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目的:視神経と虹彩に浸潤がある急性リンパ性白血病に放射線療法が奏効した症例の報告。症例:38歳男性が両眼の霧視で受診した。1年前にフィラデルフィア(Ph)染色体陽性急性リンパ性白血病と診断され加療中であった。矯正視力は左右とも1.2で,両眼に虹彩炎,虹彩結節,乳頭の出血と浮腫があった。FISH(fluorescence ◆in situ◆ hybridization)法で前房水のPh陽性細胞を定量的に解析し,急性リンパ性白血病の視神経と虹彩浸潤と診断した。イマチニブの内服と放射線療法で眼病変は7か月後に寛解した。結論:FISH法による前房水Ph陽性細胞の解析は診断と治療効果の判定に有用である。本症例では,Ph染色体陽性急性リンパ性白血病の眼病変に放射線療法が著効を示した。
Purpose:To report a case of acute lymphocytic leukemia with infiltration in the iris and optic disc. Case:A 38-year-old male presented with blurring of vision in both eyes. He had been treated for Philadelphia chromosome-positive acute lymphatic leukemia(ALL)since one year before. His corrected visual acuity was 1.2 in either eye. Both eyes showed iritis, nodules in the iris, and optic disc swelling with hemorrhage. Fluorescence ◆in situ◆ hybridization(FISH)was used to quantitate Ph-positive cells in the aqueous. The findings led to the diagnosis of ALL with infiltration in the iris and optic disc. Peroral imatinib and radiation led to resolution of ocular lesions 7 months later. Conclusion:Use of FISH in the analysis of anterior chamber was useful in the diagnosis and evaluation of therapeutic effect. Radiotherapy was effective for ocular involvement by ALL in the present case.
Rinsho Ganka(Jpn J Clin Ophthalmol)60(8):1391-1395, 2006
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