We have reviewed and analyzed the clinical and radiographic features of 38 patients with proven carcinoma involving the esophagogastric junction. There were 29 cases of adenocarcinoma and nine of squamous cell carcinoma presenting with similar symptoms, surgical findings and radiographic characteristics. Features that suggest adenocarcinoma are: 1. mass or distortion of the gastric fundus; 2. short lesion; 3. smooth submucosal contour defect representing tumor undermining mucosa. Hiatus hernia was present in 17% of adenocarcinomas and 44% of epidermoid carcinomas but the association appears to be coincidental. Atypical forms of presentation such as lesions involving almost the entire esophagus or mimicking peptic esophagitis and achalasia are discussed and illustrated. Pertinent data from the literature is reviewed. In order to avoid errors in the roentgenographic diagnosis routine careful examination of the esophagogastric junction is recommended.