Topic outline

  • Grand Rounds

    A patient presented to the emergency department for a history of tearing on the right eye and medial canthal mass. He had a history of chronic sinus pain for months, initial examination was notable for increased tear lake on the right eye, along with an irregular 1 cm ~ non mobile lesion overlying lacrimal sac, with mild tenderness, there was no reflux to sac palpation and there was mild erythema of the skin of the area. Imaging demonstrated an expansive lytic irregular lesion of the right lacrimal sac causing bony erosion and infiltration to the soft tissues anterior maxilla and nasal bone. Biopsy was expedited and revealed an squamous cell carcinoma of the right lacrimal sac, complimentary studies demonstrated uptake on ipsilateral cervical lymph nodes, the patient was taken for en bloc resection of the lesion with neck dissection and reconstruction requiring titanium plate, poly-I-Lactic Acid orbital implant with a nasoseptal + paramedian flap. Pathology revealed positive margins of the medial maxilla and anterior ethmoid as well as compromised lymph nodes for which the patient required supplemental 66 Gy radiotherapy and a 2-month weekly cycle of chemotherapy with cisplatin. On follow up the patient required a second stage procedure to release the paramedian flap, the patient successfully completed adjuvant therapy and has had no evidence of recurrence on 2 years of follow up.

    Presentation Date: 02/01/2024
    Issue Date: 02/09/2024