Indeterminate malignant potential glomus tumor of the esophagus: A case report.

RATIONALE: Glomus tumors of the esophagus are exceedingly rare neoplasms with poorly defined biological behavior and malignant potential. Their diagnostic ambiguity and management dilemmas necessitate detailed case documentation to refine clinical strategies.

PATIENT CONCERNS: A 62-year-old male presented with progressive 4-month dysphagia for solid foods, without weight loss or hematemesis.

DIAGNOSES: Contrast-enhanced computed tomography identified a 50 mm × 23 mm mid-thoracic esophageal mass. Endoscopic ultrasound localized a hypoechoic muscularis propria-originating lesion. Histopathological examination postresection confirmed glomus tumor morphology, with immunohistochemical evidence of smooth muscle actin, H-caldesmon, and vimentin positivity. The tumor demonstrated a Ki-67 proliferation index of 8% without mitotic activity. Based on WHO criteria (deep visceral location, size >5 cm), it was classified as a glomus tumor of uncertain malignant potential (GT-UMP).

INTERVENTIONS: Complete surgical en bloc resection via right thoracotomy approach.

OUTCOMES: No perioperative complications occurred. Serial imaging and endoscopic surveillance over 6 months showed no local recurrence or distant metastasis.

LESSONS: Esophageal GT-UMP diagnosis requires multimodal correlation: characteristic immunohistochemical profile (smooth muscle markers positivity) combined with WHO size/location criteria. The absence of recurrence in this large (5 cm) GT-UMP case challenges current size-based risk stratification, suggesting biological heterogeneity within this classification. Molecular profiling and extended (>5 years) follow-up are imperative to establish reliable prognostic markers for visceral glomus tumors.