眼窩尖端症候群を呈した蝶形骨洞原発の悪性リンパ腫の1例

Primary Malignant Lymphoma in the Sphenoid Sinus with Orbitai Apex Syndrome;A case report

I．はじめに

　節外リンパ腫の2.0-6.8％が鼻腔，副鼻腔に発生するが，その中でも蝶形骨洞に原発するものは非常に稀である^{3,5,7,12,13,15）}．われわれは，眼窩尖端症候群にて発症し，手術により視力の回復をみた蝶形骨洞原発の悪性リンパ腫の1例を経験したので，文献的考察を加えて報告する．

Only 2.0-6.8% of extranodal malignant lymphomas are found in the nasal region and paranasal sinuses.Primary malignant lymphoma of the paranasal sinuses usually occurs in the maxillary or ethmoid sinuses, and is very rare in the sphenoid sinus. Here we report a rare case of primary malignant lymphoma of the sphe-noid sinus that was found accompanying orbital apex syndrome. The patient's progressively deteriorating neurological condition was improved after surgery via the transsphenoidal approach.

A 52-year-old man was admitted with reduced left visual acuity, diplopia, and retroorbital pain. CT showed an isodense mass in the sphenoid sinus with slight enhancement, and MRI showed that the lesion was slightly hypointense on T₁-weighted images, hypointense on T₂-weighted images, and slightly en-hanced by Gd-DTPA.

On January 19, 1989, the patient suddenly became blind. An operation via the transsphenoidal approach was (lone as an emergency procedure to decompress the sphenoid sinus and the left optic canal. The histolo-gical diagnosis was non-Hodgkin's lymphoma of the diffuse large cell type (B cell lymphoma).

Malignant lymphoma in the paranasal sinuses is usually biopsied and treated by chemotherapy and/or radiotherapy without surgical resection. In this rare case, an operation via the transsphenoidal approach was effective in improving the patient's visual acuity.