涙道癌に陽子線治療を施行した1例

A case of lacrimal duct carcinoma treated by proton radiation

要約　目的：涙道癌に陽子線治療を行った1症例の報告。症例：72歳男性が5か月前からの右涙道部の腫瘍で受診した。前医での生検で涙道部の低分化腺癌と診断されていた。所見と経過：磁気共鳴画像検査（MRI）で，右眼の涙囊から眼窩内下方に連続する不整形の腫瘤があった。陽電子放出断層撮影（PET）で，右涙囊部と右頸部リンパ節に集積があった。TS-1^®内服と2か月間の陽子線照射を行った。治療から16か月後に右眼に眼痛と前房出血が生じ，眼圧が上昇した。放射線網膜症と診断した。2か月後に視力は0になった。以後4か月後の現在まで経過を観察中である。結論：涙道癌に対する抗癌薬投与と陽子線照射で，視力は温存できず，骨転移が生じた。

Abstract.　Purpose：To report a case of lacrimal gland carcinoma treated by proton radiation. Case：A 72-year-old male was referred to us for a tumor corresponding to the site of right lacrimal sac since 5 years before. The lesion had been diagnosed with poorly differentiated adenocarcinoma. Findings and Clinical Course：MRI showed an irregular tumor extending from the right lacrimal sac to lower nasal orbital tissue. PET showed accumulation of radioactivity in the right lacrimal sac and right cervical lymphnode. He was treated by peroral TS-1^TM and proton radiation for 2 months. He developed right ocular pain, elevated intraocular pressure and hyphema 16 months later. He was diagnosed with radiation retinopathy. The right eye became blind 2 months later. He has been under observation for 4 months until present. Conclusion：Treatment with chemotherapy and proton radiation failed to prevent blindness and metastasis to the bone in a case of lacrimal duct carcinoma.