J Rhinol.  2017 May;24(1):14-19. 10.18787/jr.2017.24.1.14.

Clinical Characteristics of Lacrimal Sac Tumors: Report of Ten Cases

• Kang B
• Jung H
• Shin JM
• Park IH
• Lee HM

• KMID: 2379784
• DOI: http://doi.org/10.18787/jr.2017.24.1.14

Abstract

BACKGROUND AND OBJECTIVES
To review our experience with lacrimal sac tumors in an effort to identify features, to evaluate the results of various methods of management, and to compare our data with previous studies.
METHODS
We reviewed the medical records of all patients with lacrimal sac tumors who were managed in our institution between January 1990 and December 2015. The pre-operative clinical data, imaging, operation notes, and follow-up records were reviewed for each patient.
RESULTS
The study group consisted of four men and six women with a mean age of 47.6 years. Most patients experienced long-standing epiphora, for a mean period of 20 months. Two of the tumors were benign, and eight of them were malignant. The benign tumors were treated with dacryocystectomy. All but one malignant tumor were treated with medial or total maxillectomy. Adjuvant radiotherapy was administered to four patients with malignant tumors. In the eight patients with malignant tumors, the mean follow-up period was 65 months.
CONCLUSIONS
Important characteristics of lacrimal sac tumors include dacryocystitis, epiphora, and in some cases, a palpable medial canthal area mass. Wide en bloc resection via medial or total maxillectomy and/or postoperative radiotherapy are proper treatments for malignant lesions of the lacrimal sac.

Keyword

Nasolacrimal system; Lacrimal sac tumor; Lacrimal sac carcinoma

MeSH Terms

Dacryocystitis
Female
Follow-Up Studies
Humans
Lacrimal Apparatus Diseases
Male
Medical Records
Nasolacrimal Duct*
Radiotherapy
Radiotherapy, Adjuvant

Figure

• 

  Fig. 1. Histopathologic findings of lacrimal sac tumors. ( A) Squamous cell carcinoma ( Case 10). The tumor shows a squamous nest containing keratin pearls and hyperchromatic cells with nuclear atypia (×100, H&E stain). ( B) Malignant melanoma ( Case 8). The tumor shows diffuse sheets of melanoma cells, with melanin pigments that show hyperchromatic nuclei and prominent nucleoli (×100, H&E stain). ( C) Undifferentiated carcinoma ( Case 9). The tumor shows a nested pattern with comedonecrosis without squamous or glandular differentiation (×40, H&E stain).

• 

  Fig. 2. Radiologic findings of the patient with undifferentiated carcinoma ( Case 9). ( A) Computed tomogram shows expansion of the lacrimal sac fossa with bony erosion ( white arrow). ( B) Magnetic resonance imaging shows a low signal intensity lesion on T2 weighted image, extending to upper nasolacrimal duct. ( C) The mass shows heterogeneously enhancement on contrast en-hanced T1 weighted image. These findings provide more accurate soft-tissue differentiation.

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  Fig. 3. Intra-operative findings ( Case 9). ( A) Exposure of the lesion was done with a lat-eral rhinotomy incision. ( B) The tumor and surrounding structures were excise d with a medial maxillectomy.

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