Arjamilah Mohamed Noor, Zamli Akmal Haliza, Tai Evelyn, Shatriah Ismail
Opthalmology, Hospital Tengku Ampuan Afzan, Kuantan, MYS.
Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS.
Cureus. 2022 Sep 13;14(9):e29114. doi: 10.7759/cureus.29114. eCollection 2022 Sep.
Primary non-Hodgkin's lymphoma of the lacrimal sac is extremely rare, usually representing secondary involvement of systemic malignancy. We report a case of bilateral primary non-Hodgkin's lymphoma of the lacrimal sac presenting with bilateral medial canthal swelling for one month which was preceded by a history of chronic bilateral epiphora and a recurrent history of dacryocystitis. The symptoms partially responded to systemic antibiotics for the past three years. Clinical examination revealed bilateral diffuse erythematous medial canthal swelling extending to the upper cheeks. CT of the orbits and paranasal sinuses demonstrated soft tissue masses involving bilateral lacrimal sacs and ducts. Endoscopic dacryocystorhinostomy (DCR) with excision biopsy of both lacrimal sac was performed and histopathologically confirmed the diagnosis of extranodal marginal zone B-cell lymphoma. She completed six cycles of chemotherapy. The symptoms subsided and radiologically showed a significant reduction of soft tissue mass at bilateral nasolacrimal sacs and ducts after completion of chemotherapy. Recurrent atypical presentation of dacryocystitis with suboptimal response to standard treatment should raise a suspicion of secondary cause. Histopathological examination is therefore crucial to avoid delays in diagnosis and treatment.
泪囊原发性非霍奇金淋巴瘤极为罕见，通常为系统性恶性肿瘤的继发性累及。我们报告一例双侧泪囊原发性非霍奇金淋巴瘤病例，患者表现为双侧内眦肿胀1个月，之前有双侧慢性溢泪病史及泪囊炎反复发作史。在过去三年中，症状对全身使用抗生素有部分反应。临床检查发现双侧弥漫性红斑性内眦肿胀，向上颊部延伸。眼眶和鼻窦CT显示软组织肿块累及双侧泪囊和泪管。进行了内镜下泪囊鼻腔吻合术（DCR）并切除双侧泪囊活检，组织病理学确诊为结外边缘区B细胞淋巴瘤。她完成了六个周期的化疗。化疗完成后，症状消退，影像学显示双侧鼻泪囊和泪管的软组织肿块明显缩小。泪囊炎反复出现非典型表现且对标准治疗反应欠佳时，应怀疑有继发原因。因此，组织病理学检查对于避免诊断和治疗延误至关重要。
