全身性濾胞性リンパ腫に関連した両側眼瞼結節性腫瘤

Bilateral nodular eyelid margin masses associated with systemic follicular lymphoma

要約　目的：全身性濾胞性リンパ腫に関連して特異な眼瞼の結節性腫瘤を呈した1例を報告する。

症例：70歳，女性。全身の難治性結節性痒疹で皮膚科にてx−4年よりシクロスポリンA（CyA）内服投与の既往をもつ。x年に両上下眼瞼縁全幅に結節性腫瘤がみられ関西医科大学附属病院（当院）眼科に紹介された。病変部生検で限局的なCD20（＋）bcl-2（−）の反応性リンパ球増殖と診断され，いったん当院皮膚科でのCyA内服再開とともにタクロリムス点眼を開始するも改善しなかった。x＋1年に左耳前部および前額部に皮下硬結と腫瘤を認め，それぞれの病理生検において組織診断および染色体検査でいずれも濾胞性リンパ腫（grade 2）と診断された。当院血液腫瘍内科でリツキシマブ単独治療開始後，両上下眼瞼部腫瘤は2か月で著明に改善した。

結論：本症例でみられた結節性眼瞼縁腫瘤は，濾胞性リンパ腫に関連した腫瘍であった可能性がある。濾胞性リンパ腫は通常，結膜円蓋部や球結膜に好発するが，眼瞼縁にも関連した病変が生じる可能性が示唆される。

Abstract　Purpose：To report a case of bilateral nodular eyelid margin mass associated with systemic follicular lymphoma.

Case：The patient was a 70-year-old woman with a history of generalized refractory prurigo nodularis was followed up at the dermatology department and treated with oral cyclosporine（CyA）administration since x−4 years. She was referred to our department because of nodular swelling of both upper and lower eyelid margins in x years. A biopsy of the lesion revealed a localized accumulation of CD20（＋）bcl-2（−）reactive lymphocytes. Tacrolimus eye drops were started along with resumption of CyA by the dermatologist which, did not result in any improvement. In x＋1, subcutaneous induration and accompanied by a mass appeared in the left preauricular and forehead area. The biopsied samples revealed to systemic follicular lymphoma（grade 2）when analyzed using the histological examination, fluorescence-activated cell sorting（FACS）, gene reconstruction, and chromosomal analysis. After rituximab was started as a single agent by the hematologist- oncologist, the masses in both upper and lower eyelids improved markedly within 2 months.

Conclusion：Although follicular lymphoma usually occurs in the conjunctival arcuate region and the globe conjunctiva, the eyelid margin could be another site associated with follicular lymphoma that may arise in a form of nodular masses.