The most common neoplasm of the esophagus is leiomyoma, accounting for 75% of tumors. They occur in a younger population (median age, 35 years) compared to GISTs, which are relatively uncommon in the esophagus and occur in older patients (median age, 63 years).15 Esophageal GISTs are most commonly located in the distal third of the esophagus and may extend into the stomach. These lesions may be homogeneous or heterogeneous with central areas of low attenuation due to hemorrhage, necrosis, or cystic degeneration. Most esophageal GISTs are benign, unlike the trend seen elsewhere in the gastrointestinal tract where most GISTs are malignant.

The differential diagnosis of esophageal GISTs include leiomyoma, duplication cysts, lipoma, neurofibroma, schwannoma, and hemangioma. GISTs may also simulate other lesions that have a polypoid appearance such as papil-loma, adenoma, fibrovascular polyp, and inflammatory polyp. Large GISTs may invade the mediastinum, simulating advanced carcinoma, lymphoma, leiomyosarcoma, and malignant melanoma.

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