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Lacrimal Sac Wall Granuloma Simulating a Neoplasm

Ali, Mohammad Javed F.R.C.S.; Mishra, Dilip Kumar M.D.

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Ophthalmic Plastic & Reconstructive Surgery: November/December 2016 - Volume 32 - Issue 6 - p e165
doi: 10.1097/IOP.0000000000000651
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Lacrimal sac wall granulomas are uncommon and secondary to chronic inflammation. A female, 60 years old presented with left-sided epiphora of 2 years duration and a rapidly growing, palpable, firm lesion below the medial canthus of 2 months duration, extending laterally towards the inferior orbital rim (Fig. 1A). The lesion was nontender and showed no regurgitation on pressure. Irrigation of the lacrimal passages was suggestive of a left acquired nasolacrimal duct obstruction. CT scan showed a mass lesion in the lacrimal sac region without any overlying bony erosions. An impression of possible lacrimal sac neoplasm was made and patient underwent an exploration and extirpation of the sac. Gross examination showed the lesion to arise from the lateral wall of the lacrimal sac (Fig. 1B). Whole mount section of the lesion showed the mass to arise from the lateral sac wall all along its entire extent (Fig. 1C). Histopathological examination revealed features suggestive of a chronic granuloma arising from the chronically inflamed and fibrosed sac wall (Fig. 1D). Taking the endemic geographical nature (South India) into account, detailed laboratory work up was performed to rule out granulomas of tubercular or fungal origin, which yielded negative results. Although uncommon, lacrimal sac granulomas should also be kept in the differential diagnosis of a rapidly growing lacrimal sac mass.

FIG. 1
FIG. 1:
Lacrimal sac wall granuloma.A, Clinical photograph showing the fullness of the lacrimal sac fossa below the medial canthal tendon. B, Gross pathology specimen showing lacrimal sac wall (L) and the mass lesion arising from the wall (black arrow). C, Whole mount section showing the lacrimal sac wall (L) and the lesion (black arrow). D, Microphotography showing a chronic inflammatory infiltrate and fibrosis of the sac wall with surrounding organized granuloma.
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