유방암 전이에 의한 압박 시신경병증 1예
A Case of Compressive Optic Neuropathy due toBreast Cancer Metastasis
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목적: 유방암으로부터 전이된 안와 주변부 종양에 의한 압박 시신경병증 1예를 보고하고자 한다. 증례요약: 내원 26년 전에 발견된 침윤성 유관암으로 좌측 근치적절제술, 9년 전 우측 광범위절제술 및 액와곽청술 시행 후 항암화학요법 및 방사선요법으로 치료받아 오던 환자가 4개월 전부터 있어 온 좌측 두통과 안면통을 동반한 좌안 시력저하를 주소로 내원하였다. 교정시력은 우안 1.0, 좌안 0.4였으며, 좌안 색각이상이 동반되어 있었다. 자기공명영상 및 PET-CT 결과 좌측 안와 주변부를 침범하여 시신경을 압박하고 있는 종양이 발견되어 신경외과에 의뢰하여 부분적 종양절제술 및 외측 안와벽제거술을 시행하고 술 후 항암화학요법 및 방사선요법을 시행하였다. 술 후 2개월째 좌안 교정시력은 1.0이었고, 색각이상은 없었으며 이는 1년 후까지 유지되고 있다. 결론: 유방암 전이로 인한 압박 시신경병증에 의해 시력이 저하된 경우 적극적인 치료로 시력을 회복한 1예를 보고하고자 한다.
Abstract
Purpose: To report a case of compressive optic neuropathy due to breast cancer metastasis to the periorbital lesion 26 years after the treatment of primary cancer. Case summary: A 64-year-old female presented with headache, facial pain and visual disturbance in her left eye for four months. The patient had received chemotherapy and radiotherapy after left breast modified radical mastectomy for invasive ductal carcinoma 26 years previously, and right breast wide resection with axillary dissection nine years earlier. Best corrected visual acuity was 20/20 in the right eye and 8/20 in the left eye. The color perception test showed abnormal findings in the left eye. MRI and PET-CT revealed an enhancing mass in the left periorbital area that was compressing the optic nerve. Partial resection of the tumor and left orbital wall was performed. Adjuvant chemotherapy and radiotherapy was performed after the operation. After two months later, the best corrected visual acuity was 20/20 in the left eye, and the color perception test showed normal findings, which have been maintained for one year. Conclusions: Prompt management can result in visual recovery in patients with compressive optic neuropathy caused by breast cancer metastasis.
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