Nasolacrimal Duct Obstruction Caused by Oncocytic Carcinoma
A 64-year-old man was referred to the ophthalmology department of Pusan National University Hospital for evaluation of tearing, nasal obstruction, and trifling epistaxis of the left side that had arisen 12 months earlier. His medical history was free of allergies, chronic sinusitis, and rhinologic pathologies. Ophthalmologic examination confirmed mild swelling in the left medial canthal area and obstruction in the area of the left lacrimal duct (). Visual acuity, intraocular pressure, ocular motility, and the anterior segment were within normal limits. There was no exophthalmos. The patient was referred to the otolaryngology department, and nasal endoscopies revealed the presence of a diffuse, smooth, and flush swelling mass in the inferior meatus. Computed tomography (CT) revealed that the tumor extended from inferior meatus to the entire length of the left nasolacrimal duct and sac, with involvement of the medial wall of the maxillary sinus (). We observed neither regional lymph node involvement nor metastasis to other organs. We performed external dacryocystectomy to remove the lacrimal sac and proximal nasolacrimal duct and endoscopic inferior medial maxillectomy, including medial wall of maxillary sinus, inferior turbinate, and lateral wall of nasal cavity.\nMicroscopically, the tumor demonstrated a destructive, infiltrative growth pattern and was composed of numerous irregular small nests of pleomorphic oncocytic epithelial cells with abundant eosinophilic cytoplasm. It was positive for pancytokeratin (). Adjuvant radiotherapy was recommended to the patient after surgery, but the patient refused further treatment. Nine months after surgery, the patient complained of purulent discharge with tearing, swelling, and tenderness in the medial canthal area of the left eye. An orbital CT revealed a mass in the medial orbital wall ().\nThe orbital mass was removed through an inferior transconjunctival approach, and histological examination confirmed oncocytic carcinoma recurrence (). The patient was referred for adjuvant radiotherapy to eradicate any residual tumor. He received computer controlled radiation therapy as 60 Gy in 33 fractions over 8 weeks. The patient remains free of tumor recurrence after 1 year.