양안성 미만성 포도막 멜라닌세포 증식증으로 나타난 샘암종
An Adenocarcinoma Associated with Bilateral, Diffuse, Uveal Melanocytic Proliferation
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목적: 양안 미만성 포도막 멜라닌세포 증식증으로 나타난 위 샘암종 증례를 보고하고자 한다. 증례요약: 78세 남자가 3개월 전 발생한 양안 시력저하 주소로 내원하였다. 당뇨 외 특이 병력은 없으며, 4년 전 양안 백내장수술을 받았다. 교정시력은 우안 안전수지, 좌안 20/160로 측정되었고, 안압 및 전안부는 정상이었다. 양안 안저에서 여러 개의 둥근 모양의 반점이 후극부에 관찰되었고, 망막하 망막색소상피 과색소 및 탈색소 병변이 동반된 삼출망막박리가 관찰되었다. 빛간섭단층촬영에서 색소성 병변은 시세포와 망막색소상피 사이에서 과반사를 보이는 망막하 삼출물로 확인되었고 망막하액과 망막내액이 관찰되었다. 양안 미만성 포도막 멜라닌세포 증식증으로 진단 후 영상학적 전신 평가를 시행하였다. 복부 컴퓨터 전산화단층촬영에서 악성종양으로 의심되는 종괴가 다수 관찰되었다. 상부위장관 내시경 조직검사를 시행 후 샘암종으로 진단되었다. 결론: 원발악성종양에 의해 이차적으로 발생한 양안 미만성 포도막 멜라닌세포 증식증은 다발성의 색소성 망막하 삼출물을 동반한 삼출망막박리로 나타나며, 이와 같은 안저 소견을 보이는 환자에서는 전신검사를 통해 악성종양에 대한 평가가 필요하다.
Abstract
Purpose: We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma. Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas. Conclusions: A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.
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