Che Zi-Gang, Ni Ting, Wang Zhen-Chang, Wang De-Wang
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Department of Radiology, Nanjing Tongren Hospital, Southeast University Medical College, Nanjing 211102, Jiangsu Province, China.
World J Clin Cases. 2021 Mar 16;9(8):1940-1945. doi: 10.12998/wjcc.v9.i8.1940.
Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.
A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.
This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.
鼻泪管阻塞导致溢泪是一种常见的眼科病症，在罕见情况下可能源于淀粉样变性。关于局限性淀粉样变性的报道较少，而累及鼻泪管并导致阻塞的淀粉样变性极为罕见。
一名54岁男性，左泪囊上方肿物2年，近半年迅速增大。体格检查发现左泪囊处有一质地坚硬的肿物。鼻内镜检查发现左下鼻道鼻泪管入口处有外观似沉积物的病变，易出血。计算机断层扫描显示左泪囊及鼻泪管扩张处有斑点状高密度影。在内镜探查及切除过程中，发现大量泪石。病理显示纤维组织中有无定形粉红色物质及多核巨细胞反应。
本病例显示为局限性淀粉样变性，酷似伴有鼻泪管阻塞的泪石。在临床实践中，我们应意识到鼻泪排泄系统发生局限性淀粉样变性的可能性。
