Malignant Oncocytoma of the Lacrimal Sac as an Unusual Cause of Epiphora

Abstract

A 72-year-old man presented with a 2-year history of epiphora. CT revealed an extensive inferomedial orbital tumor connected to the lacrimal sac and duct. Incisional biopsy revealed malignant oncocytoma of the lacrimal sac. The patient was treated with exenteration and maxillectomy followed by a course of postoperative radiotherapy. Patients with malignant oncocytoma may present with simple epiphora in absence of other signs and symptoms such as blood stained tearing or purulent rhinorrhea.

Androgen receptor-positive ductal adenocarcinoma of the nasolacrimal duct: A case report

“…In addition, oncocytic carcinoma of the lacrimal sac/nasolacrimal duct is reported to be more frequent than ductal adenocarcinoma. 18 , 19 , 20 , 21 , 22 , 23 , 24 However, the tumor cells in our current patient proved by electron microscopy examination not to be oncocytic, but to be oncocytoid cells. The presence of intracytoplasmic secretory granules also suggested apocrine differentiation.…”

Nasal Epithelial Myoepithelial Carcinoma: An Unusual Cause of Epiphora, a Case Report and Review of the Literature

“… 33 When epiphora is unilateral, excluding an obstructing neoplastic growth as a contributing factor of epiphora is critical. 19 , 20 For example, in the present case, we described a patient who presented with bilateral lower lid ectropion and blepharitis, along with a small puncta on the side of the tumor, suggestive of punctal stenosis, all of which constitute potential independent risk factors for epiphora. Thorough history taking, which revealed epistaxis, and results of an examination, which demonstrated a total nasolacrimal duct obstruction, however, led to an endoscopic examination and then computed tomography, both of which showed the true cause of epiphora to be a neoplasm.…”

“…, iodine-131 therapy, 8 glaucoma drops, 9 rhinosinusitis 10 ), systemic inflammatory disease ( e.g. , Wegener granulomatosis, 11 sarcoidosis 12 ), facial trauma, 13 previous sinonasal surgery, 14–18 or nasolacrimal system 19,20 or sinonasal 20 neoplasia.…”

Oncocytic lesions of the ocular adnexa

“…[ 19 ] Histopathological diagnosis of oncocytic adenocarcinoma of the lacrimal drainage system requires demonstration of destructive infiltrative growth with lymphovascular permeation and perineural infiltration, as well as oncocytes demonstrating nuclear atypia in small nests and abortive glandular elements; mitotic figures may be uncommon. [ 20 21 ] One case of an oncocytic adenocarcinoma of the sac presenting with cervical nodal metastases has been reported. [ 22 ] There have been at least two reports of benign sac oncocytomas undergoing transformation into oncocytic adenocarcinoma, one of which initially recurred as an oncocytoma with atypia.…”