Primary Non Hodgkin’s Lymphoma of the Lacrimal Sac-A Noteworthy Watery Eye

Abstract

Lacrimal sac tumours are rare tumours in ophthalmology but may have serious complications when misdiagnosed. Lacrimal sac tumours can be either epithelial or non epithelial tumours. Epithelial tumours account for 60-94% of tumours. Pseudostratified ciliated columnar epithelium lines the lacrimal sac. Squamous cell carcinoma, transitional cell carcinoma, mucoepidermoid carcinoma, oncocytic adenocarcinoma, adenoid cystic carcinoma and metastasis are the commonly occurring epithelial tumours. Inverted papilloma is a locally aggressive tumour. Non epithelial tumours (25%) are rarer than the epithelial tumours. Lymphoproliferative, melanocytic, and mesenchymal tumours are the non epithelial tumours, among which the lymphoproliferative tumours constitute 2-8%. Very rarely Non Hodgkin’s lymphoma can occur as a primary in the lacrimal sac. Melanoma can occur as a primary from the melanocytes of the lining in the lacrimal sac or as a secondary from the conjuctival melanoma. Kaposi sarcoma and rhabdomyosarcoma are the mesenchymal tumours. Here is a case of Non Hodgkin’s Lymphoma (NHL) occurring in the lacrimal sac in an 80-year-old male. The patient came with the chief complaint of swelling around the right eye since two months. On radiological examination, Computed Tomography (CT) revealed a homogenous solid mass in the right medial canthus, causing bony erosions of the orbit and extending into the nasolacrimal canal. An incisional biopsy of the mass was consistent with the diagnosis of Non Hodgkin’s lymphoma which was further confirmed by immunohistochemistry. This unusual presentation and histopathological features are described.

Keywords

• immunohistochemistry
• lymphoproliferative lesion
• non epithelial tumour
• orbit