Esophageal schwannoma with unusual endoscopic ultrasound imaging findings

Esophageal schwannomas are a subset of rare tumors that are difficult to differentiate from other esophageal tumors preoperatively. On endoscopic ultrasound (EUS), esophageal schwannomas generally appear as well-demarcated masses that are heterogeneous, hypoechoic, or mixed-echogenic in nature. We present a case of esophageal schwannoma with atypical EUS findings. EUS revealed two lobulated tumors that originated from the muscularis propria and characterized by heterogeneous hypoechoic features and poor blood flow signals. Right-sided video-assisted thoracoscopic surgery with esophageal tumor enucleation was performed. Immunostaining finally confirmed the diagnosis of an esophageal schwannoma. Esophageal schwannomas tend to show heterogeneous hypoechoic or mixed-echogenic features, but they rarely present with two lobulated masses.