A 62-year-old man was diagnosed with superficial esophageal cancer on upper endoscopy during health screening. Endoscopic examination with iodine staining and narrow-band imaging revealed three superficial erosive lesions in the middle and lower thoracic esophagus. The depth of tumor invasion was diagnosed as shallow invasion into the submucosal layer on endoscopic ultrasonography. Since enhanced computed tomography showed a markedly swollen lymph node at the right cardia, with higher F-deoxyglucose uptake on F-deoxyglucose positron emission tomography, lymph node metastasis was suspected. Then esophagectomy with lymph node dissection was performed, and histopathologic examination of the resected specimen revealed metastasis of squamous cell carcinoma in the huge lymph node along the celiac artery. In superficial esophageal cancer with a distinct depressed lesion, horizontal extension, and especially with erosive esophagitis, the possibility of lymph node metastases should be kept in mind even the depth of tumor invasion was lamina propria mucosa.
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