J Korean Ophthalmol Soc.  2012 Feb;53(2):348-352.

A Case of Juvenile Xanthogranuloma in the Lacrimal Sac

• Ko SJ
• Kim SD

Abstract

PURPOSE
To report a rare case of juvenile xanthogranuloma in the lacrimal sac.
CASE SUMMARY
An 8-year-old female presented to our hospital with epiphora and palpable mass on the left medial canthal area. As a symptom, a sticky and bloody discharge through the punctum had begun on occasion 3 months previously. When pressure was applied on the left medial canthal area, a mucoid discharge through the punctum occurred, and a solid mass was palpable. The mass localized in the lacrimal sac and upper nasolacrimal duct was observed on orbit CT. No invasion into the surrounding tissue was present. The authors of the present study decided to perform endonasal dacryocystorhinostomy, and subsequently a skin-colored mass was found in the lacrimal sac. The histopathological and immunohistochemical diagnosis was histiocytic proliferation, compatible with juvenile xanthogranuloma. Six months later, the patient complained of epiphora recurrence with palpable mass on medial canthal area. The tumor recurrence was confirmed with enhanced orbit CT finding 14 months after the first surgery. A second surgery using endonasal dacryocystorhinostomy was performed to remove the mass.

Keyword

Endonasal dacryocystorhinostomy; Juvenile xanthogranuloma; Lacrimal sac tumor

MeSH Terms

Child
Dacryocystorhinostomy
Female
Humans
Lacrimal Apparatus Diseases
Nasolacrimal Duct
Orbit
Recurrence
Xanthogranuloma, Juvenile

Figure

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  Figure 1 Widening of the left lacrimal fossa, and enhancing soft tissue mass lesion confined in the lacrimal duct and fossa, no extension into the surrounding tissue and bone destruction.

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  Figure 2 Soft tissue thickening and the size of intraductal mass enlarged with mass extension into the extraconal space and preseptal area. Bony remodeling due to previous dacryocystorhinostomy is shown.

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  Figure 3 Protruded mass from the lacrimal sac to the nasal cavity at reoperation of endonasal dacryocystorhinostomy.

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  Figure 4 Well marginated, yellow-gray mass, xanthogranuloma.

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  Figure 5 Histiocyte infiltration with a homogeneous plump cytoplasm, H-E stain, magnification, ×200.

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  Figure 6 CD68 positive finding on immunohistochemical stain, magnification ×100.

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