脈絡膜転移性乳癌の胞状網膜剥離に対する光凝固治療例

Photocoagulation for choroidal cancer metastatic from the breast

　網膜剥離を伴った乳癌の脈絡膜転移例を報告した。38歳の女性で3年前に右乳癌で非定型右乳房切除術を受けている。右眼上鼻側に脈絡膜腫瘍と胞状網膜剥離を認めた。病変部はフルオレセイン螢光眼底造影では点状過螢光と網膜下螢光貯留を示し，インドシアニングリーン赤外螢光眼底造影では低螢光を示した。脳，肺，縦隔リンパ節にも腫瘍を認め，本症例を乳癌の転移性脈絡膜腫瘍と診断した。治療は全身的には化学療法を施行し，脈絡膜転移巣に対しては光凝固術を施行した。治療後，腫瘍部からの螢光漏出と漿液性網膜剥離は消失し，脈絡膜転移巣はMRIでも消失を認めた。他の転移巣も現在まで13か月の間増悪を認めていない。

A 38-year-old woman presented with blurred in her right eye as chief complaint. She had undergone radical mastectomy for right breast cancer 3 years before. Funduscopy showed a bullous retinal detachment surrounded by choroidal elevation in the superonasal quadrant. Fluorescein angiography showed multiple pinpoint leakages from the retinal pigment epithelium. The subretinal fluid shifted inferiorly 2 days later. Metastasis of tumor was also detected in the lung and brain. She was treated by combination of systemic cyclophosphamide, ADM and fluorouracil (CAF). The choroidal tumor was treated by dye laser photocoagulation. Dye leakage disappeared 2 weeks later. The choroidal elevation and bullous detachment disappeared after 3 months of chemotherapy.