緑内障を合併した虹彩悪性黒色腫の1例

A case of iris malignant melanoma with secondary glaucoma

　本邦では稀な疾患である緑内障を合併した49歳女性のぶどう膜悪性黒色腫につき報告した。術前のCTでは虹彩・毛様体に限局していると思われたが，腫瘍の著明な増大，コントロール困難な緑内障の合併，腫瘍の浸潤度が不明などの理由で右眼球摘出術を施行した。病理組織所見は一部壊死巣を含むepithelioid cellsを主体とした悪性度の高い腫瘍であり，Callender分類のmixed cells typeであった。眼圧上昇は，黒色腫融解による隅角閉塞が原因と考えられた。

A 49-year-old female presented with pigmented iris tumor and intraocular pressure of 25 mmHg in her right eye. Blurring of vision had been noted since one month before. The chamber angle was covered by pigmented material along the whole circumference. The optic disc in the affected eye showed total cupping. Visual acuity was 20/20. The glaucomatous visual field was progressive. As malignancy was suspected by rapid increase of the iris tumor, the eye was enucleated 2 months later. Histological sections showed a tumor with localized necrosis composed of epithelioid cells compatible with mixed cell type malignant melanoma. The present case is an unusual one since malignant uveal melanoma is very rare in the Japanese at about 0.25 per one million in the general population.