急性骨髄性白血病にみられた黄斑病変の組織所見

Histopathological findings of the macula in a case of acute myelogenous leukemia

要約　目的：急性骨髄性白血病の黄斑部の剖検所見の報告。症例：52歳女性が3週間前からの右眼中心視野欠損で受診した。4か月前に貧血があり，8週間前に急性骨髄性白血病と診断され，加療中であった。矯正視力は右0.2，左1.0で，右眼黄斑部に出血を伴う滲出性病変，その下方に滲出性網膜剝離があった。著しい白血球減少と免疫不全があり，受診の5週間後からサイトメガロウイルス腸炎による下血が生じ，受診の9週間後にショックと腎不全で死亡した。所見：剖検で得られた眼球には，脈絡膜血管と間質に白血球の浸潤，網膜黄斑部に血管閉塞とその周囲に好酸性物質の遺残があった。結論：滲出性網膜剝離は白血球浸潤による脈絡膜の循環障害に続発した可能性がある。

Abstract.　Purpose：To report histopathological findings of the macula in a case of acute myelogenous leukemia. Case：A 52-year-old female presented with central visual field defect in her right eye since 3 weeks before. Anemia had been detected 4 months before. She had been treated for acute myelogenous leukemia since 8 weeks before. Her corrected visual acuity was 0.2 right and 1.0 left. The right eye showed exudative lesion and hemorrhage in the macula. Exudative retinal detachment was present in the inferior fundus. She had extreme leucopenia and immune deficiency followed by cytomegalovirus enteritis. She died of renal insufficiency and hemorrhagic shock 9 weeks after her initial visit. Findings：The right eye showed,by autopsy,leukemic infiltration in and around choroidal vessels. The macula showed microvascular occlusion. Conclusion：Choroidal infiltration of leukemic cells appeared to have caused the exudative retinal detachment.