616.329-006.311.03-072.1-073.4:616-089.87

Esophageal hemangioma (EH) is an exceedingly rare benign vascular neoplasm, accoun-ting for less than 0.04 % of all endoscopic findings. Due to location and vascular nature, it poses significant diagnos-tic challenges and a high risk of life-threatening hemorrhage. Traditionally, surgical resection was the mainstay of treatment, but the paradigm has shifted toward minimally invasive endoscopic techniques at present. The purpose of the study was to highlight the importance of a multimodal diagnostic approach in differentiating rare EH from other subepithelial lesions, to demonstrate the feasibility, safety, and effectiveness of endoscopic submucosal dissection (ESD) for the treatment of a giant cavernous EH in the cervical esophagus and to provide an updated review of cur-rent diagnostic and therapeutic strategies based on recent clinical evidence. Case presentation. We report a clinical case of a 57-year-old female presenting with progressive dysphagia when drinking liquids. Endoscopy revealed a large soft elastic tuberculate cyanotic subepithelial mass on the posterior wall of the cervical esophagus, extending from 16 to 21 cm from the incisors (50 mm in length), which filled up to 2/3 of the esophageal lumen, flattened under pressure with the device and restored its shape. Endoscopic ultrasonography (EUS) confirmed a heterogeneous hypoechoic lesion within the submucosal layer with no active intralesional arterial blood flow. MSCT-angiography identified peripheral phleboliths, further supporting the diagnosis of a cavernous EH. The patient successfully under-went ESD. Despite the technical complexity, the lesion was resected en bloc without complications. Histopathology confirmed a cavernous hemangioma (ICD-O 9120/0). The patient was discharged on the second postoperative day. Conclusions. This case illustrates that advanced operative endoscopy, specifically ESD, is a safe and effective organ-preserving alternative to radical surgery for large EH, even in challenging anatomical locations such as the cervical esophagus. Multimodal imaging (EUS and MSCT) is crucial for accurate preoperative planning.