Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Primary lacrimal sac lymphoma:a case-based retrospective study in a Chinese population

AIM:To determine the clinical characteristics,pathological types,tumor markers,treatments,and outcomes of Chinese patients with primary lacrimal sac lymphoma.METHODS:This case-based retrospective study analyzed 15 Chinese patients with primary lacrimal sac lymphoma.The clinical data collected included gender,age at diagnosis,symptoms,imaging examination results,pathologic diagnosis,pathogen identification,tumor markers,treatments,follow-up,and prognosis.Descriptive statistics were used to characterize the patients.Progression-free survival(PFS)was defined as the time from surgery to the last follow-up,first record of tumor recurrence,or death.RESULTS:There were 7 males and 8 females with unilateral primar y lacrimal sac lymphoma in the lef t eye(n=6)or right eye(n=9).The initial symptom in 13 patients was epiphora,and 2 patients had redness and swelling in the lacrimal sac area.All patients ultimately developed epiphora,and 12 had masses in the lacrimal sac area.Analysis of preoperative plasma tumor markers indicated 14 patients had elevated homocysteine,9 had elevatedβ2-microglobulin,and 2 had elevated lactate dehydrogenase(LDH);2 patients had elevations of all three markers,and 1 patient had no elevation of any marker.All patients underwent surgical resection and 12 patients received postoperative chemotherapy.The pathological types were DLBCL(n=8),MALT lymphoma(n=5),and NK/T-cell lymphoma,nasal type(n=2).The mean followup time was 25.8mo(range:4-41)and 2 patients died.Seven patients who underwent mass excision combined with dacryocystorhinostomy(DCR)had no postoperative epiphora.Eight patients who only underwent mass excision had varying degrees of postoperative epiphora.Preoperative LDH elevation and NK/T-cell lymphoma,nasal type were associated with poor prognoses.CONCLUSION:Early diagnosis and treatment can lead to a good prognosis for most patients with primary lacrimal sac lymphoma.Mass resection combined with DCR can reduce the occurrence of post-surgical epiphora.The pathology type and tumor marker status are associated with prognosis.

Lacrimal sac lymphoma: a case series and literature review

AIM: To study the clinical and pathological characteristics of the lacrimal sac lymphoma, which is rare but it is the major type of non-epithelial malignant tumor in the lacrimal sac region. METHODS: Sixty-four cases of malignant lacrimal sac tumors in our hospital from 1986 to 2020 were retrospectively reviewed. Eight cases of lacrimal sac lymphoma were carefully reviewed. RESULTS: There were five mucosal-associated lymphoid tissue(MALT) lymphomas, one diffused large B-cell lymphoma, one NK/T cell lymphoma, and one mantle cell lymphoma. All eight patients represented symptoms of epiphora with swelling in the lacrimal sac for a certain period of time and showed no signs of systemic involvement at the first time of clinical visits. They had received either chemotherapy or radiotherapy after surgery. Long-term follow-up(from 11 to 220 mo) showed that, except one patient with MALT lymphoma died for unknown reasons at 104 mo after surgery, the other 7 patients were all alive with no signs of local recurrence, neither in other organs. CONCLUSION: Non-epithelial malignant tumors of the lacrimal sac are rare and lymphoma is the major subtype.

Pathological,immunohistochemical and microbiologicalal analysis of lacrimal sac biopsies in patients with chronic dacrocystitis

AIM:To analyze cases of obstruction of the nasolacrimal duct which creates a fertile environment for secondary bacterial Infection and can result in dacryocystitis,which is a constant threat to cornea and orbital soft tissue and a potential source of endophthalmitis following intraocular surgery.The majority of obstructions of the lacrimal excretory outflow system are acquired ones occurring in adulthood and involving the distal parts of the system.Acquired obstruction may be primary/idiopathic or secondary to a wide variety of infectious,inflammatory,traumatic,mechanical,toxic or neoplastic causes mimicking idiopathic inflammation.These cases are treated by dacryocystorhinostomy(DCR).METHODS:The present study was conducted to determine the histopathologic,immunohistochemical and current microbiologic characteristics of lacrimal sac specimens in patients undergoing external dacryocystorhinostomy.RESULTS:Non-specific lacrimal sac pathology was present in all 33 cases and 81.8%of the cases showed moderate chronic inflammation with a chronic inflammatory score(CIS)ranging between 4 and 6,whereas 12.12%showed severe inflammatory changes with a CIS of 7.Mild degree of inflammation was seen in6.06%with a CIS of 3.The total prevalence of grampositive,gram-negative,and culture-negative samples were 59.4%,37.5%,and 3%respectively.CONCLUSION:Non-specific chronic inflammation withfibrosis is indeed the most commonly reported histopathological finding in lacrimal sac wall biopsy specimens.

