放射線照射と化学療法が奏効した髄膜癌腫症と転移性脈絡膜腫瘍の合併例

A case of meningeal carcinomatosis with metastatic choroidal tumor

要約　目的：肺癌が転移し，髄膜癌腫症と転移性脈絡膜腫瘍を合併した症例の報告。症例：1か月前に肺腺癌Ⅳ期と診断された59歳男性が，眼瞼下垂と複視で受診した。所見：矯正視力は左右ともに1.2であり，右動眼神経麻痺と両眼転移性脈絡膜腫瘍を認めた。髄液細胞診にて髄膜癌腫症と診断され，化学療法と全脳・全眼球放射線照射により動眼神経麻痺は改善し，脈絡膜腫瘍も縮小した。発症から1年5か月以上経過した現在も化学療法を継続中で，視力も維持できている。結論：髄膜癌腫症と転移性脈絡膜腫瘍はともに予後不良な疾患であるが，生存期間中のquality of visionの観点から積極的治療を行うべきである。

Abstract.　Purpose：To report a case of lung carcinoma, meningeal carcinomatosis, and bilateral metastatic choroidal tumor. Case：A 59-year-old male presented with diplopia and blepharoptosis in the right eye of recent onset. He had been diagnosed with advanced lung adenocarcinoma one month before. Findings：Corrected visual acuity was 1.2 in either eye. Both eyes showed choroidal tumor. Oculomotor palsy was present in the right eye. Cerebrospinal fluid showed malignant cells, leading to the diagnosis of metastatic meningeal carcinomatosis and choroidal tumor. He received chemotherapy and radiation of the whole brain. Oculomotor palsy started to improve one month later and choroidal tumor became reduced 4 months later. There has been no recurrence of ocular lesions for 17 months until present. Conclusion：Treatment with radiation and chemotherapy was effective for meningeal carcinomatosis and bilateral metastatic choroidal tumor. It contributed to improve the quality of vision.