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Rinsho Ganka Volume 73, Issue 5 （May 2019）

臨床眼科 73巻5号（2019年5月発行）

Japanese English

特集第72回日本臨床眼科学会講演集［3］

原著

旭川医科大学病院眼科における眼表面扁平上皮新生物（OSSN）の検討 A review of ocular surface squamous neoplasia at the Department of Ophthalmology, Asahikawa Medical University 花田一臣 ^1,2 , 廣川博之 ² , 武井英博 ³ , 西川典子 ² , 石居信人 ² , 宇都宮嗣了 ² , 横山一弘 ² , 吉田晃敏 ² Kazuomi Hanada ^1,2 , Hiroyuki Hirokawa ² , Hidehiro Takei ³ , Noriko Nishikawa ² , Nobuhito Ishii ² , Tsugiaki Utsunomiya ² , Kazuhiro Yokoyama ² , Akitoshi Yoshida ² ¹旭川医科大学医工連携総研講座 ²旭川医科大学眼科学教室 ³旭川医科大学病院病理部 ¹Department of Medicine and Engineering Combined Research Institute, Asahikawa Medical University ²Department of Ophthalmology, Asahikawa Medical University ³Department of Surgical Pathology, Asahikawa Medical University Hospital pp.603-609

発行日 2019年5月15日 Published Date 2019/5/15

DOI https://doi.org/10.11477/mf.1410213141

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要約　目的：眼表面扁平上皮新生物（OSSN）について病理組織学的診断と臨床的傾向を検討する。

対象と方法：2005年6月〜2018年5月の間に旭川医科大学病院眼科で加療したOSSN 16名18眼。性別，発症時年齢，発生部位，病理組織学的診断，治療，経過を後ろ向きに調査した。

結果：性別は男性14名16眼，女性2名2眼，発症時年齢は平均62.0±20.5歳（30〜96歳），病理組織学的診断は角結膜上皮内新生物（CIN）15眼，扁平上皮癌（SCC）3眼であった。発生部位は角膜輪部9眼，球結膜2眼，円蓋部結膜5眼，瞼結膜2眼であった。初回術式は13眼（CIN 12眼，SCC 1眼）に腫瘍全切除と羊膜移植，CIN 3眼に腫瘍全切除，SCC 2眼に部分切除生検が行われ，術後療法は6眼（CIN 5眼，SCC 1眼）にマイトマイシンC点眼，CIN 4眼にインターフェロン点眼，SCC 3眼に放射線照射が行われた。CIN 6眼には術後療法が行われなかった。再発は3眼（17％）で，CIN 2眼に再切除と羊膜移植，SCC 1眼に放射線再照射が行われた。合併症は2眼に瞼球癒着，1眼に角膜輪部疲弊が生じた。

結論：OSSNは男性に多く，発生部位は角膜輪部と球結膜にCINが多く，円蓋部結膜と瞼結膜にSCCがみられた。腫瘍切除と羊膜移植の組み合わせと術後治療の工夫で，腫瘍再発防止と良好な眼表面再建を得た。

Abstract　Purpose：To present a review of ocular surface squamous neoplasia.

Cases：This study was made on 18 eyes of 16 patients who were treated for ocular surface squamous neoplasia during 13 years through 2018. The series comprised 16 eyes of 14 males and 2 eyes of 2 females. The age ranged from 30 to 96 years, average 62 years. The lesion was located in the corneal limbus in 9 eyes, bulbar conjunctiva in 2 eyes, the fornical conjunctiva in 5 eyes, and palpebral conjunctiva in 2 eyes. Histopathological diagnosis included conjunctival intraepithelial neoplasia（CIN）in 15 eyes and squamous cell carcinoma（SCC）in 3 eyes.

Results：Tumor excision was performed in 3 eyes of CIN. Additional amniotic membrane transplantation was performed in 12 eyes of CIN and one eye of SCC. Biopsy was performed in 2 eyes of SCC. Postoperatively, topical mitomycin C was applied to 5 eyes of CIN and one eye of SCC. Interferon eye drops were applied to 4 eyes of CIN. Three eyes of SCC were treated by irradiation. No additional treatment was made in 6 eyes with CIN. The tumor recurred in 3 eyes（17％）, of which 2 eyes with CIN received re-excision and one eye with SCC received irradiation. Postoperatively, symblepharon developed in 2 eyes and corneal limbal deficiency in one eye.

Conclusion：Ocular surface squamous neoplasia were more common in males than females. CIN often involved the corneal limbus and bulbar conjunctiva. SCC often involved the fornical and palpebral conjunctiva. Recurrence of tumor could be prevented by the combination of tumor excision, amniotic membrane transplantation, and postoperative treatment.