RAPID PROGRESSION OF BARRETTS-ESOPHAGUS TO METASTATIC ESOPHAGEAL-CARCINOMA IN A PATIENT WITH CHRONIC LYMPHOCYTIC-LEUKEMIA

Barrett's esophagus is a common premalignant condition that predispose s to the development of adenocarcinoma of the esophagus through a proc ess of transformation from metaplasia to dysplasia and then carcinoma. Periodic endoscopic surveillance with multiple biopsies is adopted by most physicians to detect dysplasia or early carcinoma. We report a c ase of an 80-year-old white man with chronic lymphocytic leukemia (CLL ) who had periodic endoscopic surveillance without any evidence of dys plasia or cancer, and who died of metastatic carcinoma of the esophagu s only 18 months after his last upper endoscopic examination. We suspe ct that the relative immunosuppressed state resulting from his CLL was the major contributor to the rapid progression of the Barrett's esoph agus to cancer. Patients with CLL have higher risk of second cancers, and several cases of aggressive carcinomas have been reported in assoc iation with CLL. This is the first case report of metastatic esophagea l cancer arising in Barrett's esophagus in a patient with CLL. This ca se suggests that we might need a more aggressive surveillance strategy for Barrett's esophagus in patients with CLL or other immunocompromis ed conditions.