眼球摘出後，5年後に再発し全身転移をおこした脈絡膜悪性黒色腫の1剖検例

An autopsied case of choroidal malignant melanoma with generalized metastasis 5 years after enucleation

　眼球摘出後，5年以上経て，全身転移をおこした脈絡膜悪性黒色腫の1剖検例につき報告した．

　再発時の初発症状は頸部転移による右肩甲部から右手にかけてのしびれであり，剖検により，肋骨，椎弓，肝，胆嚢，脾臓，副腎，膵臓，肺，ダグラス窩等ほぼ全身への転移を認めた．眼窩は，肉芽組織で被われ，局所再発の所見はなかった．

　本疾患は眼球摘出後，長期にわたっての経過観察および免疫賦活療法等の後療法が必要であると考えられた．

A 62-year-old woman underwent enucleation of her left eye because of choroidal tumor extending from the macula inferior temporally. The tumor measured 12 mm×6 mm and was diagnosed, his-tologically, as mixed type malignant melanoma of the choroid. There was no invasion of tumor cells in the sclera or optic nerve.

The patient developed numbness and muscular weakness in her right upper extremity 5 years after enucleation. Myelography showed complete block-age of the spinal cord. During laminectomy surgery, black tumor masses were found surrounding the spinal processes and were diagnosed as metastat-ized malignant melanoma. Later, generalized metastasis was detected by hepatic echography, bone scintigraphy and s'Ga whole body scintigra-phy. The patient died of hepatic failure 5 years and 9 months after enucleation. Autopsy showed distant metastases almost everywhere except the orbit which showd no local recurrence of the malignancy.The present case together with a review of 6 cases of malignant melanoma seen by us during the past 9 years suggest the necessity of long-term surveillance of patients after enucleation.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(10) : 1159-1164, 1987