眼瞼脂腺癌20例の治療成績

Therapeutic outcome in twenty cases of sebaceous gland carcinoma

　過去10年間の眼瞼脂腺癌20例の治療成績を検討した。男性5例，女性15例で，初診時の年齢は43歳から90歳，平均68.5歳であり，上眼瞼が17例，下眼瞼が3例であった。腫瘍はすべて眼瞼内に限局していた。発症から当科受診までの期間は2か月から8年1か月，平均25か月であった。12例は以前に霰粒腫として切開術を受けていた。初回治療として16例に手術切除を行い，うち6例には放射線照射を追加した。早期例3例には光線力学的療法で腫瘍を縮小させたのち手術を行った。当初から腫瘍が大きな1例には放射線単独照射を行った。治療開始から3か月から8年1か月，平均3年2か月の期間中，腫瘍が瞼裂幅の2／3以下の18例には再発がなく，これよりも大きい2例のうち1例に転移，1例に雨発と転移が生じた。眼瞼脂腺癌が瞼裂幅の2／3以下であるときには，手術で完全切除を行い，必要に応じて放射線照射を追加することが勧められる。

We reviewed 20 cases of sebaceous gland carcinoma of eyelid treated during the past 10 years. The series comprised 5 males and 15 females, ranging in age from 43 to 90 years, average 68.5 years. It involved the upper eyelid in 17 cases and lower eyelid in 3. The tumor was localized within the eyelid in all the cases. The interval between the onset and visiting us ranged from 2 months to 8 years, average 25 months. Twelve ceses had received incision under the diagnosis of chalazion. We excised the tumor in 16 cases, of which radiation was added later in 6 cases. Three early cases received photodynamic therapy followed by excision. The other 1 case with a large tumor received radiotherapy only. They were followed up for 2 months to 8 years, average 39 months. There was no recurrence in 18 cases in which the tumor was smaller than two-thirds of eyelid opening. Metastasis developed in 1 case and recurrence with metastasis in another. The initial tumor was larger than two-thirds of eyelid opening. The findings show that excision is the primary choice followed by eventual radiation when the tumor is smaller than two-thirds of eyelid opening.