안구돌출을 주소로 진단된 신세포암의 눈물샘 전이 1예
A Case of Diagnosed Renal Cell Carcinoma with Orbital Metastasis Presenting with Proptosis
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목적: 안구돌출을 주소로 내원했던 환자가 매우 드문 신세포암의 눈물샘 전이암으로 진단된 증례를 보고하고자 한다. 증례요약: 68세 남자환자가 3개월 전부터 발생한 우안 안구돌출을 주소로 내원하였다. 교정시력은 우안 0.8, 좌안 0.9였으며 11 mm의우안 안구돌출 관찰되었고, 우측 주시 시 안구운동 제한이 있었다. 백내장 외에 전안부와 후안부에 특별한 이상소견은 관찰되지 않았다. 안와 CT (computed tomography)에서 우안 눈물샘에 불규칙적인 조영증강을 보이는 24×36×29 mm 크기의 고형종괴 관찰되었고, 주변 안와 외측벽의 뼈 파괴와 외직근에 침윤된 소견을 보였다. 전이 종양 의심하에 시행한 흉부 CT 및 복부 CT에서 좌측 신장에과다혈관성 불균질한 조영 증강을 보이는 거대한 외장성 종괴 보였으며 복부 CT로 그 크기를 확인하였다. 악성종양 의심하에 신장종괴에 대해서 좌측 신적출술과 부신절제술을 시행하였고 안와종괴에 대해서는 쌍꺼풀선 절개법을 통해 절개생검을 시행하였다. 조직검사를 통해 두 종괴 모두 신세포암으로 확진하였다. 결론: 신세포암의 눈물샘 전이는 매우 드물며 흉부 CT를 통해 원발병소를 발견하였다. 전이종양이 의심되는 경우 전신검사를 통한원발병소 확인이 중요하며 문헌고찰과 함께 이를 보고하고자 한다.
Abstract
Purpose: To report a very rare case of lacrimal gland metastasis of renal cell carcinoma presenting with proptosis. Case Summary: A 68-year-old man visited our clinic with a 3-month history of proptosis in the right eye. Corrected visual acuity was 0.8 in the right eye and 0.9 in the left eye and 11 mm proptosis of the right eye was observed. There were no specific findings except cataracts in both eyes. Orbital computed tomography (CT) demonstrated a solid lacrimal gland mass which was 24 × 36 × 29 mm in size and showed irregular enhancement. The CT scan also showed bone destruction around the orbital lateral wall and infiltration to the lateral rectus muscle. A metastatic tumor was suspected, thus a chest CT and abdominal CT were performed. The CT scan showed a large exophytic hypervascular mass with heterogeneous enhancement. The mass size was confirmed by the abdominal CT and malignant tumors were suspected. Regarding the left renal mass, a urology surgeon performed nephrectomy and adrenalectomy and regarding the lacrimal gland mass we performed an incisional biopsy via lid crease incision. Both masses were diagnosed as renal cell carcinoma based on the pathophysiologic findings. Conclusions: Lacrimal gland metastasis of renal cell carcinoma is very rare and extensive systemic evaluation for metastatic malignancy should be performed. In the present study, the authors report of a primary tumor found by chest CT a review of the literature.
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