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Neurological Surgery No Shinkei Geka Volume 46, Issue 7 （July 2018）

Neurological Surgery 脳神経外科 46巻7号（2018年7月発行）

Japanese English

症例

乳がんの両側性眼窩内転移の2例 Two Cases of Bilateral Orbital Metastases of Breast Cancer 近藤威 ¹ , 高石吉將 ¹ , 荒井篤 ¹ , 鵜山淳 ¹ , 原田知明 ¹ , 中村直人 ¹ , 山本美保 ² , 園田隆 ³ Takeshi KONDOH ¹ , Yoshiyuki TAKAISHI ¹ , Atsushi ARAI ¹ , Atsushi UYAMA ¹ , Tomoaki HARADA ¹ , Naoto NAKAMURA ¹ , Miho YAMAMOTO ² , Takashi SONODA ³ ¹慈恵会新須磨病院脳神経外科 ²慈恵会新須磨病院眼科 ³同仁記念会明和病院腫瘍内科 ¹Department of Neurosurgery, Shinsuma General Hospital ²Department of Ophthalmology, Shinsuma General Hospital ³Department of Oncology, Meiwa Hospital キーワード： breast cancer , gamma knife radiosurgery , magnetic resonance imaging , orbital metastases Keyword: breast cancer , gamma knife radiosurgery , magnetic resonance imaging , orbital metastases pp.615-621

発行日 2018年7月10日 Published Date 2018/7/10

DOI https://doi.org/10.11477/mf.1436203779

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Ⅰ．緒　　言

　転移性の眼窩内腫瘍は比較的稀であり，米国単施設の30年間1,264例の眼窩内腫瘍において，7%が転移性腫瘍で，うち半数以上が乳がん原発であったと報告されている¹⁵⁾．国によりがん腫の頻度に差異があるにもかかわらず，眼窩内転移の原発巣は乳がんが多い．豪州の多施設調査の21年間80例の報告では，原発巣は乳がんが最多（29%．以下，悪性黒色腫20%，前立腺がん13%）¹⁸⁾，ドイツの単施設14例の眼窩内転移の報告では，乳がん（8例），肺がん（4例），その他（2例）であり，半数以上が乳がんとなっている¹³⁾．Raapら¹³⁾は既報の症例報告72症例のまとめについても報告しており，やはり乳がんが最多で29%であった．本邦では乳がんの発症数は増加しており，脳転移を治療する機会の多い脳神経外科医が，この稀な眼窩内転移に遭遇することも予想される．今回われわれは，乳がんの両側眼窩内転移の2例を経験したので報告する．

　Two cases of breast cancer with bilateral orbital metastases associated with intracranial metastases are presented. Case 1:A 61-year-old woman who was diagnosed with breast cancer 14 years earlier presented with rapid deterioration of visual acuity, eye pain, and limitation of left-sided extraocular motility. Magnetic resonance（MR）images showed an enhanced lesion in the left orbital apex, ethmoid sinus, and right middle fossa. The first gamma knife radiotherapy（35 Gy, 5 Fr）was performed successfully, but was followed by recurrence 18 months later in the right intraorbital, where newly formed iso-intensity masses in the extraconal compartment were found. The second gamma knife radiosurgery was performed for three masses（20 Gy). Case 2:A 35-year-old woman with breast cancer who was diagnosed 22 months earlier was treated for meningeal carcinomatosis by whole-brain radiation（30 Gy, 10 Fr）and intrathecal chemotherapy. Eight months later, swelling in both eyelids and limitation of extraocular motility developed rapidly. MR imaging revealed an infiltrating lesion in the cone with heterogenous signal that was encasing, but not infiltrating the optic nerves. The extraconal lesion extended into the soft tissue of the lower eye lid. She expired one week after diagnosis. With the increasing number of long-term survivors with breast cancer, intraorbital metastases may be found during the course of treatment for intracranial lesions. Understanding the unique clinical presentation and characteristic MR findings of this rare entity are emphasized.