網脈絡膜悪性リンパ腫の臨床像

Clinical features of malignant retinochoroidal lymphoma

　ぶどう膜炎症状を呈し，網脈絡膜悪性リンパ腫と考えられた4例7眼（男性1例・女性3例，年齢55歳から70歳）を経験した．3例5眼に軽度の虹彩毛様体炎，1例2眼に著明な硝子体混濁，4例7眼の眼底に軽度に隆起した黄白色滲出斑様病巣が認められた．初診時，全身的に異常のみられた症例はなかった．これらに対してステロイドは無効であり，放射線照射，レーザー光凝固が有効であった．しかし中枢神経症状，全身症状の発現とともにぶどう膜炎症状の再燃がみられ，最終的には3例が初診より5カ月から3年5カ月後に死亡した．うち1例は中枢神経系悪性リンパ腫を発症後死亡，剖検を施行し，中枢神経，両側肺，胃，肝臓，左副腎および網脈絡膜にびまん性，大細胞型悪性リンパ腫細胞の浸潤が確認された．

　今回の症例より本症の経過は，急性期，消退期，再燃・眼外発症期に分けられ，臨床的に眼球内にも悪性リンパ腫は初発しうると考えられた．

We observed 4 patients with malignant lymphoma of the retina and the choroid during a 4-year period through 1984. The condition was bilateral in 3 cases and unilateral in 1. None of the patients manifested evi-dences of systemic malignant lymphoma when they sought medical advice for their eye conditions.

They manifested, as characteristic ophthalmological features, massive vitreous opacity, mild iridocyclitis and infiltrative retinal lesions. These eye lesions were sensitive to radiation and laser treatments, but not to topical or systemic corticosteroid.

The uveitis tended to recur after appearances of involvement of the central nervous system and other systemic organs. Death resulted in 3 patients, 5 to 42 months after their first visit to us. One affected eye could be examined pathologically post mortem. Malignant lymphoma cells infiltrated into the retina, the choroid, and the space between the retinal pigment epithelium and the Bruch's membrane. From our clinical observations, it seems that malig-nant lymphoma may arise as a primary lesion in the eye. Its course of ocular involvement can be divided into three phases : acute phase, phase of disappearance, and phase of reappearance and extraocular dissemination.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(12) : 1313-1319, 1986