Indian Journal of Ophthalmology

PHOTO ESSAY
Year
: 2019  |  Volume : 67  |  Issue : 12  |  Page : 2043--2044

Solitary Fibrous Tumor of the lacrimal sac


Avriel I Gudkar1, Bipasha Mukherjee1, Subramanian Krishnakumar2,  
1 Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Larsen and Toubro Ocular Pathology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Avriel I Gudkar
Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu
India




How to cite this article:
Gudkar AI, Mukherjee B, Krishnakumar S. Solitary Fibrous Tumor of the lacrimal sac.Indian J Ophthalmol 2019;67:2043-2044


How to cite this URL:
Gudkar AI, Mukherjee B, Krishnakumar S. Solitary Fibrous Tumor of the lacrimal sac. Indian J Ophthalmol [serial online] 2019 [cited 2024 Mar 29 ];67:2043-2044
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2019/67/12/2043/271399


Full Text



Solitary Fibrous Tumor (SFT) was first described as a primary spindle cell tumor of the pleura.[1] There has been an increase in its incidence in nonpleural sites. SFTs of the lacrimal sac are rare with only six cases reported. We report the first case from the Indian subcontinent. A 65-year-old female presented with right eye watering for 2 years, associated with painless and progressive swelling at right medial canthus. Her best corrected visual acuity was 20/50 in right and 20/20 in left eye. External examination revealed a firm, well-circumscribed, nontender mass in right lacrimal sac region extending above medial canthal tendon [Figure 1]. There was no fistula and no regurgitation of fluid on pressure over lacrimal sac. Anterior segment examination revealed age-related immature cataracts in both the eyes while posterior segment examination was normal.{Figure 1}

Computed Tomography (CT) scan revealed a well-circumscribed, homogenous, right medial canthal mass of about 2.7 × 2.1 cms extending into the nasolacrimal duct with adjacent bone remodeling [Figure 2]a and [Figure 2]b. En bloc excision of the mass along with the nasolacrimal duct was performed through both external and endonasal approach [Figure 3]a and [Figure 3]b. Histopathology revealed partially capsulated tumor with hyper and hypocellular areas and scattered thin-walled blood vessels [Figure 4]a. The cells were distributed haphazardly with spindle-shaped and epithelioid morphology, mitotic index of < 4/10 high power field and absence of necrosis or giant cells were also noted [Figure 4]b. Immunohistochemistry was diffusely positive for CD34 and Bcl-2 and negative for cytokeratin, S-100, smooth muscle actin (SMA), epithelial membrane antigen (EMA), and desmin thus establishing the diagnosis of lacrimal sac SFT [Figure 5]a and [Figure 5]b. The patient was asymptomatic at 6 weeks follow-up.{Figure 2}{Figure 3}{Figure 4}{Figure 5}

Lacrimal sac SFTs may present as nasolacrimal duct obstruction, recurrent dacryocystitis, or as a slow-growing mass in the medial canthal region.[2],[3],[4] Complete surgical excision should be performed. Due to histological diversity, SFTs can mimic other tumors such as mesotheliomas and sarcomas. Immunohistochemistry is confirmatory test.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

Dr Olma Veena Noronha, VRR scans, Chennai.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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