A 70-year-old man was diagnosed by upper gastrointestinal endoscopy to have superficial esophageal cancer at 34-37 cm from the incisors and had undergone ESD two years ago. After the first ESD, periodic examination had been performed every six months. At the one-year follow-up, endoscopic examination showed a small superficial protruded lesion on the posterior esophageal wall at 30 cm from the incisors. The lesion increased in size rapidly and appeared like a submucosal tumor. The tumor, however, was less than 5 mm in diameter. Magnifying endoscopy with NBI revealed B2 or B3 intraepithelial papillary capillary loops at the top of the lesion. The lesion was suspected to be malignant. A repeat ESD was performed 20 months from the first ESD. Pathological examination of the resected specimens revealed moderately differentiated squamous cell carcinoma invading the submucosal layer (SM2) , with no vascular involvement. The surgical margin was negative for cancer (pHM0 VM0) . However, in deference to the patient’s wishes, we carried out esophagectomy. Pathological examination of the resected specimens revealed no residual cancer cells or any lymph node metastasis. Herein, we have reported a rare case of micro-carcinoma of the esophagus that showed apparent protrusion.
