title: Primary Mucoepidermoid Carcinoma of the Lacrimal Sac -  a Case Report and Literature Review.
abstract: BACKGROUND
  Lacrimal sac tumors are very rare and are often missed because patients present with features consistent with chronic dacryocystitis. Squamous cell carcinoma is the common-est lacrimal sac malignancy. Although primary mucoepidermoid carcinomas of the lacrimal sac are rare, they are locally aggressive. Furthermore, their proximity to vital structures and the skull base makes them potentially life-threatening. Multidisciplinary management is required, and wide excision followed by chemoradiation is the recommended treatment.
  
  
  METHODS
  Here, we report a 65-year-old male who presented with watering eyes and a mass in the region of the medial canthus. A dia-gnosis of primary mucoepidermoid carcinoma of the lacrimal sac was made, and the case was managed successfully with radical surgery and reconstruction. The tumor was resected using the extended Lynch-Howarth incision and the resulting defect was reconstructed using a forehead flap. Histopathological examination of the excised specimen revealed mucoepidermoid carcinoma. Immunohistochemical analysis revealed that the speci-men was positive for epithelial growth factor receptor and Ki-67 protein. The patient was referred for post-operative chemoradiation. The literature is reviewed and pathological features, including immunohistochemistry are discussed.
  
  
  CONCLUSIONS
  Primary mucoepidermoid carcinoma of the lacrimal sac is a rare, locally aggressive tumor that is often mistaken for dacryocystitis. The treatment of choice is radical surgery followed by chemoradiation.
  
  
  BACKGROUND
  lacrimal sac -  mucoepidermoid carcinoma -  epithelial growth factor receptor -  Ki-67 protein.
authors.forename: T N
authors.initials: TN
authors.lastname: Janakiram
authors.forename: S
authors.initials: S
authors.lastname: Sagar
authors.forename: S B
authors.initials: SB
authors.lastname: Sharma
authors.forename: V
authors.initials: V
authors.lastname: Subramaniam
mesh_terms: D000368:Aged; D018277:Carcinoma, Mucoepidermoid / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D066246:ErbB Receptors / Q000378:metabolism; D005134:Eye Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008297:Male; D009301:Nasolacrimal Duct / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D019394:Ki-67 Antigen; C512478:EGFR protein, human; D066246:ErbB Receptors