眼窩悪性リンパ腫14症例の臨床的研究

Clinical features in 14 cases of malignant orbital lymphoma

　今回検討した眼窩悪性リンパ腫の症例は1974年から1989年までに九州大学病院眼科に入院した14症例である。男性9名，女性5名，年齢は42〜84歳，平均61歳で，全例片眼性であった。この14症例は，16年間に入院した眼窩腫瘍139例の10.1％にあたる。主訴は，眼瞼腫脹50％，眼球突出50％，腫瘤形成29％，複視25％などであった。診断にはCT, MRIやシンチグラフィーが有用であった。組織診断はすべてdiffuse typeで，small cell type　3例，medium cell type　4例，mixed cell type　3例，large cell type　4例であった。Tリンパ腫はなく，すべてBリンパ腫であった。

　組織診断は不可欠であるので生検を行い，その時できる限り腫瘍を切除する。Small cell typeの時は非ステロイド剤内服のみとし，それ以外は放射線療法を追加し，さらに治療が必要な時に化学療法を行うのがよいと考えた。5年生存率は58％であった。

We reviewed 14 cases of non-Hodgkin malignant lymphoma of the orbit during the foregoing 16-year period. They accounted for 10.1% of all orbital tumors during the period. The series comprised 9 males and 5 females. The ages ranged from 42 to 84 years, with a median of 61 years. All the cases were unilaterally affected. Chief complaints included swelling of eyelid, proptosis, palpable tumor and diplopia. Disturbance of ocular motility was pre-sent in 7 out of 12 documented cases. Visual loss related to the tumor was present in 5 out of 12 cases. Proptosis was present in 10 out of 12 cases, ranging from 3 to 22 mm with a median of 8.1 mm.Computed tomography and magnetic resonance imaging was useful in the diagnosis. Lymphography gave equivocal results. Histopathologically, 3 cases showed small lymphocytic cell type, 4 showed small cleaved cell type, 3 showed diffuse mixed type and 4 showed diffuse large cell type. Immunohis-tologically, 10 cases showed B-cell lymphomas. There was no case of T-cell lymphoma in the series. Surgery was performed in all the 14 cases to remove the tumor and to identify the histological features. Radiation was performed in 11 cases and chemotherapy in 9. The 5-year survival rate was 58%.