Lacrimal Sac Tumors: A Case Series

Syeed Mehbub Ul Kadir; Riffat Rashid; Sadia Sultana; Murtuza Nuruddin; Mst Sayedatun Nessa; Mukti Rani Mitra; Golam Haider

doi:10.1159/000520086

Lacrimal Sac Tumors: A Case Series

Ocul Oncol Pathol. 2022 Feb;8(1):42-51. doi: 10.1159/000520086. Epub 2021 Oct 18.

Authors

Syeed Mehbub Ul Kadir¹, Riffat Rashid², Sadia Sultana², Murtuza Nuruddin³, Mst Sayedatun Nessa⁴, Mukti Rani Mitra⁵, Golam Haider⁶

Affiliations

¹ Training and Academy, Sheikh Fajilatunnessa Mujib Eye Hospital and Training Institute, Gopalgonj, Bangladesh.
² Department of Ocular Oncology and Oculoplasty, Ispahani Islamia Eye Hospital and Institute (IIEHI), Dhaka, Bangladesh.
³ Department of Ocular Oncology and Oculoplasty, Chittagong Eye Infirmary and Training Complex (CEITC), Chittagong, Bangladesh.
⁴ Department of Pathology, Northern International Medical College and Hospital, Dhaka, Bangladesh.
⁵ Department of Ophthalmology, Dhaka Medical College, Dhaka, Bangladesh.
⁶ Medical Education, Bangladesh Eye Hospital and Institute, Dhaka, Bangladesh.

Abstract

Objective: The aim of the study was to describe the clinical presentation, management strategies, and outcomes in a case series of primary lacrimal sac tumors.

Methods: This retrospective study was conducted in Sheikh Fajilatunnessa Mujib Eye Hospital and Training Institute, Bangladesh, from July 1 to December 31, 2020, and included all patients who were evaluated, treated, and followed up for at least 6 months from January 2013 to October 2020. One patient developed a recurrence of the adenocarcinoma of the lacrimal sac after 1 year of primary treatment. Patients' demographic data were analyzed and reviewed from published articles on lacrimal sac tumors. We assessed patients clinically, followed by radiological evaluation. We also analyzed the biopsy technique, treatment modality, and recurrence. An oncologist reviewed all patients to prepare a plan for adjuvant treatment.

Results: Ten patients with lacrimal sac tumors were included in this study. Swelling in the medial canthal region was the most common presenting feature (100%), followed by epiphora (60%) and pain (30%). Open biopsy was preferred over fine-needle aspiration biopsy. Incisional biopsy or complete excisional biopsy was performed for all suspected malignancies. Malignant tumors were found in 7 (70%) cases, and benign tumors in 3 (30%) cases. Non-Hodgkin's lymphoma (NHL) (40%) was the most common malignant lacrimal sac tumor. Mucosa-associated lymphoid tissue lymphoma was 75%, and diffuse large B-cell lymphoma was 25% among the cases of NHL. Patients with epithelial malignancy were treated with external beam radiation therapy, while NHL patients were treated with chemotherapy (CHOP regimen). Recurrence was noted in 1 case (10%) of epithelial malignancy after 1 year of treatment.

Conclusion: Successful management of lacrimal sac tumors requires a high index of suspicion, as these are fatal tumors, often misdiagnosed as dacryocystitis. Nonepithelial malignancies are more predominant than epithelial malignancies, and hematolymphoid tumors are most frequent.

Keywords: Dacryocystectomy; Hematolymphoma; Lacrimal sac; Lymphoma; Squamous cell carcinoma; Tumor.