Korean J Ophthalmol.  2009 Jun;23(2):100-103. 10.3341/kjo.2009.23.2.100.

A Case of Recurrent Schneiderian Papilloma of the Lacrimal Sac Invading the Nasal Cavity

• Jang JH
• Chang SD
• Choe MS

• KMID: 754725
• DOI: http://doi.org/10.3341/kjo.2009.23.2.100

Abstract

A 44-year-old man presented with a history of chronic epiphora, discharge from the right eye, and a palpable mass in the medial canthal area. Irrigation of the lacrimal system revealed bloody discharge. Orbital magnetic resonance imaging (MRI) showed a well-defined heterogeneous enhanced mass filling the lacrimal sac and upper nasolacrimal duct (NLD). A wide excision and surgical biopsy were performed. Histopathology showed the tumor to be an exophytic Schneiderian papilloma with moderate to severe dysplasia. Three months later, the mass was found to be invading the nasal cavity through the NLD. Endoscopic histopathological evaluation confirmed that it was identical to the originally identified papilloma.

Keyword

Lacrimal sac; Recurrent exophytic papilloma; Schneiderian papilloma

MeSH Terms

Adult
Biopsy
Diagnosis, Differential
Endoscopy
Eye Neoplasms/*pathology/surgery
Follow-Up Studies
Humans
Lacrimal Apparatus/*pathology
Magnetic Resonance Imaging
Male
Nasal Mucosa/*pathology
Neoplasm Invasiveness/*pathology
Neoplasm Recurrence, Local/*pathology/surgery
Nose Neoplasms/*pathology/surgery
Papilloma/*pathology/surgery

Figure

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  Fig. 1 Dacryocystography shows an uneven, mottled density of contrast media, evidence of a soft tissue mass (A: blue arrow, B: black arrow) at the right lacrimal sac.

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  Fig. 2 Orbital MRI before surgery. (A) A well-defined mass lesion (arrow) at the right lacrimal sac (T2WI, sagittal view, fat saturation enhancement). (B) A heterogeneous enhancementin the lesion that extends anteriorly adjacent to the right facial soft tissues without evidence of bony structure destruction (T1WI, axial view, Gadolinium enhancement).

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  Fig. 3 Orbital MRI, 3 months after surgery. (A) A small enhancing recurred lesion (thick arrow) is seen in the right nasolacrimal sac (T1WI, axial view, Gadolinium enhancement). (B) A recurred mass (thin arrow) invading the nasal cavity via the inferior meatus (T1WI, coronal view, Gadolinium enhancement).

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  Fig. 4 Histological examination reveals a fungiform mass with projecting finger-like proliferation of the epithelium. The tumor has an exophytic growth pattern with branching fibrovascular stalks covered by an epithelial layer (Hematoxylin-eosin stain, ×40).

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  Fig. 5 Transitional-type epithelial lining containing goblet cells (thick arrow). Occasionally, a single layer of columnar ciliated respiratory epithelial cells (thin arrow) is seen to line the surface of the hyperplastic transitional cells (Hematoxylin-eosin stain, ×200).

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  Fig. 6 A partial severe dysplasia in the papilloma (Hematoxylineosin stain ×600).

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