外眼筋の肥厚を伴った眼窩悪性リンパ腫

A case of malignant lymphoma of the orbit with enlarged extraocular muscles

　右眼の眼瞼腫脹と眼球突出を繰り返し，眼窩CT検査にて外眼筋の肥厚を認めたが確定診断に至らず，全身悪性リンパ腫となって死亡した37歳の男性症例を報告した．

　眼窩CT所見では，右眼の外眼筋の肥厚と，眼窩内や眼球周囲に高吸収の軟部組織陰影がみられたが，明らかな腫瘤は認められなかったため，眼窩炎症性偽腫瘍の眼筋型や眼窩筋炎などの非特異的炎症性疾患を考えていたが，剖検時の病理組織学的検索により，悪性リンパ腫，免疫芽球型，形質細胞様と判明した．外眼筋は，両眼の四直筋全てに腫瘍細胞の浸潤を認め，著しく肥厚していた．

　悪性リンパ腫においても，その浸潤性進展から，外眼筋の肥厚を引き起こすこともあり，注意を要する．

A 37-year-old male presented with exophthal-mos of the right eye, edema of the right upper eyelid, laryngoplegia and slight fever. Significant improvement was induced following systemic cor-ticosteroid treatment.

Exophthalmos and edema of upper eyelid of the right eye recurred 6 months later. Computed tomo-graphy (CT) showed enlargement of extraocular muscles in the right eye suggestive of an inflamma-tory process. Death followed one month later due to disseminated intravascular coagulation and multi-ple organ failure.

Autopsy showed malignant lymphoma dis-seminated all over the body. All the extraocular muscles of both eyes were infiltrated by lymphoma cells. The muscle fibers were degenerated. The present case illustrate that malignant lymphoma may induce enlargement of extraocular muscles even during its early stage.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(11) : 1269-1272, 1988