Microscopic squamous cell carcinoma of the esophagus with early submucosal spread was diagnosed in two patients with hiatal hernia and evidence of esophageal reflux. The lesions were not suggestive of malignancy on endoscopic examination. Both patients are known to be alive more than one year after resection and presumably without recurrence. More liberal use of endoscopic brush cytology and biopsy or intubation cytology particularly in the cases at high risk, might substantially improve the chances of very early diagnosis and favorably alter the present grim mortality rate.
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