Giant esophageal schwannoma mimicking a mediastinal tumor: a case report and review of the literature

Introduction: Esophageal schwannomas are rare, benign tumors arising from Schwann cells in the esophageal wall. Giant forms are particularly rare and can resemble mediastinal tumors, making preoperative diagnosis difficult. Case presentation: Herein, we present the case of a 55-year-old man with hypertension, obesity, and obstructive sleep apnea syndrome who was referred for evaluation of a large mediastinal mass. The lesion was incidentally discovered 7 years earlier and was monitored without intervention. Chest computed tomography (CT) revealed a well-circumscribed middle mediastinal mass measuring 93 × 91 × 73 mm 3 , compressing the esophagus. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased uptake, with a maximum standardized uptake value of 10.156, suggesting malignancy. However, endoscopic ultrasonography failed to provide a definitive diagnosis. Due to tumor growth and the inability to rule out malignancy, surgical resection was performed. A right thoracotomy with subtotal esophagectomy and retrosternal gastric tube reconstruction was performed. Histopathological examination confirmed that the lesion was a benign esophageal schwannoma. The patient recovered uneventfully and has remained recurrence-free for 1 year postoperatively. Clinical discussion: Giant esophageal schwannomas are rare and pose diagnostic challenges, particularly because of their potential for high FDG uptake despite their benign pathology. Complete surgical excision remains the definitive treatment for this condition. The choice of surgical approach should be guided by tumor size, location, and involvement of surrounding structures. Conclusion: This case highlights the diagnostic difficulties and surgical management of giant esophageal schwannomas. Clinicians should consider this rare condition in the differential diagnosis of large mediastinal masses. This case also underscores the importance of surgical decision-making in the context of diagnostic uncertainty and tumor size, contributing to the limited literature on giant esophageal schwannomas requiring esophagectomy.