眼底に巨大隆起性病変を認めた多発性骨髄腫の1例

A giant and elevated fundus tumor in a case of multiple myeloma

（P-1-116）　61歳の女性が，5日前からの左眼眼痛，充血，変視症で受診した。29年前に乳癌手術と輸血による慢性C型肝炎，2年前にlgA-λ型の多発性骨髄腫，21か月前から慢性腎不全を発症し，人工透析中であった。矯正視力は右0.6，左0.1。左眼の乳頭耳側に黄斑部を含む黄白色の隆起性病変があり，大きさは縦横ともに7乳頭径であった。さらにその耳側から下方に網膜剥離があった。プレドニゾロンの全身投与を行い，5日後に腫瘍の縮小と平坦化が得られた。このことから，乳癌の転移ではなく，骨髄腫の転移であると解釈された。受診から25日後に死亡したが，剖検は行われなかった。

A 61-year-old female presented with pain, hyperemia and metamorphopsia in her left eye since 5 days before. She had the past history of breast tumor followed by chronic hepatitis C 29 years before, multiple myeloma of type IgA-A 2 years before, and chronic renal insufficiency 21 months before. She was currently treated by dialysis. Her corrected visual acuity was 0.6 right and 0.1 left. Funduscopy showed a yellowish and elevated tumor temporal to the disc in the left eye. Its size was 7 × 7 disc diameters. Retinal detachment was present inferior temporal to the tumor. Systemic prednisolone induced reduction in size with flattening of the tumor. This finding appeared to show the tumor to be metastasis of multiple myeloma rather than that of breast carcinoma. The patient died 25 days after her initial visit. No post mortem studies could be performed.