涙嚢に原発したB cell lymphomaの1例

A case of primary B cell lymphoma originating from the lacrimal sac

　40歳女性が8か月前からの右眼の流涙，眼脂，内眼角部の腫脹で受診した。他医で涙嚢炎として治療を受けていたが無効であった。右眼内眼角部に2cm大の無痛性腫瘤があり，内側眼瞼腱を越えて進展していた。通水試験では涙管に通過障害はなく，血性逆流はなかった。磁気共鳴画像検査（MRDで涙嚢腫瘍があり，涙嚢摘出術を行った。病理組織学的に悪性であり，免疫染色検査はL−26陽性で，B cell lymphomaと診断された。末梢血には異常がなく，全身的にリンパ節の腫脹はなく，頸部・胸部・腹部のCT検査で涙嚢以外にはリンパ腫は検出されず，涙嚢に原発したと判断した。

A 40-year-old female presented with epiphora, discharge and swelling of lacrimal sac area since 8 months before. She had been treated as dacryocystitis before with no improvement. She had a painless swel-ling in the right inner canthus displacing the medial canthal ligament. Irrigation test showed the nasolacrimal duct to be patent. There was no blood discharge from the puncta by compression. Magnetic resonance imaging (MRI) showed a tumor of the lacrimal sac, leading to extirpation of the right lacrimal sac. Histopathologically, the tumor was found malignant. It was positive for L-26 by immunostaining. She was diagnosed with B cell lymphoma. No abnormality was detected in the peripheral blood. She was free of swelling of lymph nodes sys-tematically. Computed tomography (CT) failed to show lymphomas in the neck, chest or abdomen. These find-ings led to the diagnosis of B cell lymphoma originating from the lacrimal sac.