When Epiphora Hides a Sarcoma: Rhabdomyosarcoma Masquerading as Nasolacrimal Duct Obstruction
Author: Fadi Hassanin
Base Hospital / Institution: University of Jeddah
ePoster presentation
Abstract ID: 25-402
Purpose
To present a rare and misleading case of alveolar rhabdomyosarcoma (RMS) misdiagnosed as primary nasolacrimal duct obstruction (NLDO), and to highlight the importance of early suspicion and appropriate imaging in atypical cases of epiphora.
Methods
A 20-year-old male initially presented with isolated left eye tearing. Based on clinical assessment and irrigation findings suggestive of NLDO, an external dacryocystorhinostomy (DCR) was performed. Postoperatively, he developed rapidly progressive left periorbital swelling, chemosis, proptosis, and vision deterioration. Further history revealed pre-existing diplopia and anosmia, which had not been elicited initially. Imaging and biopsy were performed.
Results
Postoperative imaging revealed a highly aggressive, destructive left sinonasal mass with multisinus invasion, orbital extension, perineural spread, and suspicious cervical lymphadenopathy. Histopathology confirmed alveolar RMS.
The patient was started on combination chemotherapy. After the fourth cycle, there was significant clinical and radiological improvement, with visual acuity improving from counting fingers to 20/80, resolution of chemosis, and improved ocular motility.
Conclusion
This case underscores the critical need to consider serious secondary causes in young patients presenting with NLDO, especially when associated with atypical features such as diplopia, anosmia, or rapid progression. Retrospective evaluation suggested the tumor was already present preoperatively, and we hypothesize that DCR surgery may have facilitated its rapid orbital expansion by breaching anatomical barriers.
This is among the few documented cases of sinonasal alveolar RMS presenting as isolated NLDO—and possibly the first where anosmia and diplopia preceded epiphora.
Imaging should be considered in all atypical cases. Early diagnosis is essential, as RMS is an aggressive tumor with significant morbidity if not promptly treated. Management is multidisciplinary, including chemotherapy, radiotherapy, and surgical excision, with close clinical and radiological follow-up.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Manal | Hadrawi | King Fahad Armed Forces Hospital, Jeddah |
| Sumayah | Hanafi | King Fahad Armed Forces Hospital, Jeddah |
| Asma’a | Saleh | King Fahad Armed Forces Hospital, Jeddah |
| Wasayf | Almehmadi | King Fahad Armed Forces Hospital, Jeddah |
