Esophageal cancer is one of the most common cancers worldwide. All patients present with dysphagia, weight loss, or chest pain. There are many methods to establish a definite diagnosis and tumor staging, including computed tomography, an upper gastrointestinal series, and panendoscopy. An intramural tumor of the esophagus was strongly suspected in our patient based on radiological findings and panendoscopy. However, the final diagnosis, based on positive histopathology for TTF-1, was of a metastatic small cell carcinoma originating in the lung.