眼窩内容除去術を施行した眼瞼悪性腫瘍の3例

Three cases of malignant eyelid tumors treated with orbital exenteration

要約　目的：4か月の短期間に進行した眼瞼悪性腫瘍のため眼窩内容除去術を施行した3例の報告。

症例：症例1は83歳，女性。1年前から右上眼瞼に腫瘤を自覚した。半年前から徐々に増大していたが，コロナ禍で受診の機会を失っていた。初診時，右上眼瞼全体に腫瘍性病変があり，球結膜の充血も認めた。球結膜を含む5か所のmapping biopsyを行ったところすべて脂腺癌で，球結膜にも浸潤していた。症例2は83歳，女性。2か月前から右上眼瞼の腫脹，疼痛，出血が出現した。初診時，右上眼瞼縁に大きな潰瘍を伴う硬い腫瘍性病変を認め，生検を行ったところ脂腺癌であった。眼窩MRIでは上眼瞼挙筋や涙腺への浸潤が疑われた。全身CTでは右頸部リンパ節転移を認めた。症例3は74歳，男性。2年前，右下眼瞼に腫瘤を自覚したものの放置していた。初診時，下眼瞼全体に大きな潰瘍を伴う硬い腫瘍性病変を認め，生検を行ったところ基底細胞癌であった。眼窩CTで腫瘍は眼窩に浸潤し，眼球や外眼筋に接していた。症例1〜3に対して眼窩内容除去術を施行した。症例2は右頸部に放射線治療も行った。

結論：眼瞼悪性腫瘍で視機能を失わないために，眼瞼悪性腫瘍は早期に発見し，小さいうちに治療することが大切である。新型コロナウイルス感染症が流行するなかで受診抑制とならないように，医療界で必要な受診を促すことは大切と思われた。

Abstract　Purpose：To report 3 cases of advanced malignant eyelid tumors treated with orbital exenteration in a short period of 4 months.

Cases：Case 1 was an 83-year-old female. A tumor was noticed in the upper right eyelid 1 year ago and had been gradually increasing from half a year ago, but she had not found the opportunity to see a doctor due to the COVID-19 pandemic. At the first visit, a neoplastic lesion in the entire upper eyelid of the right eye and hyperemia of the bulbar conjunctiva were observed. When mapping biopsy was performed at 5 sites, including the bulbar conjunctiva, all of them were sebaceous carcinomas and infiltrated the bulbar conjunctiva. Case 2 was an 83-year-old female. Two months ago, swelling, pain, and bleeding of the upper eyelid of the right eye appeared. At the first visit, a hard neoplastic lesion with a large ulcer was found on the upper eyelid margin, and a biopsy revealed sebaceous carcinoma. Orbital MRI suggested the tumor cell invasion into the levator muscle of the upper eyelid and lacrimal gland. Systemic CT showed the metastasis to the right cervical lymph node. Case 3 was a 74-year-old male. Two years ago, he had noticed a tumor in his lower right eyelid, but left it alone. At the first visit, a hard lesion with a large ulcer was found on the entire lower eyelid, and a biopsy was performed. It was a basal cell carcinoma. Orbital CT showed the tumor had invaded the orbit and was in contact with the eyeball and extraocular muscles. Orbital exenteration was performed for case 1, 2, and 3. In case 2, radiation therapy was also performed on the right neck.

Conclusions：Early detection of malignant eyelid tumors and treating them while they are small in order to avoid losing the visual function due to the malignant eyelid tumors is important. Medical professionals should urge necessary medical examinations so that the tumors would not be ignored in the midst of the epidemic of new coronavirus infections.