LACRIMAL SAC TUMORS

This is a clinicopathologic study of 115 lacrimal sac neoplasms in adu lts (mean 52 years). The most common presenting signs and symptoms wer e epiphora (53%), recurrent dacryocystitis (38%), and/or lacrimal sac mass (36%). The tumors were divided into epithelial (82 cases) and non -epithelial (33 cases) neoplasms. Benign epithelial tumors included sq uamous and transitional cell papillomas (32), oncocytomas (4), and ben ign mixed tumors (2). The malignant epithelial neoplasms included squa mous cell carcinoma (22), transitional cell carcinoma (5), adenocarcin oma (4), mucoepidermoid (3), adenoid cystic (3), and poorly differenti ated carcinoma (1). The nonepithelial tumors consisted of fibrous hist iocytoma (13), lymphoid lesions (10), malignant melanoma (6), hemangio pericytoma (1), lipoma (1), granulocytic sarcoma (1), and neurofibroma (1). Review of the literature, including our own series, discloses a 55% malignancy rate for tumors originating in the lacrimal sac. Malign ant epithelial neoplasms, especially invasive transitional cell carcin oma, often recur locally and can metastasize and be fatal. Epithelial malignancies tend to grow along the epithelium of the lacrimal drainag e system, and thus cure is dependent on a wide surgical excision of th e tumor and of the entire lacrimal drainage system (canaliculi, sac, a nd nasolacrimal duct) combined with a lateral rhinostomy and radiation therapy.