剖検で視神経浸潤を確認できた悪性リンパ腫の1例

Clinicopathological observation of malignant lymphoma with optic nerve infiltration

　視神経浸潤をきたした悪性リンパ腫の1症例に対し病理組織学的検索を行った．経過中左眼眼底は網膜中心静脈閉塞症の所見を呈するとともに，後極部に網膜深層の斑状出血が多数混在していた．剖検により左視神経，右前頭葉，腎臓，胃等にリンパ腫の浸潤を確認した．視神経における腫瘍細胞浸潤は前部視交叉から強膜篩状板の範囲におよび，くも膜から中隔内血管周囲に強く認められた．実質は著明な空胞化と萎縮をきたしていたが，浸潤は軽度であった．視機能障害の機序としては，軟膜中隔への腫瘍細胞浸潤による血管系閉塞に起因した虚血性機序を重視した．

A 59-year-old male presented with acute loss of vision in his left eye and was tentatively diagnosed as central retinal vein occlusion on funduscopic and fluore-scein angiographic findings. Cerebral lymphoma was suspected on computed tomographic findings. The patient died 2 months later due to disseminated intravascular coagulation (DIC).

Postmortem studies showed generalized lympho-matous infiltration including the brain and the optic nerve. The eyeglobe was free of the disease. The infil-tration into the optic nerve involved, predominantly, the septal tissues and perivascular spaces rather than the interstitial tissues. The acute visual disturbance in this case was apparently due to ischemic process in the optic nerve.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(10) : 1170-1173, 1986