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Abstract ID: 24-140
An Incidental finding of high-grade Lymphoma of the Lacrimal Sac
Dilip Kumar Mishra
Purpose
To report the clinical and histopathological aspect of lacrimal sac non- Hodgkin’s lymphoma, a rare non- epithelial malignant neoplasm of lacrimal sac region.
Methods
This is a case report of a 66-year-old lady presented with both eye (BE) lid recurrent acute dacryocystitis with suboptimal response to medical management. There was a history of failed dacryocystorhinostomy elsewhere. On syringing hard stop with mucoid regurgitation from opposite punctum was noted. Since the patient refused the option of BE revision dacryocystorhinostomy, BE dacryocysectomy was performed and the excised sac tissue was sent for routine histopathological examination.
Results
On haematoxylin and eosin stain of excised sac tissue on microscopy revealed the attenuated epithelium lining of sac with dense monomorphic round cell infiltrates into the stroma, and these round cells on immunohistochemistry diffusely expressed CD45 and CD20 which favours the lesion is B-cell origin lymphoma and surprisingly these round cells also expressed high Ki- 67 index which supported the diagnosis of diffuse large B cell lymphoma ( DLBCL).
Conclusion
Acute dacryocystitis is reported in as high as 35% of patients with lacrimal sac lymphoproliferative disorders. Hence a differential diagnosis of lymphoma should be kept in mind for elderly patients who present with recurrent acute dacryocystitis with suboptimal response to medical management. DLBCL of the lacrimal sac is a high grade lymphoma (DLBCL), which is a very aggressive tumor and delay in diagnosis and treatment may lead to poor prognosis.
Additional Authors
Nandini Bothra – OPHTHALMIC PATHOLOGY LABORATORY LV PRASAD EYE INSTITUTE
MOHAMMAD JAVED ALI – OPHTHALMIC PATHOLOGY LABORATORY LV PRASAD EYE INSTITUTE