Recurrent Epiphora after Dacryocystorhinostomy as an Initial Symptom of Lacrimal Sac Malignancy: A Case Report

淚囊惡性腫瘤以鼻腔淚囊吻合術後再發生溢淚作為初始徵兆：病例報告

陳孟德(Meng-Te Chen) ； 魏利真(Li-Chen Wei) ； 蔡顯揚(Hin-Yeung Choi)

《中華民國眼科醫學會雜誌》 47卷4期 (2008/12) Pp. 455-461

https://doi.org/10.30048/ACTASOS.200812.0010

摘要

前言：淚囊惡性腫瘤十分罕見，我們在此呈報一個病例，先前已接受過鼻腔淚囊吻合術，以再次溢淚作為惡性腫瘤的病癥。
個案報告：一位六十五歲男性，卅年前因左眼溢淚而接受鼻腔淚囊吻合術，近年又復發左眼溢淚。在他院診斷為二度鼻淚引流系統阻塞。於是轉診至本院，眼窩電腦斷層發現一淚囊腫瘤延伸至下鼻腔，並且有骨骼侵蝕的現象。曾診耳鼻喉科醫生內視鏡檢查發現鼻淚管的開口有灰白色硬組織。生物切片為上皮細胞癌。於是接受眼窩內容剜除與側邊鼻腔切除，輔助以術後放射線化學治療。目前尚無惡性腫瘤復發現象。
結論：淚囊之惡性腫瘤十分罕見。診斷鼻淚囊惡性腫瘤需要臨床上小心的病史詢問，理學檢查。

並列摘要

Purpose: We here report a rare case of lacrimal sac tumor of which initial presentation was epiphora.
Pateint: A 69-year-old male experienced left dacryocystorhinotomy at a private clinic about 30 years ago. He presented to our department with a 5-month history of recurrent excessive tearing of his left eye. Irrigation examination revealed reflux from the other canaliculus. Scintodacryocystography showed left side obstruction between the lacrimal sacs and the nasolacrimal ducts. A firm mass beneath left medial canthus was palpable and medial ectropion of left lower lid was noted. Orbital CT scan revealed a soft tissue mass in left lacrimal sac with invasion to left nasal cavity region. Laryngorhinologists were consulted for biopsy from nasal cavity and it was later reported as malignancy.
Result: We performed extensive tumor resection including left orbital exenteration, lateral partial rhinectomy and partial maxillectomy. Pathology studies preferred squamous cell carcinoma. Local radiation-therapy with concurrent chemotherapy was performed. There was no evidence showing tumor recurrence after 18 months of follow-up.
Conclusion: Lacrimal sac neoplasms are rare. Meticulous clinical approaches are necessary to make correct diagnoses.

並列關鍵字

Squamous cell carcinoma of the lacrimal sac ； Lacrimal sac tumor ； Lacrimal sac neoplasm