A 53-year-old asymptomatic male presented to the Lishui Municipal Central Hospital (Lishui, China) with a mass discovered on gastroscopy due to a routine medical examination. He had a history of smoking 40 cigarettes per day for 30 years and no history of diabetes mellitus, hepatitis, hypertensive disease, and tuberculosis. Written informed consent was obtained from the patient for the publication of the present study. Gastroscopy revealed a mass in the lower esophagus with rigid tissue (Figure 1). Pathological examination indicated heterotrophic hyperplasia of epithelial cells and possible malignancy. Esophageal CT (Philips, Brilliance ICT CP 200063) showed thickening of the wall of the lower esophagus with a thickness of about 0.7 cm, and an enhanced scan showed uneven enhancement of the thickened esophageal wall. A preoperative diagnosis of esophageal cancer was considered due to the gastroscopic pathological examination and enhanced CT features. Other physical examinations, including lung functional examination, electrocardiogram, abdominal ultrasound, brain magnetic resonance imaging (MRI), and radionuclide bone imaging, were normal. The serum levels of the tumor markers (alpha fetal protein, carcinoma embryonic antigen, squamous cell carcinoma antigen, carbohydrate antigen (CA)72-4, CA199, CA125, and cytokeratin 19 fragment) were within normal limits. Due to the possibility that the mass was malignant, a thoracoscopic esophagectomy was performed under general anesthesia on May 31, 2021. Intraoperatively, the tumor was in the lower esophagus and the tissue was tough. The tumor measured 20 mm and was present along the esophageal wall. Pathological examination revealed the tumor was characterized by biphasic architecture consisting of cuboidal ductal cells and myoepithelial cells (Figure 2). On immunohistochemistry, the duct-forming epithelial cells were positive for cytokeratin 7 (Figure 3). The outer cells were positive for p40, p63 (Figure 4), and cytokeratin 5/6, suggesting a myoepithelial phenotype. The Ki-67 labeling index was about 20% (Figure 5). The patient's postoperative recovery was eventful, an anastomotic fistula occurred, and the patient was discharged from the hospital after 84 days. Due to the esophageal anastomotic fistula resulting in anastomotic local scar hyperplasia, the patient underwent esophageal dilation three times. One year postsurgery, the patient remained in good health, with no evidence of metastasis and recurrence.