Laryngeal leiomyosarcomas are extremely rare malignancies that arise from smooth muscle cells. The extend of its rarity is supported by the fact that only less than 50 cases of pure laryngeal leiomyosarcomas and less than 10 cases of hypopharyngeal leiomyosarcomas have been reported in modern medical literature.1, 2 Even though the clinical presentation mimic that of a laryngeal carcinoma; which form the major bulk of the laryngeal malignancies; the differences in management warrants an accurate diagnosis. An accurate histological diagnosis may be difficult; but when supplemented by electron microscopy and immunohistochemical tests, the diagnosis can be reached with certainty. We report a case of this very rare malignancy presenting in the supraglottic region with an even rare feature of hypopharyngeal extension. An extensive review of literature has been done highlighting the clinical features, histological and radiological diagnosis and management of this extremely rare malignant entity.