Transitional Cell Carcinoma of Lacrimal Sac

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Primary lacrimal sac malignancies are uncommon lesions. A male patient, aged 83 years, presented with rapidly growing lesion near the medial canthus of the right eye (Fig. A). The lesion was first noticed by the patient 3 weeks back as mild fullness. This was associated with constant epiphora and a single episode of bloody epiphora. On examination, there was a firm mass in the lacrimal sac area with extension above the medial canthus (Fig. A). The skin over the lesion had restricted mobility. Irrigation was not patent and the probe showed a firm stop at the level of distal canaliculi. Endoscopic examination showed a highly vascular mass involving the nasolacrimal duct area in the inferior meatus (Fig. B). CT scans showed a large mass lesion arising from the lacrimal sac and traversing the entire lacrimal fossa and bony nasolacrimal duct into the inferior meatus (Fig. C). The left lacrimal system and both eyes ocular examination were normal. An endoscopic punch biopsy was taken from the nasolacrimal duct area in the inferior meatus. Histopathology and immunohistochemistry was suggestive of a transitional cell carcinoma (Fig. D–F). The patient was referred for a head and neck surgical oncology opinion for complete resection and adjuvant radiotherapy. However, the patient succumbed to a massive cerebrovascular accident a week later, before any treatment could be initiated.
Transitional cell carcinomas of the lacrimal sac are very rare with a high potential for local recurrence and mortality. Common initial presentations include mass lesion, epiphora, and dacryocystitis. Although rare, these lesions should be included in the differential diagnosis of a rapidly growing medial canthal mass.
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