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Diagnosis: Squamous cell carcinoma of the nasolacrimal sac

Squamous cell carcinoma is the most common malignant neoplasm of the nasal lacrimal duct and sac. Other malignant neoplasms include transitional cell carcinoma, adenocarcinoma, mucoid epidermoid carcinoma, and adenoid cystic carcinoma in the epithelial category. Non-epithelial lacrimal duct malignancies include fibrous histiocytoma which is half as frequent as squamous cell carcinoma, lymphoma and malignant melanoma. Benign lesions include papillomas, oncocytomas and benign mixed tumors. A nasal lacrimal duct tumor has over 50% chance of being malignant. These lesions tend to be invasive, metastasize and recur. Patients with nasal lacrimal duct masses often present with epiphora since the drainage of tears is blocked as well as recurrent dacryocystitis.

The normal lacrimal sac and duct may be filled with air or tears. The sac itself should not be larger than 2mm in diameter unless distended with air. The lacrimal sac is the proximal portion of the nasal lacrimal drainage system. The nasal lacrimal duct is the inferior extension of the lacrimal sac and drains into the nasal cavity via in the inferior meatus. Pathologic entities other than neoplasm which involve the nasal lacrimal duct system include dacryocystitis, anterior ethmoidal mucoceles, dermoids, and lacrimal duct stones. The differential here is limited to malignancy due to the chronicity and destructiveness of the mass. Primary ethmoidal malignancy is a possibility, although the epicenter looks like it is more in the orbit. malignancy Related Cases

Stefamuszyn MA, Hidayat AA, Pe'er JJ, et al. Lacrimal sac tumors. Ophthalmic Plastic & Reconstructive Surgery, Sep 1994; 10(3):169-84.

Nasolacrimal carcinoma Squamous cell carcinoma Periorbital cellulitis