The present report is that of a 40-year-old woman admitted with hematemesis and epigastric pain. Endoscopy revealed a fungating mass in the lower esophagus. Esophageal brushing revealed clustered and single malignant cells with ample cytoplasm, large bizarre nuclei and prominent, irregular nucleoli; the chromatin was irregular with clumping at the nuclear borders. Giant multinucleated malignant cells were numerous. These cells had nuclear molding and abundant acidophilic cytoplasm. Autopsy findings included a large tumor in the lower esophagus and metastases to lung, liver and kidneys. Microscopically, the fungating esophageal tumor and metastases were composed of cyto- and syncytiotrophoblastic elements. Choriocarcinoma of the esophagus is a rarity, and only two cases were found in the literature. The diagnosis, however, can be achieved by brush biopsy since the characteristic cyto- and syncytiotrophoblastic cells can be readily identified, provided that the possibility of this ectopic occurrence is recognized.