눈물주머니에 발생한 연소형 황색육아종 1예
A Case of Juvenile Xanthogranuloma in the Lacrimal Sac
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목적: 눈물주머니에 매우 드물게 발생하는 연소성 황색육아종을 경험하고 이를 보고하고자 한다. 증례요약: 8세 여아가 왼눈의 눈물흘림과 왼쪽 눈물주머니 부위에 종괴가 만져져 본원 안과에 내원하였다. 한 달 전부터 눈물이 끈적끈적하고 가끔씩 피가 섞여 나왔으며 종괴가 촉지되었다고 하였다. 눈 검사에서 왼쪽 눈물주머니 부위의 피부를 눌렀을 때 점액 분비물이 눈물점을 통해 흘러나왔으며 단단한 종괴가 만져졌다. 안와전산화단층촬영검사에서 주변 조직을 침범하지 않는 눈물주머니와 상부코눈물관 내에 국한된 종괴가 관찰되었다. 내시경을 이용하여 코경유 눈물주머니코안연결술을 시행하였으며 수술 중 연한 살색을 띠고 쉽게 박리되는 종괴가 눈물주머니와 상부 코눈물관에서 발견되었다. 수술 6개월 후 호전되었던 왼눈 눈물흘림 및 안쪽눈구석 부위종괴가 다시 촉지되었으며 수술 14개월 후 다시 시행한 안와전산화단층촬영검사에서 처음보다 더 커진 종괴가 발견되어 재수술을 시행하였다.
Abstract
Purpose: To report a rare case of juvenile xanthogranuloma in the lacrimal sac. Case summary: An 8-year-old female presented to our hospital with epiphora and palpable mass on the left medial canthal area. As a symptom, a sticky and bloody discharge through the punctum had begun on occasion 3 months previously. When pressure was applied on the left medial canthal area, a mucoid discharge through the punctum occurred, and a solid mass was palpable. The mass localized in the lacrimal sac and upper nasolacrimal duct was observed on orbit CT. No invasion into the surrounding tissue was present. The authors of the present study decided to perform endonasal dacryocystorhinostomy,and subsequently a skin-colored mass was found in the lacrimal sac. The histopathological and immunohistochemical diagnosis was histiocytic proliferation, compatible with juvenile xanthogranuloma. Six months later,the patient complained of epiphora recurrence with palpable mass on medial canthal area. The tumor recurrence was confirmed with enhanced orbit CT finding 14 months after the first surgery. A second surgery using endonasal dacryocystorhinostomy was performed to remove the mass.
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