肺腺癌の脈絡膜転移に全身化学療法を施行し視力の改善が得られた1例

Improved visual acuity after chemotherapy in a case of choroidal metastasis from adenocarcinoma of the lung

要約　目的：肺腺癌の脈絡膜転移に対し，全身化学療法で視力が改善した症例の報告。症例：60歳女性が左眼視力低下で受診した。3か月前から咳，痰，頸部腫瘤があり，肺癌が疑われていた。所見と経過：矯正視力は右1.2，左0.4で，左眼の乳頭から上方に3.5乳頭径大の白色の隆起があり，乳頭鼻側に4乳頭径大の漿液性網膜剝離があった。全身検査で肺腺癌と肝，骨，リンパ節への転移があり，stage Ⅳと判定された。2か月間のTS-1^®の経口投与は原病巣には無効で，カルボプラチンとパクリタキセルに切り替えた。2か月後に肺病変は縮小し，網膜剝離が消失し，視力は0.8に回復した。治療開始から14か月後の現在まで経過は良好である。結論：肺腺癌の脈絡膜転移に対し，全身化学療法が原発巣と眼転移巣の双方に奏効した。

Abstract.　Purpose：To report a case of adenocarcinoma of the lung with choroidal metastasis that responded to systemic chemotherapy. Case：A 60-yearld female presented with impaired visual acuity in the left eye. She had had cough and phlegm and was suspected of lung malignancy. Finding：Corrected visual acuity was 1.2 right and 0.4 left. The left fundus showed a white tumor of 3.5 disc diameters superior to the optic disc. She was diagnosed with adenocarcinoma of the lung with metastasis to the liver,bones and lymphnodes. The lesions failed to respond to 2 months of peroral treatment with TS-1^®. Switching to carboplatin and paclitaxel resulted in decreased size of lung tumor and retinal detachment. Visual acuity improved to 0.8. She has been doing well for 14 months until present. Conclusion：This case illustrates that chemotherapy may be effective for adenocarcinoma of the lung with systemic metastases.