黄白色結節から網膜下腫瘤性病巣へと進展した眼内悪性リンパ腫の1例

A case of malignant lymphoma developing from yellow retinal spots into subretinal tumorous lesion

　73歳女性が左眼の眼底異常を偶然に発見されて受診した。矯正視力は左右とも0.7であり，左眼眼底後極部の網目状の色調変化と，上方に黄白色の小結節が散在していた。硝子体混濁はなかった。蛍光眼底造影では後極部から中間周辺部にかけて網目状の低蛍光と過蛍光が混在していた。11か月後の再診時に，左眼眼底の下耳側の網膜下に腫瘤が発見され，両眼に硝子体混濁があった。両眼の硝子体生検の結果は陰性であったが，悪性リンパ腫を疑い放射線照射を行った。左眼の腫瘤は消失し網脈絡膜萎縮巣になった。右眼の硝子体混濁に対し硝子体切除術を行い，病理組織学的所見と，硝子体内のIL-10/IL-6比が高いことから，眼内悪性リンパ腫と診断した。網膜の黄白色小結節が眼内悪性リンパ腫の初発病変であった可能性がある。

　A 73-year-old woman was referred to us for abnormal left fundus. Her corrected visual acuity was 0.7 in either eye. The left fundus showed reticular appearance in the macular area and yellow nodules scattered over the superior midperiphery. There was no vitreous opacity. Fluorescein angiography showed multiple hyper-and hypofluorescent patches. A subretinal tumor was detected in the inferotemporal fundus in her left eye 11months later. Both eyes showed vitreous opacity. Malignant lymphoma was suspected,although biopsy of the vitreous in both eyes showed negative findings. Radiation induced disappearance of the subretinal tumor in the left fundus. Malignant lymphoma was diagnosed after histopathological examination of vitreous specimen in the right eye and by the high ratio of IL-10 to IL-6. There is a possibility that the yellow nodules in the fundus were the initial manifestation of intraocular malignant lymphoma.