방수세포검사로 확진한 비소세포 폐암의 홍채 전이 1예
Iris Metastasis of Non-small-cell Lung Cancer Confirmed via Aqueous Humor Cytology
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목적: 방수세포검사를 통하여 진단된 비소세포성 폐암의 홍채 전이를 경험하였기에, 이를 보고하고자 한다. 증례요약: 53세 여성 환자가 좌안 시력저하와 통증으로 내원하였다. 환자는 비흡연자로 안과적 수술력은 없었다. 최대교정시력 우안0.9, 좌안 0.9, 골드만압평안압계로 측정한 안압이 좌안 42 mmHg까지 상승하였고 홍채의 다발성 결절이 관찰되었다. 환자는 의뢰되기13개월 전 폐암을 진단받고, 항암 치료를 받고 있었다. 사용 가능한 모든 안압하강제를 점안하고, 탄산탈수효소억제제(acetazolamide) 까지 복용하였으나 안압은 조절되지 않았다. 홍채의 다발성 결절 소견으로 폐암의 홍채 전이를 의심하여 전방세척 및 천자를 시행하여 얻은 안방수로 병리검사를 시행하였으나, 악성 종양세포가 검출되지 않았다. 이에 1주 후 전방천자를 다시 시행하였고, 병리검사를의뢰하여 비소세포 폐암의 전이로 확진하였다. 안구 전이를 확인한 후에 혈액종양내과에서 항암치료제를 변경하였다. 결론: 비소세포 폐암 환자에서 홍채 결절이 관찰되는 경우 전방천자를 통해 방수를 얻고 세포검사를 시행하여 홍채 전이를 확진할수 있다.
Abstract
Purpose: To report an iris metastasis associated with non-small-cell lung cancer (NLC) confirmed via repeat aqueous humor cytology. Case summary: A 53-year-old female presented to our ophthalmology outpatient department with complaints of vision impairment and pain in the left eye 1 month in duration. In ophthalmologic examinations, the best-corrected visual acuities were 20/20 oculus dexter (OD) and 20/32 oculus sinister (OS). The intraocular pressures measured using standard Goldmann applanation tonometery were 12 mmHg OD and 42 mmHg OS. Slit-lamp examination revealed multiple iris nodules in the left eye. Thirteen months prior, the patient had been diagnosed with NLC and was on chemotherapy. Despite the maximal tolerated medical therapy, the intraocular pressure was not controlled. As an iris metastasis was suspected, anterior chamber paracentesis was performed for aqueous humor sampling. Cytological analysis did not reveal malignant cells. One week later, aqueous humor sampling was repeated. Malignant cells were histopathologically confirmed. Given the ocular metastasis, the oncologists changed the chemotherapy regimen. Conclusions: When an NLC patient exhibits iris nodules, repeat aqueous humor cytology can confirm an iris metastasis.
참고문헌 (15)
- Weiss L, "Analysis of the incidence of intraocular metastasis", Br J Ophthalmol, 77, pp.149~151 (1993)
- Goldberg RA, "Tumors metastatic to the orbit : a changing picture", Surv Ophthalmol, 35, pp.1~24 (1990)
- Cohen VM, "Ocular metastases", Eye(Lond), 27, pp.137~141 (2013)
- Sobol EK, "Iris mass and secondary glaucoma : the presenting sign of lung adenocarcinoma", Ophthalmol Glaucoma, 3, pp.217~ (2020)
- Shields CL, "Survey of 520 eyes with uveal metastases", Ophthalmology, 104, pp.1265~1276 (1997)
- Shields JA, "Metastatic tumors to the iris in 40 patients", Am J Ophthalmol, 119, pp.422~430 (1995)
- Kim DJ, "Two cases of uveal metastasis of lung cancer with systemic metastasis", J Korean Opthalmol Soc, 40, pp.2027~2035 (1999)
- 김재경, "폐비소세포암종에서 이차성 녹내장을 유발한 홍채 전이 1예", 대한안과학회지, 47(10), pp.1703~1707 (2006), 대한안과학회
- Shields CL, "Iris metastasis from systemic cancer in 104 patients: the 2014 Jerry A. Shields lecture", Cornea, 34, pp.42~48 (2015)
- Shah SU, "Uveal metastasis from lung cancer : clinical features, treatment, and outcome in 194 patients", Ophthalmology, 121, pp.352~357 (2014)
- Ferry AP, "Carcinoma metastatic to the eye and orbit. I. A clinicopathologic study of 227 cases", Arch Ophthalmol, 92, pp.276~286 (1974)
- Benhaddou R, "Iris metastasis from lung cancer", J Fr Ophtalmol, 31, pp.427~429 (2008)
- Shields CL, "Fine-needle aspiration biopsy of iris tumors in 100 consecutive cases : technique and complications", Ophthalmology, 113, pp.2080~2086 (2006)
- Finger PT, "Anterior chamber paracentesis cytology(cytospin technique)for the diagnosis of intraocular lymphoma", Br J Ophthalmol, 90, pp.690~692 (2006)
- Lam DS, "Efficacy and safety of immediate anterior chamber paracentesis in the treatment of acute primary angle-closure glaucoma : a pilot study", Ophthalmology, 109, pp.64~70 (2002)