涙囊鼻腔吻合術後に診断された涙囊部低分化型腺癌の1例

A case of poorly differentiated adenocarcinoma of the lacrimal sac diagnosed after dacryocystorhinostomy

要約　目的：涙囊鼻腔吻合術後に涙囊の悪性腫瘍が診断された症例の報告。症例：52歳女性が再発性の慢性涙囊炎として紹介受診した。所見と経過：涙囊部に腫脹があり，通水試験で上下の涙点とも通水可能であったが，膿の逆流があった。涙囊鼻腔吻合術を行ったが通過障害が進行し，6か月後に涙道再建術を行った。吻合孔に涙囊原発と推定される腫瘤があり，生検で低分化型腺癌と診断した。画像診断で右内眼角に充実性の腫瘤と骨破壊像があり，拡大涙囊腫瘍摘出術と遊離皮弁移植術を実施した。17か月後の現在まで再発や転移はない。結論：涙囊に原発した腫瘍では，涙囊炎との鑑別が必要である。

Abstract.　Purpose：To report a case of malignancy of the lacrimal sac diagnosed after dacryocystorhinostomy. Case：A 52-year-old woman was referred to us for presumed recurrent dacryocystitis. Findings：She showed swelling in the site of right lacrimal sac. Irrigation showed patency of the lacrimal drainage system with regurgitation of putrid material. Dacryocystorhinostomy was followed by progressively impaired lacrimal drainage, necessitating another surgery 6 months later. A tumor was detected as intraoperative finding at the site of prior surgery. Diagnostic imaging showed a tumor with erosion of adjacent bones. Biopsy showed poorly differentiated adenocarcinoma. She received en bloc excision with free skin graft. She has been doing well for 17 months until present. Conclusion：This case illustrates the need to differentiate malignant tumor of the lacrimal gland from dacryocystitis.