A Rare Case of Proximal Esophageal Leiomyoma Presenting with Progressive Dysphagia Mimicking Malignancy.

Introduction: Esophageal leiomyomas are rare benign tumors representing less than 1% of esophageal neoplasms. They typically arise from the muscularis propria and present in the distal two-thirds of the esophagus. Though often asymptomatic, larger lesions may cause dysphagia, weight loss, or mimic malignancy. Case Presentation: We report a case of a 41-year-old male with a 5-month history of progressive dysphagia and weight loss. Imaging revealed esophageal wall thickening in the upper third of the esophagus. Endoscopic ultrasound (EUS) identified a large hypoechoic submucosal lesion, but fine-needle aspiration (FNA) was nondiagnostic. The patient underwent right thoracotomy with successful enucleation of a 6.5 cm esophageal leiomyoma. Histopathology confirmed a benign smooth muscle tumor with negative margins. Leiomyomas are most frequently located in the mid-to-distal esophagus. Diagnosis can be challenging due to non-specific symptoms and limited biopsy yield. Imaging modalities, particularly EUS, are crucial for evaluating lesion characteristics and guiding management. Surgical approach depends on tumor size, location, and relation to surrounding structures. Conclusion: This case highlights the diagnostic challenges and therapeutic strategies in managing atypically located esophageal leiomyomas. Surgical excision offers both definitive diagnosis and symptom resolution in such cases.