Abstract: Intramural metastasis (IM) is defined as metastatic tumor from the primary tumor to the digestive tracts through the intramural lymphatic system. It can occur in esophageal, gastric and colorectal carcinomas, especially in esophageal squamous cell carcinoma. The combination of histological morphological evaluation and molecular pathology can assist in the identification of IM and multiple primary carcinomas (MPCs). IM is usually associated with a poor prognosis and also affects the treatment. This article reviews the anatomical and histological basis, clinicopathological characteristics, treatment and prognosis of IM in ESCC, the identification of IM and MPCs and how to improve the detection rate of IM, to guide accurate diagnosis and treatment.