涙腺腫脹とぶどう膜炎様症状で発症した非ホジキンリンパ腫の1例

Uveitis and lacrimal gland enlargement as initial manifestations in a case of non-Hodgkin lymphoma

　28歳女性が右眼の重篤な病変で紹介され受診した。10週間前に右結膜充血を自覚した。視力は1.2であったという。右涙腺が腫脹し，ぶどう膜炎，硝子体混濁，滲出性網膜剥離などが急速に進行，悪化した。当科初診時の右眼視力は光覚弁であり，左眼には異常所見はなかった。画像診断で右眼窩に限局した炎症性またはリンパ腫性病変が疑われた。左眼には異常所見はなかった。硝子体手術で得られた硝子体組織の検索から，非ホジキンリンパ腫の診断が確定した。全脳と右眼球に放射線照射を行い、以後頭蓋内への転移はない。非ホジキンリンパ腫が涙腺腫脹を伴うぶどう膜炎で初発しうることを示す1例である。硝子体組織からの診断ではフローサイトメトリーが有用であった。

A 28-year-old woman was referred to us for severe problems in her right eye. She had noted hyperemia in her right eye 10 weeks before. Her visual acuity is reported to have been 1.2. She had had swelling of the right lac-rimal gland by magnetic resonance imaging (MRI), followed by rapid exacerbation of uveitis, vitreous opacity, and ex-udative retinal detachment. When seen by us, her visual acuity was light perception right. We could confirm the above findings in her right eye. Her left eye was free of pathological findings. Diagnostic imaging showed findings suggestive of inflammatory or lymphomatous lesions in the right orbit. Flow cytometry of vitreous obtained by therapeutic vitrec-tomy led to the diagnosis of non-Hodgkin lymphoma. She was then treated by radiation to the brain and the right eye. This case illustrates that swelling of lacrimal gland and uveitis may be the initial manifestations of non-Hodgkin lym-phoma. Flow cytometry was useful in confirming the diagnosis.