Undifferentiated Carcinoma of the Lacrimal Sac: Case Report and Review of Literature

A 55-year-old man presented with a 2-year history of right-sided epiphora and was referred to the Oculoplastic services for dacryocystorhinostomy. A 3-month progressive growth of a right medial canthal mass was found. MRI revealed an extraconal, lobulated, homogeneously enhancing mass in the lacrimal sac fossa with globe indentation and displacement supero-temporally. Following a transcanalicular needle biopsy which was suggestive of a carcinoma, he underwent medial orbitectomy and maxillectomy, through a lateral rhinotomy, with removal of puncta and canaliculi after ensuring no regional or systemic spread. The lacrimal sac tumor was encapsulated, extending superiorly above the medial canthal tendon and involving the nasolacrimal duct, and posteriorly along the medial orbital wall. After ensuring surgical margins were cleared of tumor infiltration, orbital reconstruction was performed with titanium plate and nasolabial flap. He has completed adjuvant radiotherapy with no evidence of tumor recurrence at 15 months of follow-up.