A 68 year old woman with primary hepatic leiomyosarcoma, impairement of general status and right upper quadrant pain was diagnosed with liver tumor by sonography, CT scan and nuclear magnetic resonance imaging. Angiograms showed a hypervascular tumor. The patient was treated by hepatic transplantation but died 15 days after operation. The diagnosis of leiomyosarcoma was established by immunohistochemical and ultrastructural studies; the primary nature was confirmed by necropsy. Diagnostic and therapeutic features of primary hepatic leiomyosarcoma--the 19th case reported in the literature--are discussed.