Esophageal verrucous carcinoma: histologically a low-grade malignancy but clinically a fatal disease. A 76-year-old woman had a verrucous carcinoma of the esophagus with a fistula of the left main bronchus. We discuss this case together with those of eleven other patients with verrucous carcinoma of the esophagus reported previously. Differentiation between this tumor and squamous cell papilloma is often difficult. The central cores of fibrous tissue in verrucous carcinoma are heavily infiltrated with inflammatory cells, which accounts for the stenosis often found. The mortality in verrucous carcinoma of the esophagus is 67% even though histologically it is a low-grade malignancy. 