乳癌原発の両眼転移性脈絡膜腫瘍に放射線療法と薬物療法の併用療法が奏効した1症例

Radiotherapy with simultaneous chemotherapy was effective in a case of bilateral choroidal tumor metastatic from breast cancer

要約　目的：乳癌原発の両眼転移性脈絡膜腫瘍に対し，放射線・分子標的薬・抗癌剤・ホルモン製剤の併用療法が奏効した1症例の報告。

症例：41歳女性が，3か月前から右眼の視野欠損を自覚しており，2週間前より急激な視力低下となったため眼科受診した。

所見と経過：視力は右手動弁，左1.5であり，右眼に胞状の網膜剝離と耳側上方に白色の隆起があった。左眼の下方と鼻側上方に白色の隆起があった。蛍光眼底造影で，腫瘍全体が色素で染まり，顆粒状の漏出点があった。全身検査で乳癌があり，両眼の転移性脈絡膜腫瘍と診断した。放射線・分子標的薬・抗癌剤・ホルモン製剤の併用療法が行われ，両眼の脈絡膜腫瘍は瘢痕化ないし縮小し，右眼の網膜剝離はやや改善した。初診から3年後の不帰の転帰まで，左眼は1.0の視力を維持した。

結論：転移性脈絡膜腫瘍の早期発見と治療で，患者のquality of visionを維持することができた。

Abstract　Purpose：To report a case of bilateral choroidal tumor metastatic from breast cancer that responded to combined treatment with radiation, molecularly targeted medication, anticancer drug, and hormone preparations.

Case：A 41-year old female presented with impaired vision in the right eye since 2 weeks before. She had noticed impaired visual field in the right eye since 3 months before. Her mother had suffered from lung carcinoma.

Findings and Clinical Course：Visual acuity was hand motion right and 1.5 left. The right eye showed bullous retinal detachment and white mass in the temporal quadrant. The left eye showed white mass in the inferior and nasal quadrants. Fluorescein and ICG angiography showed staining of the tumor area with granular exudations. Systemic examination showed breast cancer. Fundus lesions in both eyes were diagnosed with choroidal tumor metastatic from breast cancer. She received combined treatment with radiation, molecularly targeted medication, anticancer drug, and hormone preparations. Tumor masses in both eyes became smaller and cicatricial. Retinal detachment in the right eye showed signs of regression. The left eye retained visual acuity of 1.0 until her decease 3 years later.

Conclusion：Early detection and treatment contributed to the quality of vision in this patient with metastatic choroidal cancer.