Primary ductal adenocarcinoma of lacrimal sac: A case report

Abstract

Primary lacrimal sac tumor is extremely rare and mostly malignant. Only limited cases have been reported. We herein presented a case of primary ductal adenocarcinoma of lacrimal sac with androgen receptor expression. A 69-year-old Thai male presented with progressive painless visual disturbance of his right eye weeks before a palpable mass was observed at right medial canthal area. Computed tomography demonstrated a heterogeneous enhancing mass at right lacrimal sac region which involves right upper nasolacrimal duct, right medial canthus, right lower and upper eyelid at nasal side with skin involvement. The mass posteriorly involves right extraconal fat and insertion of right medial rectus muscle. Biopsy from the right medial canthal mass was initially suggestive of oncocytic adenocarcinoma which can resemble primary ductal adenocarcinoma. After right eye exenteration was done, the final pathological findings and immunochemistry revealed a diagnosis of primary ductal adenocarcinoma of the lacrimal sac with androgen receptor expression. At first, the metastasis work up was equivocal. Only few nodules at lung were observed. However, the tumor is this case showed a progressive clinical course with multiple lymph nodes, lung and bone metastasis despite post-op radiation. This is the first case of primary ductal adenocarcinoma of the lacrimal sac with aggressive active disease at Thammasat University Hospital.