title: Transitional cell-type papillary carcinoma of the lacrimal sac manifesting as a medial canthal skin lesion.
abstract: A 61-year-old man presented with a 2.5 cm fungating skin lesion above the right medial canthus, accompanied by fluctuance and subtle inferotemporal globe displacement. The tumor had erupted 2 months previously and grown rapidly. Computed tomography (CT) revealed a 4.2 × 2.8 × 2.1 cm exophytic mass of the right orbit, superimposed on chronic dacryocystitis. Incisional biopsy disclosed faulty epithelial maturation sequence with possible basement membrane invasion. The patient underwent wide excision with medial maxillectomy, inferior turbinectomy, ethmoidectomy, and partial rhinectomy. The orbital floor was then reconstructed; a paramedian forehead flap and myocutaneous cheek advancement flap were used to fill cutaneous defects. All surgical margins were negative on both frozen and permanent sections. Definitive histopathology was consistent with transitional cell type papillary carcinoma of the lacrimal sac. Adjuvant radiotherapy was recommended, but the patient has declined further treatment. He remains recurrence-free at one year.
authors.affiliation: Bascom Palmer Eye Institute , Miami, Florida , USA and.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Erickson
authors.forename: Yasha S
authors.initials: YS
authors.lastname: Modi
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Ko
authors.forename: Rehan M
authors.initials: RM
authors.lastname: Hussain
authors.forename: Carmen
authors.initials: C
authors.lastname: Gomez-Fernandez
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Johnson
mesh_terms: D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000601:surgery; D005134:Eye Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005142:Eyelid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D019651:Plastic Surgery Procedures; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Cutaneous lesion; lacrimal sac tumor; orbital tumor; transitional cell carcinoma