양측성 결막-각막 상피내 신생물의 성공적 치료 1예와 문헌고찰
Successful Treatment of Bilateral Conjunctival-Corneal Intraepithelial Neoplasia: Case Report and Review of the Literature
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목적: 국내 최초로 양측성 결막‐각막 상피내 신생물(Conjunctival‐corneal Intraepithelial Neoplasia)을 진단 및 치료한 1예를 문헌고찰과 함께 보고하고자 한다. 증례요약: 74세 남자환자가 4달전부터 시작된 양안의 이물감과 시력저하로 내원하였다. 내원시 환자의 교정시력은 우안 20/50, 좌안20/30이었다. 세극등 검사에서 우안 7시에서 11시 방향과 좌안 3시에서 5시 방향 윤부를 포함하는 9 × 11 mm, 6 × 7.5 mm 크기의각막‐결막 병소가 관찰되었다. 각막은 경계가 분명하고 불투명한 상피 증식이 보였고 구결막은 갈색의 색소 침착을 동반한 융기된섬유혈관 조직이 관찰되었다. 진단 및 치료 목적의 절제생검과 결막의 절제 가장자리에 냉동치료를 시행하였다. 조직병리 소견에서결막‐각막 상피내 신생물로 진단되었다. 술 후 교정시력은 양안 20/25로 호전되었고 8개월까지 재발 및 합병증은 관찰되지 않았다. 결론: 드물게 발생하는 양측성 결막-각막 상피내 신생물을, 최신 화학요법이 아닌 수술적 절제 및 보조적 냉동응고술의 전통적인 치료법으로 종양의 제거 및 재발 방지에 성공한 1예를 보고하는 바이다.
Abstract
Purpose: We report a case of successfully treating bilateral conjunctival-corneal intraepithelial neoplasia (CCIN) with surgical excision and adjunctive cryotherapy. Case summary: A 74-year-old male visited our clinic for bilateral foreign body sensation and decreased visual acuity. His initial best corrected visual acuity was 20/50 in the right eye and 20/30 in the left eye. The right eye showed a 9 mm × 11mm sized, gray-opaque limbal lesion from approximately the 7-o’clock position to the 11-o’clock position with spreading onto the cornea and conjunctiva. Biomicroscopy revealed a 6 mm × 7.5 mm sized minimally elevated, opaque lesion from the 3-o’clock to the 5-o’clock position extending to the central cornea in the left eye. The corneal lesion was well demarcated,opaque, and minimally elevated with bilateral focal pigmentation. Conjunctival lesions were finely vascularized and slightly elevated with melanocytic pigmentation. An excisional biopsy was performed to confirm the diagnosis and for therapeutic purposes, followed by an adjunctive cryotherapy. Postoperative corrected visual acuity improved up to 20/25 bilaterally and the patient had no recurrence 8 months after surgery. Conclusions: Bilateral conjunctival-corneal intraepithelial neoplasia is a rare condition. We report successful treatment and control of recurrence in a patient with bilateral conjunctival-corneal intraepithelial neoplasia using conventional surgical excision and adjuvant cryotherapy rather than topical chemotherapy.
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