Abstract
INTRODUCTION: Esophageal schwannomas are rare benign tumors arising from Schwann cells and are among the least common mesenchymal neoplasms of the gastrointestinal tract. While fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in the preoperative assessment of submucosal tumors, schwannomas are known to exhibit unexpectedly high FDG uptake, often mimicking malignant lesions. Dual-time-point FDG-PET, which evaluates both early and delayed FDG accumulation, has been employed to improve diagnostic specificity in various malignancies, including esophageal cancer. However, to date, no cases of esophageal schwannomas showing a malignant FDG uptake pattern on dual-time-point FDG-PET and resected thoracoscopically have been reported. We present a rare case of esophageal schwannoma demonstrating increased delayed FDG uptake, initially suggestive of malignancy that was successfully treated with thoracoscopic surgery following preoperative diagnosis via EUS-FNA. CASE PRESENTATION: A 55-year-old woman was referred to our hospital for evaluation of an esophageal submucosal tumor detected during health screening. FDG-PET demonstrated a high uptake pattern (SUVmax; early; 9.4, delayed; 11.8) suggestive of malignancy. However, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed histopathological features consistent with a benign schwannoma. The patient underwent thoracoscopic enucleation, and the intraoperative findings confirmed a well-circumscribed tumor without invasion of the surrounding tissues. The procedure was completed within 2 h and 5 min with minimal blood loss. The final pathological diagnosis confirmed esophageal schwannoma. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. At the 6-month follow-up, no recurrence was observed. CONCLUSIONS: This case highlights that even when dual-time-point FDG-PET suggests malignancy, thoracoscopic resection may be a viable treatment option for esophageal schwannoma if a benign diagnosis is supported by preoperative EUS-FNA. This underscores the importance of integrating metabolic imaging with histopathological assessment in surgical planning.