Primary malignant melanoma of the lacrimal sac: A case report
A 53-year-old woman was referred to the department of ophthalmology with a palpable mass at the left medial canthal region. She complained of a six month history of tearing and a two month history of occasional bloody discharge from the left eye as well as left medial canthal region swelling. The swelling was not associated with pain or visual disturbance. The patient had no previous history of regional surgery or trauma or excessive sun exposure. There was no history of a cutaneous primary melanoma.\nThe physical examination revealed a cystic, localized, non tender palpable mass at the left medial canthus consistent with an enlargement of the lacrimal sac. Computed tomography scanning of the paranasal sinus showed a soft tissue mass in the left lacrimal sac, attached to the medial orbital wall (). However, neither orbital cavity involvement nor bony destruction was detected. In addition, infiltration of the surrounding soft tissue was not detected, and the mass did not extend into the nasolacrimal duct. There was no associated cervical lymphadenopathy. The patient was taken to the operating room for a scheduled dacryocystectomy. A brown-pigmented soft tissue containing cystic mass filled the lacrimal sac and did not protrude through the nasolacrimal duct. The mass was removed from the nasal and lacrimal bone and dissected from the medial canthal tendon. The cystic mass was thought to be benign and therefore only a dacryocystectomy was performed.\nBiopsy and histological examination of the surgical specimen showed solid growth of malignant cells characterized by production of melanin pigments and hyperchromatic nuclei with prominent nucleoli (). The tumor cells showed strong immunoreactivity to melanoma specific antibody, HBM-45 in the immunohistochemical examination, consistent with a diagnosis of malignant melanoma (); whereas the immunoreactivity to the S 100 protein was negative. This histological examination confirmed the diagnosis of malignant melanoma and the resection margins were not free of tumor. A complete metastatic workup including computed tomography scanning of the head and neck, chest, abdomen and pelvis failed to demonstrate lymphadenopathy or other evidence of metastasis. A general physical examination and routine laboratory tests were all within normal limits. The patient underwent 6000 rad of adjuvant irradiation therapy at the left lacrimal region for four weeks after surgery. During the two months follow up after surgery and radiation therapy, the patient had no evidence of local recurrence; however, since then she has been lost to further follow up.