The tumor was composed of tumor heterogeneity of spindle-shaped atypical cells harboring a high nuclear/cytoplasmic ratio as well as nuclear pleomorphism with many multinucleated giant cells (Fig. 2E) immunohistochemically positive for SMA (Fig. 2F), desmin (Fig. 2G), and vimentin (Fig. 2H), consistent with the diagnosis of primary adrenal leiomyosarcoma. Here, VIM is linked to neoplasm.