Objective: The purpose of this study was to study the clinical, imaging characters and pathological characteristics of esophageal sarcomatoid carcinoma. Methods: We reviewed 23 cases of esophageal sarcomatoid carcinoma from Janu-ary 2006 to December 2013 in four hospitals. The data of patients who were esophageal sarcomatoid carcinoma operated were retrospectively analyzed. Al cases had completed upper gastrointestinal barium images materials and 14 of these cases had completed CT images materials. Upper gastrointestinal barium images and CT imaging features include tumor location, size, shape, and strengthen, etc. The biological parameters of lesions including the express of cytokeratin AE1/AE3, 34βE12, p63, Vimentin, desmin, Actin, S-100 and Ki-67 detected by immunhistochemical UltraSensitiveTM S-P method (n=23), and the patients’ data of contrastographic picture (n=23), imaging characters of CT scan (n=14), and their relationship were studied. Results:Upper gastrointestinal barium images, CT imaging and gastrointestinal fiberscopy revealed lobulated intraluminal fil ing defect 0.4 cm to 5.7 cm × 3.5 cm × 1.3 cm (mean=3. 7 cm) in the mid (n=14), lower (n=7) and upper (n=2) intrathoracic esophagus. Among 23 cases of esophageal sarcomatoid carcinoma, 19 patients were of mushroom type, 2 patients was of ulcer type, and 2 patients were of medul a type;19 patients were pedunculated, and 4 patients were no pedunculated (2 patients was of ulcer type). The tumor surface was relatively smooth and esophageal compliance was maintained. The pathological changes of esophagus such as lightly locked, rigid wal no-manifest partly, esophageal lumens expand partly, major fil ing sublobe defect could be shown through contrast medium. Normal esophagus was no unpack obviously over pathological changes. Enhanced computed tomography showed tumors in the intrathoracic esophagus and 8 lymph nodes metastases in 3 cases. Histological y, carcinomatous and sarcomatous components coexist. Microscopical y, the tumor comprised poorly dif erentiated squamous cellcarcinoma and spindle-shaped cells resembling leiomyosarcoma. Immu-nohistochemical y, spindle-shaped sarcomatous cells displayed weekly positive reaction to cytokeratin AE1/AE3. Transitional zone was seen between sarcomatous and carcinomatous elements in 5 cases. The 17 lymph nodes metastases in 5 cases (53 lymph nodes) among 23 cases esophageal sarcomatoid carcinoma (187 lymph nodes) were observed. Conclusion:The clinical and radiologic features of esophageal sarcomatoid carcinoma overlap with those of other esophageal neoplasms. There are the radiologic imaging changes such as a large, intraluminal, polypoid mass, major fil ing sublobe defect and pedicle skin flap tumor in esophageal lumen, esophageal lumen extension partly, dissepiment rigidity wal no obviously, etc. Histological y, carcinomatous and sarcomatous components coexist and the biphasic pattern is the key diagnostic feature. However, esophageal sarcomatoid carcinoma has a more favorable prognosis than other malignant esophageal neoplasms. Immunohistochemical staining seems necessary to distinguish these lesions from other esophageal neoplasms.