マイトマイシンCの術前点眼が著効した巨大結膜扁平上皮癌の1例

Instillation of mitomycin C was effective in a case of giant squamous cell carcinoma of conjunctiva prior to surgery

要約　目的：結膜の再発性巨大扁平上皮癌に術前のマイトマイシンC点眼が奏効した症例の報告。症例：83歳女性の左眼に角結膜腫瘍が15年前からあった。8回の切除と複数回の冷凍凝固を受けたが再発を繰り返していた。腫瘍が大きくなり，閉瞼不能になって紹介され受診した。所見：左眼視力は零で，球結膜の耳側から鼻側にかけて角膜を被覆する多房性の巨大腫瘍があった。術前処置として0.04％マイトマイシンCの1日4回点眼を1週間行い，次の1週間を休薬とする治療を4回繰り返した。これにより腫瘍は著しく縮小し，鼻側角膜が露出した。3週間後に角結膜腫瘍切除術を行った。高分化した扁平上皮癌であった。以後6か月間，再発転移はない。結論：術前のマイトマイシンC点眼で，巨大結膜腫瘍が縮小し，侵襲が小さい外科的切除が容易になった。

Abstract.　Purpose：To report a case of recurrent giant squamous cell carcinoma of bulbar conjunctiva treated by instillation of mitomycin C prior to surgery. Case：An 83-year-old female had had corneoconjunctival tumor in the left eye since 15 years before. The tumor had recurred after 8 sessions of resection and multiple applications of cryosurgery. She was referred to us for enlarged tumor that interfered with lid closure. Findings：Visual acuity was zero in the left eye. Giant multilocular tumor entirely covered the cornea by extending from the temporal to nasal sector of conjunctiva. The tumor was treated by topical instillation of 0.04％ mitomycin C 4 times daily for one week followed by one week of no treatment. After 4 such sessions,the tumor remarkably decreased in size and the cornea became exposed. Surgical resection was performed 3 weeks later. The tumor was diagnosed with highly differentiated squamous cell carcinoma. There has been no recurrence or metastasis during 6 months until present. Conclusion：Instillation of mitomycin C resulted in decreased size of giant conjunctival tumor and enabled less invasive surgical resection.