急速に発生し，遡及的な検討が可能であったBarrett食道由来の未分化癌の1例

An Undifferentiated Barrett's Carcinoma Grew Rapidly in 5 months, Report of a Case

要旨●患者は60歳代，男性．下部食道の前壁から右壁側にかけて，8cm大の2型潰瘍性病変を認めた．潰瘍辺縁からの生検標本では中型〜大型の異型細胞が充実性に増殖し，各免疫組織化学染色がすべて陰性であり，食道癌，Type 2，未分化癌，cT3-4N1M1，cStage IVbと診断した．噴門部リンパ節転移，多発肝転移を認め，化学療法を施行したが入院後77日で原病死された．本例は診断5か月前の人間ドックにてEGDが施行されており，遡及的検討が可能であった．GERD-Bを伴うC2M5のSSBEを認め，NBI拡大観察にてBarrett食道に異型はなく，扁平上皮領域にもbrownish areaを認めなかった．特徴的な舌状Barrett粘膜をもとに原発部位を推定したところ，SSBEから発生した未分化癌と推察された．5か月前の内視鏡検査では腫瘍を疑う所見はなく，急速に発生，増大したと推察された．

　A 60-year-old male with an advanced type 2 tumor in the lower esophagus was referred to our hospital. CT scan showed multiple lymph node and liver metastases. A specimen collected from the lesion was biopsied and the pathological diagnosis was of an undifferentiated carcinoma. Chemotherapy was performed but was not effective, and the patient died of esophageal cancer 77 days after hospitalization.

　A screening EGD was performed five months before this admission, and the patient had C2M5 Barrett's esophagus with GERD-B. WLI, NBI, and NBI magnified endoscopy showed no malignancy. The primary site was estimated in the Barrett's mucosa based on a comparison between the two EGD findings.

　This is an important case report showing rapid growth of undifferentiated cancer derived from Barrett's esophagus in five months.