蜂刺傷が誘因となり緩徐に眼窩内浸潤をきたした微小囊胞性付属器癌の1例

A case of microcystic adnexal carcinoma with past history of sting by hornets

要約　目的：蜂刺傷瘢痕を契機に緩徐に進行し眼窩内深部浸潤をきたした微小囊胞性付属器癌の1例を報告する。症例：67歳，男性。33年前にスズメバチに刺された右前額部の刺傷部が瘢痕化し緩徐に拡大，右上眼瞼腫脹，開瞼困難となり当院受診となった。右眉毛部から前額部に広がる無痛性の硬結様の皮膚腫瘤がみられ，右眼の眼球運動は全方向に運動制限を認めた。眼窩部MRIでは，充実性の右前額部皮下腫瘤が眼窩内深部，外眼筋にも浸潤している所見を認めた。病理診断は微小囊胞性付属器癌であった。眼窩内容除去術および皮弁移植術を施行，20か月後の現在，再発なく経過している。結論：微小囊胞性付属器癌は眼科領域においても鑑別を要する皮膚疾患である。

Abstract.　Purpose：To report a case of microcystic adnexal carcinoma after being stung by hornets long before. Case：A 67-year-old male presented with slowly progressive swelling of right upper eyelid. He had been stung in the face by hornets 33 years before. He had felt stiffness in the right eyebrow ever since. The stiffness had slowly increased, until he felt difficulty in opening his right eye. When seen by us, the stiff mass was free of pain and involved the right forehead and eyebrow. The right eye showed limited movement in all the 9 directions. Magnetic resonance imaging（MRI）showed the mass to be invading the right orbit and extraocular muscles. Biopsy showed the tumor to be microcystic adnexal carcinoma. He received orbital exenteration with skin grafting followed by radiation. He has been doing well for 20 months until present. Conclusion：This case illustrates that microcystic carcinoma may simulate benign tumor in the orbit.