副鼻腔から眼窩内浸潤を来した悪性腫瘍例

Survey of malignant tumors in the orbit originating from the paranasal sinus

　1974年から'85年までの12年間に慶大眼科外来を受診した眼窩腫瘍のうち，副鼻腔から眼窩内に浸潤を来した悪性腫瘍24例について統計的観察を加えた．同期間の眼窩腫瘍は199例で，副鼻腔から眼窩内に浸潤した悪性腫瘍は，眼窩炎性偽腫瘍についで第2位，12％であった．24例のうち，副鼻腔原発の症例が21例，88％を占め，他部位から副鼻腔へ転移，浸潤した続発性の症例が3例，13％であった．病理組織学的診断では，扁平上皮癌および悪性リンパ腫が18例，86％を占めた．副鼻腔原発例21例の腫瘍発生部位は，上顎洞が最も多く16例で，以下節骨洞4例，前頭洞1例であった．眼症状を初発症状とする副鼻腔悪性腫瘍は6例あったが，大部分は篩骨洞，前頭洞由来であり，腫瘍の眼窩内への浸潤や視神経の圧迫によって視力が低下した症例は，眼症状を初発症状とした篩骨洞癌に多かった．5年生存率は50％で予後は不良であった．

We reviewed a total of 24 cases of malignant tumor in the orbit invading from the paranasal sinuses during the past 12-year period (1974-85). This group ranked as the second most frequent among orbital tumors (12%) next to pseudotumor of the orbit (14%). Pathologically, 18 cases (86%) were either squamous cell carcinoma or malignant lymphoma. Paranasal sinuses served as the primary sites of origin in 21 cases (88%) : maxillary sinus in 16 cases, ethmoidal in 4 and frontal sinus in one.

In a previous report, the incidence of malignant tumor originating in the ethmoidal and frontalsinuses was 5% (5 cases in a series of 96). As the incidence of orbital tumor invasion from ethmoidal and frontal sinuses in our series was 24% (5/21), tumors originating from ethmoidal and frontal sinuses seemed to have more ready access to the orbit than those originating in the maxillar sinus. In 6 cases in the present series, the patient sought medical advice on account of ocular signs. In 5 of these cases, the orbital tumor originated from the ethmoidal or frontal sinuses. The anatomically close location of these two sinuses to the optic nerve and thin bony septum seemed to be a major cause of this finding. The overall five-year survival rate in the present series was very poor at 50%.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(8) : 949-952, 1987