A Study on Inverting Papilloma of the Lacrimal Sac: A Case Report and Literature Review

Objective: To report a rare case of inverting papilloma originating from the lacrimal sac, and to review the literature of inverting papilloma of the lacrimal sac as main origin.

Method: Case report.

Results: Inverting papilloma is uncommon in the lacrimal sac. More often it presents in the maxillary sinus, ethmoid sinus and lateral wall of the nasal cavity. This is a case of a 69 year old, Filipino male, who presented with a two-year history of gradually enlarging left medial canthal mass, and tearing. The patient had no history of trauma. There were no ophthalmoplegia, visual disturbances, proptosis or pain but there was globe displacement superolaterally. Orbital CT-scan revealed a heterogenously enhancing mass extending to the ipsilateral nasolacrimal canal and nasal cavity causing mass effect. There was note of a suspicious area of hyperostosis. Patient was referred to the Department of Otolaryngology Head and Neck Surgery for co-management. Punch biopsy was done and histopathology revealed inverting papilloma. Combined surgical management of anterior maxillectomy via lateral rhinotomy approach and dacryocystectomy was done. Intraoperatively, there was note of adhesion to bone in the area of the lacrimal sac corresponding to the area of hyperostosis on CT-scan. Post-operative recovery was unremarkable with unchanged visual acuity and extraocular muscle movement.

Conclusion: This is a case of an inverting papilloma involving the lacrimal sac and nasolacrimal duct that was managed with combined anterior maxillectomy via lateral rhinotomy approach and dacryocystectomy for complete resection. We recommended complete resection of the tumor to minimize recurrence. Origin in the lacrimal sac area was confirmed by intraoperative findings which correlated with CT- scan findings.