Ungerechts R., Lang M., Emmerich K. H.

Augenklinik, Klinikum Darmstadt, Heidelberger Landstraße 379, 64297 Darmstadt

The malignant tumors of the lacrimal sac are very rare and limited on a few case reports.
Types: The malignant tumors of the lacrimal sac are divided into epithelial tumors (54%) and non epithelial tumors (46%). Clinical Signs: Important symptoms are the epiphora and a painless swelling in the area of the lacrimal sac. Additionally, a secondary dacryocystitis may occur. At first, an irrigation of the lacrimal system is often still possible, whereby during the irrigation a bleeding may occur. Due to the extension beyond the lacrimal sac nasal symptoms, infiltration of soft parts tissue, skin and bone as well as lymphadenopathy may occur. A biopsy is necessary.
Case report: A 55 year old patient presented himself complaining about epiphora and a painless swelling of the lacrimal sac. The irrigation of the lacrimal systems was possible against resistance. The dacryocystography showed a contrast filling up to upper third of the lacrimal sac. In the following dacryozystorhinostomia a process which extended over the entire fossa lacrimalis was found. Intraoperatively several bioptic probes were taken. Histologically an invasive keratinized squamous cell carcinoma was found. In co-operation with the ENT-hospital a resection of the approximal structures was performed. The defect was secondarily covered and the patient submitted a radiatio.
Summary: A carcinoma may cause a stenosis of the lacrimal system in patients presenting a hydrops of the lacrimal sac without inflammation. Further signs may be a local infiltration of the orbital bone and soft part structures as well as tumor growth, teleangiectasis and bloody reflux. The therapy depends on the histological type and the extention of the tumor. A local excision and in some cases additional radiatio should be performed.

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