Sadhar Birkaran, Slupek David, Steehler Andrew, Denne Carter, Steehler Kirk
Lake Erie College of Osteopathic Medicine, Erie, PA, United States.
Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA, United States.
J Surg Case Rep. 2024 Jul 20;2024(7):rjae453. doi: 10.1093/jscr/rjae453. eCollection 2024 Jul.
Primary lacrimal sac lymphoma is a rare condition, often presenting with nasolacrimal duct obstruction. Herein, we present a unique case of diffuse large B-cell lymphoma (DLBCL) involving the lacrimal sac, maxillary sinus, and infraorbital nerve. Prompt diagnosis via biopsy is essential for timely treatment and the prevention of tumor progression. A 66-year-old female presented with intractable epiphora, infraorbital nerve hypesthesia, and medial canthal swelling. Imaging revealed a soft tissue mass in the right maxillary sinus extending into the right inferior orbit and nasal cavity. A biopsy confirmed DLBCL, prompting systemic chemotherapy. Residual disease prompted high-dose involved-site radiation, resulting in tumor regression. To our knowledge, this is the first case of primary DLBCL of the lacrimal sac with concurrent involvement of the maxillary sinus and infraorbital nerve. This case underscores the significance of lacrimal sac biopsy in refractory dacryocystitis or unilateral sinus disease and the effectiveness of multimodal treatment approaches in managing DLBCL.
原发性泪囊淋巴瘤是一种罕见疾病，常表现为鼻泪管阻塞。在此，我们报告一例独特的弥漫性大B细胞淋巴瘤（DLBCL）累及泪囊、上颌窦和眶下神经的病例。通过活检进行及时诊断对于及时治疗和预防肿瘤进展至关重要。一名66岁女性出现难治性溢泪、眶下神经感觉减退和内眦肿胀。影像学检查显示右侧上颌窦有一软组织肿块，延伸至右下眼眶和鼻腔。活检确诊为DLBCL，遂进行全身化疗。残留病灶促使进行高剂量受累部位放疗，导致肿瘤消退。据我们所知，这是首例原发性泪囊DLBCL同时累及上颌窦和眶下神经的病例。该病例强调了泪囊活检在难治性泪囊炎或单侧鼻窦疾病中的重要性以及多模式治疗方法在管理DLBCL方面的有效性。
