Educational report: A case of lacrimal sac rhinosporidiosis

This article reports a presentation of lacrimal sac rhinosporidiosis and informs the reader of this uncommon but important diagnosis. A 36-year-old man from Pakistan presented with a 3-month history of swelling at the nasal aspect of the left lower lid. This was associated with occasional crepitus and slight localised discomfort, but no epiphora. There was a palpable fullness near the left medial canthus associated with telecanthus but a normal sac washout and normal eye examination otherwise. Previous medical history included an ipsilateral nasal polypectomy and inferior meatal antrostomy around 10 years previously, whilst living in Pakistan. Various imaging modalities were useful in identifying a soft tissue mass within the left nasolacrimal duct. Following excision biopsy, histological examination confirmed the presence of rhinosporidiosis, likely caused by the organism Rhinosporidium seeberi. Rhinosporidiosis should be considered as a potential cause in any case of lacrimal sac pathology. Imaging studies may be helpful in measuring the extent of disease, although histological examination is required to confirm the diagnosis. Although rare, the complications of rhinosporidiosis can be potentially blinding or fatal. As discussed in this case, the presence of telecanthus may represent a lacrimal system tumour, either malignant or benign, and should always prompt further investigation.     

Lacrimal sac diverticula associated with a patent lacrimal system

PURPOSE: To describe the clinical features of lacrimal sac diverticula. METHODS: Orbital masses were evaluated in 3 patients. One patient had a large tumor extending from the medial orbit associated with upward globe displacement, one had a mass inferior to the medial canthus, and one had an inflamed mass in the right lower lid. Two of the patients had no history of chronic epiphora, sinus disease, or nasal trauma. In all patients, irrigation demonstrated lacrimal drainage system patency. RESULTS: Surgical exploration confirmed the diagnosis of lacrimal sac diverticulum in all patients. Two diverticula were associated with a dacryolith. Each patient was successfully managed with excision of the diverticulum and dacryocystorhinostomy. CONCLUSIONS: Lacrimal sac diverticula should be considered in the diagnosis of medial orbital tumors, and computed tomography is useful in the diagnosis of lacrimal sac diverticula.     

Hemangiopericytoma of the lacrimal sac.

Hemangiopericytomas are soft tissue tumors composed of pericapillary pericytes. These tumors are rare in the lacrimal sac. To the author's knowledge, only four previous cases of these tumors occurring in the lacrimal sac have been reported. A primary hemangiopericytoma of the lacrimal sac in a 34-year-old female is reported. Total excision with the surrounding tissue appears to be the treatment of choice for this tumor.     

Haemangiopericytoma of the lacrimal sac

Haemangiopericytomas (HPCs) are rare tumours which infrequently occur in the lacrimal sac. Only 8 cases of lacrimal sac HPC have previously been reported. The authors report 2 additional cases presenting clinically with epiphora and a mass. One case recurred 3 times during an 18-year period. The other case did not recur during 51 months of follow-up. The tumours showed immunohistochemical features consistent with a diagnosis of HPC. The authors recommend wide excision for these tumours and careful long-term follow-up to detect recurrence which is not uncommon.     

anastomosis lacrimal sac conjunctival sac in severe laceration of lacrimal canaliculus

PURPOSE:To investigate the clinical effect of anastomosis lacrimal sac conjunctival sac in the treatment of severe laceration of lacrimal canaliculus. METHODS:A total of 19 cases (19 eyes) with laceration of lacrimal canaliculus underwent anastomosis lacrimal sac conjunctival sac.All the patients were followed up for 3 to 24 months postoperatively. RESULTS:Among all the 19 patients (19 eyes), 14 cases were cured,3 cases wre markedly improved and 2 cases had no effect,and the effect rate was 89.47%. CONCLUSION:Anastomosis lacrimal sac conjunctival sac is an effective surgical technique in the management of severe laceration of lacrimal canaliculus.     

Neurofibroma of the lacrimal sac

Neurofibroma is an extremely rare neural tumor of the lacrimal sac. We present a case of neurofibroma of the lacrimal sac in a 45-year-old lady. Based on the history of intermittent epiphora, presence of a mass in the lacrimal sac region, dacryocystogram suggestive of space occupying lesion within the lacrimal sac and computed tomographic image of a tumor lying in the lacrimal fossa region, a tentative diagnosis of lacrimal sac neoplasm was made. Excision of the tumor with repair of the lacrimal sac was performed. Histopathology proved it to be neurofibroma of the lacrimal sac. Until now, only four cases have been reported worldwide. The paucity of reported cases limits our knowledge regarding the natural course, treatment, results and prognosis of this tumor.     

Argyrosis of the lacrimal sac

Silver deposition in the wall of the lacrimal sac after prolonged application of mild silver protein (Argyrol) eye drops is documented at the light and electron microscopical level. Silver granules were found in the extracellular matrix predominantly on elastic fibres and within cells forming conglomerates in secondary lysosomes. Most of the silver-containing cells showed a prominent rough endoplasmic reticulum, suggesting their fibroblastic origin. Investigation by energy-dispersive analysis of X-rays (EDAX) indicated the precipitation of silver as selenide.     

Hemangiopericytoma of the lacrimal sac

Hemangiopericytomas of the orbit are rare tumors with low malignancy potential. To the authors' knowledge, only three previous cases of these tumors occurring in the lacrimal sac have been reported. The authors report a fourth case. Follow-up was obtained on the first reported case, and the patient in that case had a recurrence after 15 years. These tumors should be totally excised and followed for long periods of time.     

Compression pneumatocele of the lacrimal sac

Case report on a 39-year-old man who for five years suffered from a recurrent, firm, crepitant swelling in the medial canthal region after coughing and sneezing. The swelling could be eliminated by digital compression. During a severe bout of sneezing a walnut-sized swelling suddenly occurred which could not be eliminated by compression. Echographic and intraoperative findings confirmed the diagnosis of a large, diverticulous pneumatocele that had compressed the lacrimal sac to such an extent that the entrapped air could not escape. Endoscopy of the nose revealed a wide nasolacrimal ostium, without a Hasner's valve. It was thus possible for air to flow back into the lacrimal drainage system from the nasal cavity.