マイトマイシンC点眼にて軽快した脂腺癌の1症例

A case of sebaceous carcinoma treated with mitomycin eye drops

要約　目的：脂腺癌は，再発や遠隔転移が多く悪性度が高いため，早期に診断し早期に切除する必要がある。今回，超高齢者のために外科的治療を望まない症例に対し，0.04％マイトマイシンC（MMC）点眼を使用し軽快した症例を経験したので報告する。

症例：97歳，女性。右眼瞼腫脹と眼脂を認め，近医で点眼加療を行っていたが改善を認めず，誤嚥性肺炎のため川崎市立多摩病院に入院し初診となった。初診時に上下眼瞼に乳頭腫様腫瘤と眼瞼肥厚を認め，病理所見と合わせ脂腺癌と診断し，0.04％MMC点眼による治療を開始した。1クール目施行時に腫瘍は縮小し軽快したものの，2クール目開始後に眼瞼皮膚炎を生じたため0.04％MMC点眼を休止した。中止6か月後に再び脂腺癌の増悪を認め，0.04％MMC点眼を再開したところ改善がみられた。

結論：高齢などの理由で積極的な治療が不可能な症例に対しては，副作用の発現に注意しながらMMC点眼で保存的な治療を行うことも，脂腺癌に対する治療の選択肢の1つであることが示唆された。

Abstract　Purpose：Sebaceous gland carcinoma（SGC）is a highly malignant tumor with a high recurrence rate and risk of distant metastases. Therefore, prompt diagnosis and appropriate treatment are extremely important for patients with SGC. We encountered a case of a super-elderly individual with SGC who could not undergo a surgical excision and was treated using 0.04％ topical mitomycin C（MMC）.

Case：A 97-year-old woman presented with swelling and erythema in the right eye. She was treated with eye drops prescribed by a nearby doctor, but no improvement was observed. She was admitted to our hospital for aspiration pneumonia. At first visit to our hospital, we observed a papilloma-like mass and thickening of her upper and lower eyelids. We diagnosed her with SGC based on the pathological and clinical findings, and treatment with the 0.04％ topical MMC was administered. Although the tumor decreased in size and her condition improved after the 1st cycle, eyelid dermatitis developed after the 2nd cycle；the 0.04％ topical MMC was discontinued. Six months after the discontinuation of topical MMC, recurrence of SGC was noted. Therefore, 0.04％ MMC was restarted, and consequently, the tumor decreased in size.

Conclusion：The use of topical MMC along with careful monitoring of the occurrence of side effects is one of the treatment options for SGC in cases wherein active treatment is not possible due to a super-elderly age.