漿液性網膜剝離と脈絡膜肥厚が初発所見であった肺腺癌脈絡膜転移の1例

Serous retinal detachment and choroidal thickening as the initial manifestation in a case of adenocarcinoma of the lung metastatic to the choroid

要約　目的：軽度の脈絡膜肥厚と漿液性網膜剝離から肺腺癌脈絡膜転移の診断に至った1例を報告する。

対象と方法：63歳，男性。肺腺癌で治療中。受診2日前からの左眼視力低下を主訴に初診した。視力右（1.2），左（0.9），OCTでは左眼に脈絡膜肥厚および黄斑部漿液性網膜剝離を認めた。MRI検査では眼転移を示す所見はなかったが，フルオレセイン蛍光眼底造影で左眼乳頭周囲に顆粒状の過蛍光，インドシアニングリーン（ICG）蛍光眼底検査で低蛍光領域を認めた。4か月後の時点でICG低蛍光領域の増大を認め，転移性脈絡膜腫瘍と診断した。

結論：転移性脈絡膜腫瘍の所見として，脈絡膜肥厚も念頭に置く必要がある。

Abstract　Purpose：To report a case who showed serous retinal detachment and choroidal thickening and who was later diagnosed choroidal metastasis of adenocarcinoma of the lung.

Case：A 63-year-old male presented with impaired vision in the left eye 2 days before. He had been diagnosed with stage Ⅳ adenocarcinoma of the lung and had been receiving chemotherapy.

Findings and Clinical Course：Best-corrected visual acuity（BCVA）was 1.2 right and 0.9 left. The left eye showed choroidal thickening and serous retinal detachment in the posterior fundus by optical coherence tomography. Magnetic resonance imaging showed no signs suggestive of orbital metastasis. Fluorescein fundus angiography showed granular hyperfluorescent spots around the left optic disc. Indocyanine green angiography showed hypofluorescent areas. The hypofluorescent area enlarged 4 months later and led to the diagnosis of metastatic choroidal tumor.

Conclusion：This case illustrates that serous retinal detachment and choroidal thickening in the macular area may be initial signs of choroidal metastasis of malignancy.