Primary spindle cell lesions of lymph nodes, with the exception of Kaposi's sarcoma, are rare. Intranodal palisaded myofibroblastoma has been described as a spindle cell tumor with prominent amianthoid fibers, intralesional hemorrhage, and intracellular or extracellular inclusions. Another spindle cell lesion, intranodal leiomyoma, has been reported only occasionally. We report the case of a 6-year-old boy with a mass in the neck without other systemic complaints. Excision biopsy of the lymph node revealed a spindle cell tumor with lymph nodal tissue at the periphery. The tumor showed features of smooth muscle differentiation with focally high mitotic index. The classical features of myofibroblastoma were not present. A final pathologic diagnosis of intranodal leiomyoma was rendered. The child has been free of recurrence in the follow-up period. Intranodal leiomyoma is a rare primary spindle cell lesion of the lymph nodes and should be considered in the differential diagnosis of the same.