網膜芽細胞腫の診断と臨床経過の検討

Review of diagnosis and clinical course of retinoblastoma

要約　目的：網膜芽細胞腫の診断と臨床経過の報告。症例：過去8年間の網膜芽細胞腫の自験例7症例を検索した。結果：男児2例，女児5例で，5例が片眼性，2例が両眼性であった。年齢は6例が4歳以下で，1例が7歳であった。主訴は白色瞳孔と斜視が5例，視力低下が1例，結膜充血と眼瞼腫脹が1例にあった。国際分類での病期はB～Eの範囲にあり，3例がE期であった。初回治療として眼球摘出術を5眼，眼窩内容除去術を1眼に行った。眼球を温存した3眼中，2眼では後に眼球摘出を必要とし，1眼では再発がなかった。眼球摘出術または眼窩内容除去術を行った6眼では転移はなかった。眼球外に浸潤した2例は不帰の転帰をとった。この2例は，初診時に網膜芽細胞腫の典型的所見がなかった。結論：網膜芽細胞腫の初診時の臨床像は，必ずしも予後を示さない。

Abstract.　Purpose：To report 7 cases of retinoblastoma regarding initial diagnosis and clinical course. Cases：A retrospective study was made on 7 cases seen during the past 8 years. Results：The series comprised 2 boys and 5 girls. Five cases were unilaterally and two were bilaterally affected. Six cases were younger than 4 years and one was 7 years at the initial diagnosis. Chief complaints comprised leukocoria and squint in 5 cases,impaired vision in one,and hyperemia with edema of eyelid in one. Retinoblastoma was classified from stage B to E. Three eyes were in stage E at the time of diagnosis. Enucleation was performed in 5 eyes and orbital exenteration in one as the initial treatment. Enucleation became necessary in 2 out of 3 eyes that were conservatively treated. There was no metastasis in 6 eyes that received enucleation or exenteration. Two cases that developed extraocular infiltration resulted in fetal outcome. Initial clinical features in these 2 cases did not match with the final outcome. Conclusion：Clinical features of retinoblastoma at the initial diagnosis are not indicative of prognosis.