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We describe a middle-aged African American male in whom a large oesophageal GCT was discovered incidentally during endoscopic evaluation following traumatic injury. Despite exceeding commonly referenced size thresholds for resection, the tumour demonstrated no high-risk histological features and the patient remained asymptomatic. Given substantial operative risk from prior extensive abdominal surgery, a multidisciplinary team favoured close endoscopic surveillance. This case highlights the limitations of size-based management strategies and emphasises the importance of individualised risk assessment incorporating histology, endoscopic characteristics, symptoms and surgical risk.<\/jats:p>","DOI":"10.1136\/bcr-2026-272682","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:55:28Z","timestamp":1790258128000},"page":"e272682","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["To resect or observe? 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