Non-keratinising undifferentiated nasopharyngeal-type carcinoma of the lacrimal sac

Dear Editor,We present a case of non-keratinising undifferentiated nasopharyngeal-type carcinoma(UNPC)of nasolacrimal sac and review the previously reported cases and their treatment options and prognosis.Squamous cell carcinoma with a characteristic lymphoid stroma is a type of poorly differentiated carcinoma typically occurring in the nasopharynx[1].Non-keratinising UNPC,so called lymphoepithelioma-like carcinoma(LELC),of the lacrimal

Primary malignant melanoma of lacrimal sac

Dear Sir,We write to present a case report of primary malignant melanoma of the lacrimal sac.Tumors of the lacrimal sac are rare,and most of them are benign and of epithelial origin[1].Malignant melanoma of the lacrimal sac is even rarer accounting for 5%of lacrimal sac tumors and 0.7%of ocular melanoma[2,3].To our knowledge,only 27 cases with complete clinical information have ever been reported worldwide in English literature[4-8].The disease has an insidious onset and masquerades as a chronic

Transcatheter arterial infusion chemotherapy and embolization for primary lacrimal sac squamous cell carcinoma: A case report

BACKGROUND Although tumors of the lacrimal sac are rare,they represent a potentially lifethreatening situation that can easily be overlooked since patients present with features consistent with chronic dacryocystitis.Lacrimal sac squamous cell carcinoma is the most common lacrimal sac malignancy,but no definitive treatment is currently available.CASE SUMMARY We describe a 34-year-old unmarried male who presented with a red and swollen right lower eyelid,which gradually developed into a mass of the lower eyelid that obstructed vision in his right eye.He was treated with transcatheter arterial infusion chemotherapy and interventional embolization based on the tumor characteristics,and we also administered intensity-modulated radiotherapy and targeted therapy after tumor shrinkage.The tumor treatment demonstrated good efficacy,and the patient’s condition was stable after 10 mo of follow-up.CONCLUSION To our knowledge,this is the first report of lacrimal sac squamous cell carcinoma treated with transcatheter arterial infusion chemotherapy and interventional embolization,which might expand clinical treatment options for lacrimal sac carcinoma.

Imaging and histopathological findings of lacrimal sac lymphoma

Background Lymphoma of the lacrimal sac is rare,often misdiagnosed clinically.This study aimed to investigate the imaging features of these tumors and provide suggestions to aid the diagnosis.Methods In this retrospective study,five cases were assessed according to magnetic resonance imaging （MRI）,computed tomography （CT）,and pathological findings.All five patients underwent MRI and contrast-enhanced T1-weighted imaging （CE-T1WI）,of which four patients underwent dynamic contrast-enhanced （DCE） MRI and three patients underwent CT.Results Four cases and one case had a lymphoma in left and right medial canthus,respectively.Soft tissue surrounding the eyelids,subcutaneous tissue in the nasal dorsum,and involvement of the entire nasolacrimal canal were demonstrated in all five lesions.In two cases,the mass invaded the extraconal space.In one case,the mass invaded the adjacent medial rectus muscle and nasal area.Well-defined margins were observed in three cases and ill-defined margins in two cases.All cases showed homogeneous isointense lesions on T1Wl.Four cases showed homogeneous isointensity and one case demonstrated heterogeneous isointensity on T2Wl.After contrast injection,the lesion showed slight homogeneous isointensity and moderate enhancement in four cases and heterogeneous isointensity and moderate enhancement in one case.In the four patients who underwent DCE-MRI,a plateau pattern was revealed in three cases and washout pattern in one case.In the three cases who underwent CT,two cases had isointense and one case had hyperintense lesions.The lacrimal duct was remodeled and the surrounding bone compressed.Conclusions Tumors of the lacrimal sac showed homogeneous and isointense patterns on T1WI and T2WI with mildto-moderate enhancement and a plateau pattern on DCE-MRI.CT showed remodeling of the lacrimal duct with bone compression.

