A retrospective study was made of 28 patients who had gastric leiomyosarcomas to identify histologic patterns and radiologic appearances. Three histologic patterns were identified: spindle cell, epithelioid, and pleomorphic. The histopathologic type of tumor did not correlate with the size, the grade of malignancy, or the location of the mass within the stomach. All but one tumor presented as a submucosal mass by barium contrast examination. Ulceration was present in 17 of 28 patients. Sonographic examination in six patients and computed tomography (CT) in one provided further information about the degree of extragastric extension. Sonographically the masses were echogenic in three patients, hypoechoic in two, and anechoic in one. Surgery remains the only curative therapy and surgical excision is recommended regardless of mass size.