Hindawi Publishing Corporation Case Reports in Surgery Volume 2013, Article ID 968394, 4 pages http://dx.doi.org/10.1155/2013/968394 Case Report Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls Charalampos G. Markakis, 1 Eleftherios D. Spartalis, 1 Emmanouil Liarmakopoulos, 1 Evangelia G. Kavoura, 2 and Periklis Tomos 1 1 Second Department of Propedeutic Surgery, University of Athens, Medical School, “Laiko” General Hospital, Agiou oma 17, 11527 Athens, Greece 2 First Department of Pathology, University of Athens, Medical School, 11527 Athens, Greece Correspondence should be addressed to Eletherios D. Spartalis; eletherios.spartalis@gmail.com Received 2 March 2013; Accepted 11 April 2013 Academic Editors: J. J. Andreasen and D. E. Jaroszewski Copyright © 2013 Charalampos G. Markakis et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. his is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. he pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. he patient has shown no evidence of recurrence one year postoperatively. Conclusions. his report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs. 1. Introduction Gastrointestinal stromal tumors (GISTs) are the most com- mon mesenchymal neoplasms of the gastrointestinal tract [1]. Ater the discovery of c-kit mutations, their accurate diag- nosis and diferentiation from other mesenchymal tumors became possible and the use of imatinib mesylate provided new therapeutic options. Consequently, there was interest in these tumors and their management and prognosis has been extensively investigated and standardized. Esophageal GISTs, in contrast, are rare, amounting to 12.7–28% of mesenchymal esophageal tumors or 2% of all GISTs [1–3] and their diagnosis and management are still challenging, as illustrated in the following case. 2. Case Presentation A 50 year old Caucasian male was referred to the tho- racic surgery department for evaluation of an intramural esophageal mass. he patient complained of atypical chest pain of gradual onset over the previous 6 months. He denied weight loss, dysphagia, upper GI bleeding, relux, or other symptoms. he patient’s medical history included hyperten- sion and a 30-pack-year smoking history. Ater a chest radio- graph failed to show any pathology, a computed tomography (CT) scan was ordered which revealed showed a 5 cm mass on the midesophagus at the junction of the azygos vein with the superior vena cava (Figure 1). Endoscopy showed a normal esophageal mucosa and endoscopic ultrasound a smooth, submucosal mass. A CT scan of the abdomen did not show any evidence of distant metastases. he mass was approached via a right posterolateral tho- racotomy (Figure 1). he subcarinal lymph nodes were found to be enlarged and were sent for frozen section, which was negative for malignancy. he mass was enucleated from the esophageal wall by gently detaching it from the mucosa. No adhesions with the mucosa or muscularis were noted, and the mass was excised with its capsule intact. A frozen section of the mass indicated the mesenchymal origin, with a possible diagnosis of leiomyoma. he muscular layer of the