眼窩と副鼻腔に浸潤した巨大な眼瞼基底細胞癌の1例

A case of giant basal cell carcinoma of the eyelid invading the orbit and paranasal cavity

　眼窩と副鼻腔に浸潤した，眼瞼原発の基底細胞癌の1症例を報告した。症例は70歳の男性で，左下眼瞼に腫瘤が出現してから5年後に当科を初診した。初診時，左下眼瞼から眼球周囲にかけて潰瘍・壊死を伴った腫瘍を認め，生検にて基底細胞癌と診断された。CTスキャン・MRIにて前篩骨洞と上顎洞にまで浸潤がみられたため，拡大腫瘍根治切除術および遊離腹直筋皮弁による再建術を行った。

　比較的悪性度の低い眼瞼の基底細胞癌でも，本症例のように放置すれば眼球摘出術も必要となる場合があり，悪性腫瘍が疑われた場合はただちに生検または切除を行い，病理組織学的検査を施行することが重要であると考えられた。

A 70 year-old male presented with swelling of the left eyelids. He had noticed a small black tumor in his left lower eyelid 5 years before, which gradu-ally enlarged. When seen by us, the left eyelid was swollen with ulceration and pigmentation. The eyeball was surrounded by the tumor. Biopsy showed the tumor to be basai cell carcinoma. CT scan and MRI showed the tumor to have invaded the orbital cavity, maxillary sinus, anterior eth-moid cells and the nasal cavity. He was treated by orbital exenteration followed by radical excision. The present case is an unusual one since basal cell carcinoma of the eyelid has been regarded as being of low malignancy, growing slowly over years and rarely invading the orbit.