化学療法が短期間で著効したびまん性大細胞型B細胞リンパ腫による眼瞼結膜リンパ腫の1例

Chemotherapy induced rapid cure of conjunctival lymphoma in a case of diffuse large B-cell lymphoma

要約　目的：全身のびまん性大細胞型B細胞リンパ腫（DLBCL）に対して化学療法を行った結果，DLBCLと思われる結膜病変に対しても化学療法が著効した1例を報告する。

症例：62歳，男性。両鼠径部リンパ節に原発したDLBCLの既往があり，8クールのR-CHOP療法で寛解していた。しかし，定期検査時の陽電子放出断層撮影で多数のリンパ節に集積があり，鎖骨上リンパ節生検の結果DLBCLの再発と診断された。同時期に眼瞼結膜の腫脹があり，当院眼科を受診した。両眼ともに下眼瞼結膜に2.5mm程度のサーモンピンク色の隆起性病変を認め，眼瞼結膜に生じたDLBCLを疑った。CHASE療法が開始され，1週間で眼病変は消退した。

結論：両眼性に眼瞼結膜に生じるDLBCLに化学療法が奏効し，視機能障害や瘢痕を残さない症例を経験した。

Abstract　Purpose：To report a case of diffuse large B-cell lymphoma with conjunctival metastases that promptly responded to systemic chemotherapy.

Case：A 62-year-old male was referred to us for swelling of palpebral conjunctiva in both eyes. He had been diagnosed with diffuse large B-cell lymphoma originating in unguinal lymph nodes 2 years before. The lesion was apparently cured after systemic treatment with rituxunab-cyclophosphomide, hydroxydaunorubicin, oncovin and prednisolone. Recent positron emission tomography showed multiple metastases involving the lung, diaphragm, axial and subclavicular lymph nodes, and inferior palpebral conjunctiva in both eyes.

Findings and Clinical Course：Both eyes showed salmon-pink elevated lesions in the palpebral conjunctiva of about 2.5 mm in diameter. The finding was suggestive of diffuse large B-cell lymphoma. Systemic chemotherapy was restarted and the conjunctival lesion disappeared one week later.

Conclusion：Metastasis of diffuse large B-cell lymphoma to the palpebral conjunctiva promptly responded to systemic chemotherapy.