Inverted Papilloma of the Lacrimal Sac and Nasolacrimal Duct: A Case Report and Review of the Literature

Abstract

Inverted papillomas of the lacrimal sac and nasolacrimal duct are exceedingly rare. Though histologically benign, these tumors are locally aggressive, have propensity for recurrence and are associated with a chance of malignant transformation. These tumors can present in an innocuous manner, masquerading as more common conditions such as primary acquired nasolacrimal duct obstruction. We present our experience with one such case and a review of the literature to emphasize the importance of pre-operative assessment and intra-operative vigilance, so as to aid in accurate diagnosis and early treatment.

Keywords: dacryocystorhinostomy; inverted papilloma; lacrimal sac; nasolacrimal duct.

Figure 1. Nasoendoscopy image showing bulge over right lateral nasal wall at approximate site of the lacrimal sac with normal overlying mucosa.

LS: approximate site of lacrimal sac; S: septum; MT: middle turbinate. Arrow points to lateral nasal wall bulge.

Figure 2. CT scan of orbits showing a 2.6 cm lesion centered upon the right nasolacrimal duct with adjacent bony remodeling and expansion, as well as partial dehiscence of the medial orbital wall.

Figure 3. H&E stain of biopsy specimen showing inverted growth pattern.

Figure 4. CT sinus done prior to first definitive surgical excision showing extension of mass into the inferior meatus.

Figure 5. Nasoendoscopy image one year post-operatively showing recurrence of inverted papilloma over the right lateral nasal wall.

Arrows point to sites of papilloma recurrence.

Figure 6. MRI showing recurrent tumor extending from the frontoethmoidal recess, along the lateral nasal wall.

Figure 7. Nasoendoscopy image of right lateral nasal wall five years post-operatively, showing no evidence of tumor recurrence.