Takahashi K, Suzuki J, Ohguro H, Ohyachi H, Yoshida K, Takahashi H, Nakagawa T
Department of Ophthalmology Sapporo Medical University School of Medicine, Hokkaido, Japan.
Nippon Ganka Gakkai Zasshi. 1997 Jan;101(1):92-6.
We report a case of paraneoplastic retinopathy in a patient who was found to have small cell carcinoma of the lung and was shown to have serum antibody against retinal soluble 70 kDa protein. A 71-year-old woman visited her ophthalmologist for gradual visual loss in both eyes. Although she underwent uncomplicated cataract surgery in her left eye, she was referred to our hospital because of progressive visual deterioration in November 1994. On admission, her corrected visual acuity was 0.3 OD and hand motion OS. Funduscopic examination showed narrowing retinal arteries, pigment epithelial mottling in the posterior retina bilaterally, and optic disc pallor in the left eye. An electroretinogram demonstrated marked reduction in the a and b waves. Bilateral central scotomas were detected by kinetic perimetry. We pursued further examination for systemic disease, and identified increased serum level of neuron specific enolase and radiographically abnormal shadow in the chest. Transcutaneous needle biopsy of the mediastinum confirmed small cell carcinoma. In western blot analysis the patient's serum reacted strongly with soluble retinal proteins of 70 kDa molecular weight, although the 26 kDa CAR antigen was not labeled. This patient was diagnosed as having paraneoplastic retinopathy due to small cell carcinoma and unusual serum protein which responded to an antigen with a molecular weight of 70 kilodaltons.
我们报告一例副肿瘤性视网膜病变患者，该患者被发现患有肺小细胞癌，并被证明血清中存在针对视网膜可溶性70 kDa蛋白的抗体。一名71岁女性因双眼视力逐渐下降就诊于眼科医生。尽管她左眼接受了未出现并发症的白内障手术，但由于1994年11月视力进行性恶化，她被转诊至我院。入院时，她的矫正视力右眼为0.3，左眼仅能感知手动。眼底检查显示视网膜动脉变窄，双眼视网膜后部色素上皮斑驳，左眼视盘苍白。视网膜电图显示a波和b波明显降低。动态视野检查发现双侧中心暗点。我们对全身疾病进行了进一步检查，发现血清神经元特异性烯醇化酶水平升高，胸部影像学检查有异常阴影。经皮纵隔穿刺活检确诊为小细胞癌。在蛋白质印迹分析中，患者血清与分子量为70 kDa的可溶性视网膜蛋白强烈反应，尽管26 kDa的CAR抗原未被标记。该患者被诊断为因小细胞癌及对分子量70千道尔顿抗原产生反应的异常血清蛋白导致的副肿瘤性视网膜病变。
