Case Study: February 2014


  • A 70 year old female has a mass in the lacrimal sac associated with chronic epiphora.
  • The patient undergoes a dacryocystectomy.
  • See figs 1,2 and 3


  1. What is the histological reaction pattern seen?
  2. What is the likeliest diagnosis?
  3. What is the differential diagnosis?
Click to show answers
  1. This is a granulomatous inflammatory response. There are non-caseating granulomas present in the wall of the sac, composed of epithelioid histiocytes.
  2. Sarcoid dacryocytitis-although a diagnosis of exclusion.
  3. Differential for granulomas: Mycobacterial and fungal infection, foreign body, granulomatous vasculitis, VKH, Crohn’s, paraneoplastic granulomas, lymphoma.