Lacrimal sac rhinosporidiosis

Rhinosporidiosis is caused by the organism Rhinosporidium seeberi.It is a rare aquatic protistan parasite.Though more prevalent in Asiatic regions,cases have also been reported in European countries.In India,it mostly affects the southern part.Rhinosporidium seeberi most commonly affects the mucous membranes,but can also affect other structures including the larynx,trachea,skin,genitalia,lungs and rectum.The typical presentation is that of a pinkish mass which bleeds profusely.Isolated lacrimal sac rhinosporidiosis is very rare.Computed tomography scans and magnetic resonance imaging are helpful in diagnosis,but histopathological study along with Gomori methenamine silver,periodic acid-Schiff,and potassium chloride are required for confirmation.Its mainstay of treatment is surgery.Prognosis is excellent,but recurrence is not unusual.

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system:A case report

BACKGROUND Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint,and it may derive from amyloidosis in rare cases.There are a few reports about localized amyloidosis,and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.CASE SUMMARY A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year.Physical examination touched a firm lump in the left lacrimal sac.Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus.Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct.During an endoscopic exploration and excision,a large number of dacryoliths were exposed.Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSION This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction.In clinical practice,we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

高位泪囊鼻腔吻合术治疗小泪囊型慢性泪囊炎的临床疗效观察

目的探讨小泪囊型慢性泪囊炎患者,行高位鼻腔泪囊吻合并观察术后疗效。方法对2016年3月~2021年12月23例慢性泪囊炎患者,行泪囊造影,测量泪囊大小。根据泪囊CT造影,将造影剂充盈的最大水平径≤2 mm、最大矢状径≤4 mm判断为小泪囊。对入选的小泪囊型慢性泪囊炎患者,行高位的泪囊鼻腔吻合术(dacryocystorhinostomy,DCR),同时进行术后6个月的随访观察。结果23例小泪囊型的慢性泪囊炎患者,行高位DCR,经过术后6个月随访观察,治愈19例,有效3例,无效1例。结论小泪囊型慢性泪囊炎患者,由于泪囊较小,泪囊周围的骨质较厚,行高位DCR,可以更好的寻找泪囊,保护鼻腔外侧壁的黏膜瓣,经过术后6个月的随访观察,疗效确切。

Endoscopic dacryocystorhinostomy in acute dacryocystitis:a multicenter study in China

AIM:To repor t the clinical profile,endoscopic dacryocystorhinostomy(En-DCR)management,and acute dacryocystitis(AD)outcomes in China.METHODS:Clinical data of 554 adult AD patients(554 eyes)who presented in 7 tertiary eye care centers for 10y from Jan 2010 to Mar 2020 were retrospectively analyzed.Clinical profile,En-DCR management,and outcomes of all cases were recorded.The anatomical and functional success were evaluated for 12mo post-operation.RESULTS:The analysis included 149 males and 368 females with a median age of 55.2y(range:18-84y).There were 459 eyes with a history of epiphora or purulent secretion.The time between a symptom of lacrimal duct obstruction and acute onset was 1 to 540(66.1±58.2)mo.Fifty-nine eyes had a history of the previous acute attack.Seventy-four eyes developed a cutaneous fistula,while 11 eyes had post septal cellulitis pre-operation.En-DCR with an anatomical success of 91.7%and functional success of 90.1%.The success rate of the patients with a history of acute episodes and the preoperative fistula was lower than the overall success rates.CONCLUSION:En-DCR can be performed during an acute episode in AD with a success rate of over 90%.