Clinical features and management of tumors affecting the lacrimal drainage apparatus.
OBJECTIVE
To report the clinical features of a series of patients with lacrimal drainage apparatus tumors and present guidelines for management based on histopathology.


METHODS
A non-comparative retrospective chart review of the clinical, imaging, and pathologic findings of 37 patients presenting to four regional orbital surgery departments with tumors affecting the lacrimal drainage apparatus between 1990 and 2004.


RESULTS
There were 37 patients, of whom 62% were male. The mean age at referral was 54 years. Epiphora, a palpable mass, and dacryocystitis were the most common presentations. Two thirds of the tumors were epithelial, with carcinomas being the most frequent (38%), followed by papillomas (27%). Lymphomas were the most common nonepithelial malignancy (30%). Epithelial tumors were more common in men (87%), whereas lymphomas were more common in women (57%). Treatment modalities included surgery, in addition to radiotherapy and/or chemotherapy and immunotherapy. Mean follow-up was 38 months. Thirty-three patients (89%) remain alive without evidence of disease and 4 patients died of recurrence and/or metastases.


CONCLUSIONS
Lacrimal drainage apparatus tumors require careful initial management to ensure adequate local and systemic disease control. Atypical mucosa encountered during dacryocystorhinostomy should be biopsied and small papillomas or pedunculated tumors excised and analyzed with frozen sections. If a diffuse or infiltrative mass is encountered, it should be biopsied and managed on the basis of histopathology and extent of disease. Lymphomas should be treated according to protocols, whereas noninvasive carcinoma and extensive papillomas require complete excision of the system. Invasive disease requires en bloc excision. Long-term follow-up is essential for early detection of recurrence.
Valenzuela
Alejandra A
AA
Eyelid, Lacrimal and Orbital Clinic, Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital and the University of Queensland Medical School, Queensland, Australia.
McNab
Alan A
AA
Selva
Dinesh
D
O'Donnell
Brett A
BA
Whitehead
Kevin J
KJ
Sullivan
Timothy J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005134:Eye Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome