth muscle actin (SMA) (Figure 2A), desmin (Figure 2B), and calponin (Figure 2C). Ki-67 stain (Figure 2D) showed a high labeling index of 60% indicating a high-grade leiomyosarcoma. There was a complete lack of reactivity with DOG-1 and CD-117 (c-KIT) which excluded the diagnosis of a gastrointestinal stromal tumor (GIST). No evidence of metastatic disease and no lymph node involvement were noted in the head, abdomen, or thorax on the respective CT scans which were done for staging. Due to the large size of the tumor, the patient was started on a neoadjuvant chemotherapy regimen consisting of doxorubicin, ifosfamide, and mesna to reduce tumor burden with a future plan for surgical excision.