접수번호:08-037 Korean Journal of Ophthalm ology 2009;23:100-103 ISSN : 1011-8942 DOI : 10.3341/kjo.2009.23.2.100 A Case of Recurrent Schneiderian Papilloma of the Lacrimal Sac Invading the Nasal Cavity Ji Hye Jang, MD1, Sung Dong Chang, MD1, Mi Sun Choe, MD2 Departments of 1Ophthalmology and 2Pathology, Dongsan Medical Center, Keimyung University, Daegu, Korea A 44-year-old man presented with a history of chronic epiphora, discharge from the right eye, and a palpable mass in the medial canthal area. Irrigation of the lacrimal system revealed bloody discharge. Orbital magnetic resonance imaging (MRI) showed a well-defined heterogeneous enhanced mass filling the lacrimal sac and upper nasolacrimal duct (NLD). A wide excision and surgical biopsy were performed. Histopathology showed the tumor to be an exophytic Schneiderian papilloma with moderate to severe dysplasia. Three months later, the mass was found to be invading the nasal cavity through the NLD. Endoscopic histopathological evaluation confirmed that it was identical to the originally identified papilloma. Korean J Ophthalmol 2009;23:100-103 ⓒ 2009 by the Korean Ophthalmological Society. Key Words: Lacrimal sac, Recurrent exophytic papilloma, Schneiderian papilloma The Schneiderian papilloma originates from the mucosal epithelial lining of the nasal cavities, the paranasal sinus, the nasolacrimal duct (NLD) and the lacrimal sac.1 The majority of cases develop in the lateral nasal wall or paranasal sinus.2 A lacrimal sac is a rare location for the Schneiderian papilloma.3 We report the case of a recurrent Schneiderian papilloma of the lacrimal sac that was removed surgically, but eventually invaded the nasal cavity through the NLD. Case Repo rt Clinical History A 44-year-old male patient visited the outpatient depart- ment with complaints of a chronic epiphora, and discharge from the right eye. A palpable mass had been noted in the right medial canthal area 10 days prior to the visit. On ophthalmological examination, the visual acuity was 1.0 in both eyes without correction and there was no relative afferent pupillary defect. A firm and tender mass was palpated above the right medial canthal ligament area. Bloodstained discharge was noted after right nasolacrimal duct irrigation. Examination of the other eye and nasal cavity was normal. Dacryocystography showed evidence of a soft tissue mass Received: April 22, 2008 Accepted: March 30, 2009 Reprint requests to Sung Dong Chang, MD. Department of Ophthalmology, School of Medicine, Keimyung University, #194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. Tel: 82-53-250-7702, 7708, Fax: 82-53-250-7705, E-mail: changsd@dsmc.or.kr * This case was presented as a poster at the 99th Autumn Meeting of Korean Ophthalmology Society, November 2007, Ilsan, Korea. 100 as an uneven mottled density of the contrast media in the right lacrimal sac (Fig. 1). Magnetic resonance imaging (MRI) of the orbit revealed a well-defined heterogeneous enhancing mass lesion, approximately 18×9 mm, filling the lacrimal sac and extending to the upper NLD. The mass extended anteriorly to the right facial soft tissues with no any evidence of bony structure destruction (Fig. 2). Under local anesthesia, excision of a mass was performed by dacryocystectomy using a standard dacryocystorhinostomy skin incision. When the lacrimal sac was removed, the mass was found within lacrimal sac, extending into the NLD. Adhesions were adjacent to the sac and obstruction of the NLD occurred at the junction with the bony canal due to tumor extension to the excision margins. We removed as much of the tumor as possible, but could not excise a portion that was located in the bony canal duct. Surgical biopsy demon- strated an exophytic Schneiderian papilloma with focal mode- rate to severe dysplasia on the histopathology. Three months after the operation, the orbital MRI showed a recurrent mass in the right lacrimal sac invading the nasal A B Fig. 1. Dacryocystography shows an uneven, mottled density of contrast media, evidence of a soft tissue mass (A: blue arrow, B: black arrow) at the right lacrimal sac.