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Case Study: April 2011

History

An 80 year old man presented with an intermittent painless lump on the inner corner of his left eye associated with watering. He had a history of chronic bronchitis and congestive cardiac failure. Examination showed a 2 cm cystic swelling that caused retrograde regurgitation of mucoid fluid on pressure over the lacrimal sac from the lacrimal puncta. Lacrimal syringing showed mucoid regurgitation consistent with nasolacrimal duct obstruction. The patient opted for a dacrycystectomy. Prior to the planned surgery, he presented with an acute dacryocystitis with complete resolution of the symptoms after antibiotics. He subsequently underwent uncomplicated dacryocystectomy . The entire sac was sent for histopathological assessment.

Questions

  1. What does Fig 2 show?
  2. Collectively, what do Figs 1and 3 indicate?
  3. Which stain is Fig 4 and 5?
  4. What’s the diagnosis?
Click to show answers
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  1. This shows the mucosa of the lacrimal sac with an acute inflammatory reaction.
  2. A circumferential atypical lymphoid infiltrate.
  3. CD20
  4. B-cell non-Hodgkin’s lymphoma. The B cells were negative for CD5, Cd10, Cyclin D1 and CD23. The subtype is extranodal marginal zone lymphoma of MALT type (MALToma-WHO classification) of the lacrimal sac.

References

  1. Stefanyszyn MA, Hidayat AA, Jacob JP, Flannagan JC. Lacrimal sac tumors. Ophthal Plast Reconstr Surg 1994;10:169-84.
  2. Tucker N, Chow D, Stockl F, et al. Clinically suspected primary acquired nasolacrimal duct obstruction: clinicopathological review or 150 patients. Ophthalmology 1997; 104: 1882-6.
  3. Anderson NG, Wojno TH, Grossniklaus HE. Clinicopathological findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy. Ophthal Plast Reconstr Surg 2003: 19: 173-6
  4. Bernardini FP, Moin M, Kersten RC, et al. Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy: how useful is it? Ophthalmology 2002;109: 1214–17.
  5. Lee-Wing MW, Ashenhurst ME. Clinicopathologic analysis of 166 patients with primary acquired nasolacrimal duct obstruction. Ophthalmology 2001: 108: 2038–40.
  6. Salour H, Hatami MM, Parvin M et al. Clinicopathological study of lacrimal sac specimens obtained during DCR. Orbit 2010: 29:250-3.

Submit a case

Please send your cases to:

Dr Hardeep Singh Mudhar BSc PhD MB BChir MRCPath
Consultant Ophthalmic Histopathologist
[email protected]