면역억제제를 복용 중인 환자에서 안구표면 편평상피세포암의 안구 내 침범 1예 = Ocular Surface Squamous Cell Carcinoma with Intraorbital Extension in a Patient with Long-Term Immunosuppression

국문 초록 (Abstract)

목적: 면역억제제를 복용 중인 환자에서 발생한 안구표면 편평상피세포암의 안구 내 침범에 대한 임상적, 조직학적 소견과 치료 경과에 대해 보고하고자 한다.
증례요약: 신장이식 후 17년간 면역억제제를 복용 중인 59세 남자 환자가 재발하는 우안 결막의 하얀 병변을 주소로 내원하였다. 병변의 절제적 생검 후 절제부위에 mitomycin C 점적 및 양막이식술을 시행하였다. 조직학적 검사상 편평상피세포암으로 확인되었다. 당시 시행한 안와 전산화 단층촬영검사상 특이소견은 관찰되지 않았다. 술 후 6개월간 Interferon alpha 2b 안약을 점안하였다. 술후 1년째 우안 결막 병변이 재발하여 절제적 생검과 mitomycin C 점적, 반복적 냉응고요법, 양막이식술을 시행하였다. 같이 시행한 안와 전산화 단층촬영검사에서 우안 내측에 1.9 cm의 고밀도 종괴가 관찰되어 편평상피세포암의 안구 내 침범으로 진단하고 우안안와내용물제거술을 시행하였고, 조직학적 검사상 편평상피세포암으로 확인되었다.
결론: 면역억제제 복용 환자에서 발생한 안구표면 편평상피세포암은 빠르게 다른 부위로 침범할 수 있음을 고려할 때 수술적 완전절제 후에도 적극적인 경과 관찰이 필요하다.

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of ocular surface squamous cell carcinoma with intraorbital extension in a patient with renal transplantation and long-term immunosuppressive therapy.
Case summary: A 59-year-old Korean male presented with a whitish mass in the medial limbus and conjunctiva of the right eye. The patient had undergone renal transplantation 17 years prior due to lupus nephritis and was on systemic immunosuppression with daily prednisolone (10 mg), tacrolimus (5 mg), and mycophenolate sodium (720 mg). The complete excision of the mass was performed and mitomycin C application and amniotic membrane transplantation on the excised area were combined. Histopathological examination revealed the mass was squamous cell carcinoma. There were no abnormal findings on the orbit computed tomography (CT). The patient was additionally treated with topical interferon alpha 2b 6 months postoperatively. One year later, a mass recurred at the same site in the right eye. The complete excision of the mass, mitomycin C application, cryotherapy, and amniotic membrane transplantation were performed. Orbit CT showed a 1.9 cm-sized intraorbital mass involving the medial rectus of the right eye. The orbital exenteration was performed and the intraorbital mass was histologically proven to be squamous cell carcinoma.
Conclusions: Ocular surface squamous neoplasia in patients with renal transplantation and long-term immunosuppressive therapy should be monitored closely for the possibility of orbital invasion.

목차 (Table of Contents)

• Abstract
• 증례보고
• 고찰
• REFERENCES
• 국문초록

참고문헌 (Reference)

1 Penn I, "The incidence of malignancies in transplant recipients" 7 : 323-326, 1975

2 Lindholm A., "The impact of acute rejection episodes on long-term graft function and outcome in 1347 primary renal transplants treated by cyclosporine regimens" 56 : 307-315, 1993

3 Euvrard S., "Skin cancers after organ trans-plantation" 348 : 1681-1691, 2003

4 Porges Y., "Prevalence of HIV with conjunctival squamous cell neoplasia in an African provincial hospital" 22 : 1-4, 2003

5 Gichuhi S., "Pathophysiology of ocular surface squamous neoplasia" 129 : 172-182, 2014

6 Basti S., "Ocular surface squamous neoplasia : a review" 22 : 687-704, 2003

7 Lee GA., "Ocular surface squamous neoplasia" 39 : 429-450, 1995

8 Penn I, "Occurrence of cancers in immunosuppressed organ transplant recipients" 147-158, 1998

9 Tsatsos M., "Modern management of ocular surface squamous neoplasia" 8 : 287-295, 2013

10 Vajdic CM., "Increased incidence of squamous cell carcinoma of eye after kidney transplantation" 99 : 1340-1342, 2007

11 Shields CL., "Conjunctival squamous cell carcinoma arising in immunosuppressed patients (organ transplant, human immunodeficiency virus infection)" 118 : 2133.e1-2137.e1, 2011

12 Goedert JJ., "Conjunctival malignant disease with AIDS in USA" 346 : 257-258, 1995

13 Barrett WL., "Clinical course of malignancies in renal transplant recipients" 72 : 2186-2189, 1993

14 Penn I, "Cancers in renal transplant recipients" 7 : 147-156, 2000

15 Schreiber RD., "Cancer immunoediting : integrating immunity's roles in cancer suppression and promotion" 331 : 1565-1570, 2011