Inverted Papilloma of the Lacrimal Sac: A Clinical Case
Author: Martin Možina
Base Hospital / Institution: Eye Hospital, University Medical Centre Ljubljana, Slovenia
ePoster presentation
Abstract ID: 25-563
Purpose
To present a clinical case of an inverted sinonasal papilloma (ISP) originating from the lacrimal sac in a 58-year-old male patient managed through a multidisciplinary endoscopic and transfacial surgical approach.
Methods
The patient presented with an 8-year history of persistent left-sided epiphora and a progressively enlarging medial canthal mass over six months. The lesion was not associated with pain, discharge, or erythema. Orbital ultrasonography revealed a well-demarcated lesion beneath the left medial canthus, extending through the medial orbital wall, with moderate internal reflectivity and multifocal vascular flow on Doppler. Magnetic resonance imaging (MRI) identified a 21x18x2 mm tumor lesion in the left medial canthus with heterogeneous T1 and T2 signals and no significant diffusion restriction, though restriction was noted in the solid components, suggesting high cellularity. The lesion was well-defined, encompassing lacrimal sac and entire nasolacrimal duct down to the level of the inferior nasal conchawith no bone destruction. Following contrast administration, the lesion exhibited homogeneous moderate enhancement.
Incisional biopsy of lacrimal sac lesion and the lesion in the inferior meatus under the inferior turbinate were performed. The lesion was suspected to be a squamous papilloma. However, concern for sampling error due to tumor size prompted comprehensive surgical planning for complete excision.
Results
A combined transfacial and endoscopic transnasal resection, which involved excision of the tumor, nasolacrimal duct, common canaliculus, and part of the medial maxillary sinus was performed. Histopathology revealed an inverted papilloma of the lacrimal sac with low-grade epithelial dysplasia.
Conclusion
Inverted papillomas of the lacrimal sac are exceedingly rare benign tumors with a propensity for local recurrence and potential malignant transformation. A multidisciplinary approach involving oculoplastic and ENT expertise is vital for achieving complete tumor excision and optimizing patient outcomes.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Nihad | Ličina | Eye Hospital, University Medical Centre Ljubljana, Slovenia |
| Jure | Urbančič | Department of Otorhinolaringology and Cervicofacial Surgery, University Medical Centre Ljubljana, Slovenia |
| Gregor | Hawlina | Eye Hospital, University Medical Centre Ljubljana, Slovenia |
