Primary Localized Conjunctival Amyloidosis-A Case Report

原發性結膜類澱粉沈積症－病例報告

程羽嬿(Yu-Yen Chen) ； 林佩玉(Pei-Yu Lin) ； 李淑美(Shui-Mei Lee) ； 許紋銘(Wen-Ming Hsu)

《中華民國眼科醫學會雜誌》 45卷3期 (2006/09) Pp. 211-216

https://doi.org/10.30048/ACTASOS.200609.0011

摘要

目的：報告一例原發性結膜類澱粉沈積症的病例。討論臨床特徵，病理發現，以及手術後的結果。
方法：病例報告
結果：一位66歲男性最近三年發生兩側結膜逐漸變大之病灶。此病患兩年前在美國接受兩側結膜病灶切除手術並診斷為結膜類澱粉沈積症。手術後不久病灶又復發，病人雙眼有異物感，兩側結膜出現結節狀膠質病灶。右眼病灶切片顯示為類澱粉沈積，kappa及lambda免疫球蛋白染色呈現陽性。全身檢查結果病人沒有多發性骨髓瘤，類澱粉沈積也沒有侵犯其他器官。病人左眼病灶接受手術切除及羊膜重建。手術後一個月內，兩眼的類澱粉沈積症又復發。
結論：原發性結膜類澱粉沈積症通常不會伴隨全身疾病。建議是以潤滑劑眼藥作保守治療。類澱粉沈積在手術之後易復發，因此不建議作廣泛切除，而是以局部切除減小病灶體積來緩解症狀。

並列摘要

Purpose: To report a case of primary localized conjunctival amyloidosis. The clinical features, pathological findings, and surgical outcomes were described.
Method: Case Report.
Results: A 66-year-old man presented with progressive growing mass lesions of bilateral conjunctiva noted for three years. He underwent bilateral surgical excision of the lesions in USA two years ago and conjunctival amyloidosis was diagnosed. The mass lesions recurred soon after the surgery and he suffered from grittiness and foreign body sensation of both eyes. His best-corrected visual acuity on examination was 6/6 OU. Yellow nodular gelatinous lesions were noted in bilateral nasal bulbar conjunctiva. Incisional biopsy of the right eye lesions revealed amyloid deposits, which stained positively with antibody to human kappa and lambda immunoglobulin light chains. A systemic survey showed neither evidences of multiple myeloma, nor involvement of other organs. Surgical debulking of the left eye lesions plus reconstruction with amniotic membrane was then performed. Recurrence of amyloid deposition was noted in both eyes less than one month after surgery.
Conclusion: Primary localized conjunctival amyloidosis is usually not associated with systemic diseases. For symptomatic cases, conservative treatment with lubricants is suggested initially. Palliative debulking instead of extensive excision is considered for more advanced cases, because the amyloid deposits tend to recur soon after surgery.

並列關鍵字

amyloidosis ； conjunctiva ； lymphoma ； amniotic membrane transplantation