Nasal oncocytoma causing unilateral epiphora in an elderly patient: the vital role of nasendoscopy

Abstract

Oncocytomas are rare glandular tumours, typically found in salivary glands and kidneys. A 76-year-old man presented to an ophthalmology department after 3 months of persistent right-sided epiphora. Lacrimal syringing and a fluorescein dye test demonstrated an obstruction at the level of the nasolacrimal duct (NLD). Owing to the patient's history of dacryocystitis, endoscopic dacryocystorhinostomy was organised. When in theatre however, nasendoscopy identified a polypoid mass at the lateral aspect of the inferior turbinate, obstructing the right NLD opening. Histopathology confirmed an oncocytoma. There was no local destruction or distant metastases. The mass was resected, a Monoka stent inserted and symptomatic relief achieved. In this case, the cause of epiphora was initially missed because no direct nasal examination was performed. It is vital that patients with unilateral epiphora undergo an endoscopic nasal examination before arranging treatment. This could prevent delayed diagnoses, ensure prompt and appropriate management, and reduce morbidity and mortality.

Keywords: ear, nose and throat/otolaryngology; head and neck cancer; ophthalmology; otolaryngology / ent; pathology.

Figure 1

Histopathological evaluation of the resected oncocytoma was performed. (A) medium power light microscopy shows a well-circumscribed tumour composed of small, solid nests and glandular structures with intervening vascular stroma that is deep to the surface mucosa. (B) High-power light microscopy clearly demonstrates the characteristic features of an oncocytoma: glandular structures and eosinophilic cells with numerous mitochondria. (C) High-power light microscopy shows oncocytes and intervening vascular stroma.

Figure 2

CT of the orbit and skull was performed after the nasal mass was biopsied. (A) Bone window, axial CT of the orbit and skull: demonstrates a dilated right NLD, secondary to chronic obstruction. All bone margins remain intact. (B) Soft tissue window, coronal CT of the orbit and skull: a 7 mm well-circumscribed hyperdense lesion is visible at the right inferior meatus. (C) Soft tissue window, axial CT of the orbit and skull: a right dacryocystocele, occurring secondary to chronic obstruction, can be visualised.