Abstract
<title>Abstract</title> <p>Background Esophageal gastrointestinal stromal tumor (GIST) is exceedingly rare, accounting less than 1% of all GISTs with no distinctive clinical guidelines. Masses exceeding 5 cm have traditionally been managed by esophagectomy due to concerns about mucosal integrity and oncological safety. Case presentation : A 43-year-old woman came to our clinic with incidentally discovered giant esophageal mass, suspected to be leiomyoma, later than diagnosed with 9.4cm sized esophageal GIST. Three-port video assist thoracoscopic surgery (VATS) enucleation was performed without preoperative biopsy. Mucosal integrity and azygos vein were well preserved, and there was no evidence of tumor rupture on histologic findings. Post operative esophagography showed no leakage. The patient was discharged on third postoperative day without any complications. CD117 positivity confirmed GIST diagnosis and the patient had no evidence of recurrence on seventh week follow up and adjuvant imantinib was not required. Conclusions Current case challenges the conventional 5cm threshold of mass size for esophagectomy and demonstrates VATS enucleation is feasible for giant esophageal GISTs exceeding 9 cm. It also highlights CD117's essential role in distinguishing GIST from leiomyoma.</p>