Giant Mid-Esophageal Leiomyoma in a Young Adult Managed by Video-Assisted Thoracoscopic Enucleation: A Case Report

Background: Esophageal leiomyomas are rare benign smooth-muscle tumors, usually small and incidentally detected; giant lesions in young adults are uncommon and may mimic malignant disease when symptomatic. Case Presentation: A 22-year-old male Syrian patient with celiac disease presented with an 18-month history of progressive dysphagia, worsening over the preceding 6 months, with associated unintentional weight loss. Upper gastrointestinal endoscopy showed a submucosal lesion at 25 cm from the incisors with intact mucosa. Contrast-enhanced chest CT demonstrated a heterogeneous intramural mid-esophageal mass at the level of the carina, extending approximately 11 cm, causing mild luminal narrowing without evidence of metastatic disease. The patient underwent elective right-sided video-assisted thoracoscopic enucleation through three ports. The mass was successfully enucleated from the mid-esophageal wall, and a chest drain was placed. Histopathology revealed an encapsulated spindle-cell neoplasm without atypia or mitotic activity; immunohistochemistry supported leiomyoma and excluded malignancy. Case Discussion: This case highlights the unusual presentation of a giant mid-esophageal leiomyoma in a young adult and the diagnostic challenge of distinguishing large benign intramural tumors from malignant disease. It adds to the limited literature supporting video-assisted thoracoscopic surgery as a safe, minimally invasive, organ-preserving option for selected giant symptomatic lesions. Conclusion: VATS enucleation achieved definitive diagnosis and symptom resolution with an uncomplicated 3-month outcome. The key message is that giant esophageal leiomyoma, even in young adults, can be effectively managed with minimally invasive esophageal-preserving surgery after careful evaluation.