虹彩病変から初めて乳癌の全身転移が判明した1例

Iris nodules as the initial manifestation of generalized metastasis in a case of breast carcinoma

要約　目的：虹彩病変から初めて乳癌の全身転移が判明した症例の報告。

症例：29歳女性が左眼痛を主訴に受診した。1年前に乳癌に対し乳房部分切除術と腋窩リンパ節郭清術を施行され，術後補助療法中であった。局所再発や遠隔転移は認めていなかった。

所見：矯正視力は左右とも1.2，眼圧は右12mmHg，左13mmHgであった。左眼虹彩に直径1〜3mmの半透明で淡白色の結節を4個認めた。PET-CTで多発転移を認め，虹彩結節も転移と推測された。結節の増大に伴い視力低下と眼圧上昇をきたし，電子線総量30Gyを照射した。腫瘍は縮小し視力は改善したが，初診から7か月後に死亡した。

結論：結節性虹彩病変を認めた際は，全身既往を詳細に確認することが重要である。

Abstract　Purpose: To report a case of breast carcinoma in whom iris nodules appeared as the initial manifestation of generalized metastasis.

Case: A 29-year-old woman presented with pain in her left eye. She had been diagnosed with left breast cancer one year before. She had received partial metastectomy with dissection of axillary lymph nodes followed by chemotherapy. She was free of signs suggestive of local recurrence or metastasis.

Findings and Clinical Course: Corrected visual acuity was 1.2 in either eye The left eye showed four transparent iris nodules of 1 to 3 min in diameter. Positron emission tomography with computed tomography（PET-CT）showed multiple metastasis of breast carcinoma to the spine, pelvis and right femur, leading to the diagnosis of left iris lesion as cancer metastasis. The left eye was treated by radiation totaling 30 Gy. The patient passed away 7 months after her initial presentation.

Conclusion: This case illustrates that the iris may be affected as the initial site of generalized cancer metastasis.