Presentation
Right anteromedial orbit / lacrimal gland mass and epiphora.
Patient Data
Age: 60 years
Gender: Male
From the case:
Lacrimal sac adenocarcinoma
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- Contrast-enhancing soft tissue lesion measuring 33x20x29 mm (AP x transverse x craniocaudal) within the right orbital cavity centered on the lacrimal sac (inferomedially)
- The lesion extends within the pre- and postseptal cavity, compressing medial and inferior rectus muscles laterally, and has minor extension into subcutaneous area of the right nasal root at the naso-orbital corner.
- The lesion extends medially into the lateral aspect of the anterior ethmoidal air cells and occupies the right nasolacrimal sac and duct.
- No evidence of intracranial extension and no extension into the right maxillary sinus.
- The lesion is hyperintense on FLAIR.
- There are some internal foci of diffusion restriction suggestive of invasive nature.
From the case:
Lacrimal sac adenocarcinoma
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- A 33x20x29 mm mass metabolic primary involving the medial right orbital cavity centered on the lacrimal gland.
- At the inferior border of this lesion along the lacrimal duct, there is linear extension inferiorly with a small separate nodule which involves and seems to invade the medial aspect of the right maxillary sinus
- Nodal metastases: There is a small metabolic node within the superficial anterior aspect of the right parotid and several metabolic right level 2 nodes with a combined diameter of 5.21 x 1.75 x 2.32 cm (CC x AP x TR).
- Distant metastases: There is a small area of increased metabolic activity on the right and a metabolic medial right upper lobe apical segment lung lesion 2.39 cm in diameter with an appearance consistent with a metastasis (not shown).
Case Discussion
The patient underwent right extended orbitomaxillectomy, right parotidectomy, right neck dissection and locoregional reconstruction, followed by a staged right upper lobectomy.
Histology: Poorly differentiated adenocarcinoma invading lacrimal sac and sinonasal mucosa and 5/28 lymph node involvement.
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