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Campobasso G, Ragno MS, Monda A, Ciccarone S, Maselli del Giudice A, Barbara F, Gravante G, Lucchinelli P, Arosio AD, Volpi L, Bignami M. Exclusive or combined endoscopic approach to tumours of the lower lacrimal pathway: review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S67-S81. [PMID: 38745518 PMCID: PMC11098540 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/06/2024] [Indexed: 05/16/2024]
Abstract
A literature review was conducted to assess the role of minimally-invasive endoscopic treatments for lacrimal pathway neoplasms. The study involved the analysis of 316 patients with benign or malignant tumours affecting the lacrimal drainage system. Histologically, the analysis revealed a prevalence of squamous cell carcinoma, followed by lymphatic neoplasms and melanomas. In terms of treatment, minimally-invasive endoscopic approaches, such as endoscopic dacryocystorhinostomy, play a predominant role in managing early-stage tumours, rather than merely obtaining samples for histological analysis. For more extensive tumours, which constitute the majority of cases, more aggressive external approaches are required, along with the use of adjuvant radiotherapy and chemotherapy. The lack of universally shared staging systems poses a limitation in standardisation and comparison of results. Treatment of these tumours remains complex due to their rarity and histological heterogeneity. A multidisciplinary approach is mandatory to optimise outcomes.
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Affiliation(s)
- Giuseppe Campobasso
- Unit of Otorhinolaryngology, Presidio Ospedaliero “Mons. Dimiccoli”, Barletta, Italy
| | | | | | - Silvana Ciccarone
- Unit of Otorhinolaryngology, Presidio Ospedaliero “Mons. Dimiccoli”, Barletta, Italy
| | | | | | - Giacomo Gravante
- Unit of Otorhinolaryngology, ASST-Sette Laghi, University of Insubria, Varese, Italy
| | - Paolo Lucchinelli
- Unit of Otorhinolaryngology, ASST-Sette Laghi, University of Insubria, Varese, Italy
| | | | - Luca Volpi
- Unit of Otorhinolaryngology, ASST-Lariana, University of Como, Italy
| | - Maurizio Bignami
- Unit of Otorhinolaryngology, ASST-Sette Laghi, University of Insubria, Varese, Italy
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Sun H, Cai R, Zhai C, Song W, Sun J, Bi Y. Primary Mucoepidermoid Carcinoma of the Lacrimal Apparatus. Am J Ophthalmol 2022; 239:170-179. [PMID: 35288069 DOI: 10.1016/j.ajo.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE In this study, we evaluated the clinicopathologic and molecular characteristics of lacrimal apparatus mucoepidermoid carcinoma (MEC) to define its typical diagnostic features. DESIGN Retrospective observational case series. METHODS Institutional pathology records between 2011 and 2021 were searched for all cases of lacrimal apparatus MEC. RESULTS A total of 2 male and 6 female patients ranging in age from 18 to 83 years (median 56, mean 54) were included. Six lacrimal apparatus MECs were found in the lacrimal gland, and 2 cases occurred in the lacrimal sac and nasolacrimal duct. Histologically, there were 6 cases of conventional MEC, 1 clear-cell variant of MEC, and 1 oncocytic variant of MEC for a total of 8 cases. There were 3 low-grade cases and 5 high-grade cases. All 8 cases were evaluated via immunohistochemistry, and the results were positive (scores 1-4) for pankeratin, 34betaE12, p63, p40, CK7, CK8, and CK19, with a relatively higher expression of p63 observed in high-grade MEC. The presence of human papillomavirus (HPV) type 6 DNA was found in 4 patients. MAML2 fluorescence in situ hybridization was positive for MAML2 rearrangement in 3 lacrimal gland tumors (2 low-grade and 1 high-grade). Six tumors were managed with radical resection, and 2 patients underwent orbital exenteration. Postoperative radiation therapy was delivered to 6 patients, and chemotherapy was administered to 1 patient. CONCLUSIONS MECs of the lacrimal apparatus are rare tumors, and the rate of MAML2 translocations is lower than that in salivary MECs. Lacrimal gland and lacrimal sac MECs may not be of the same subtypes intrinsically because of the difference in MAML2 translocation, anatomy, and clinical course. The etiologic function of HPV type 6 infection should be explored in lacrimal apparatus MECs. Radical surgery is the treatment of choice. The description of these unique findings may assist in the definitive diagnosis of and improve our understanding of lacrimal apparatus MEC.
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Affiliation(s)
- Hui Sun
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.); Department of Pathology, Fudan University Shanghai Cancer Center (H.S.), Shanghai, China
| | - Rongrong Cai
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Changwen Zhai
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Wanjing Song
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Ji Sun
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Yingwen Bi
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.).
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Kadir SMU, Rashid R, Sultana S, Nuruddin M, Nessa MS, Mitra MR, Haider G. Lacrimal Sac Tumors: A Case Series. Ocul Oncol Pathol 2022; 8:42-51. [PMID: 35356605 PMCID: PMC8914267 DOI: 10.1159/000520086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/29/2021] [Indexed: 02/03/2023] Open
Abstract
Objective The aim of the study was to describe the clinical presentation, management strategies, and outcomes in a case series of primary lacrimal sac tumors. Methods This retrospective study was conducted in Sheikh Fajilatunnessa Mujib Eye Hospital and Training Institute, Bangladesh, from July 1 to December 31, 2020, and included all patients who were evaluated, treated, and followed up for at least 6 months from January 2013 to October 2020. One patient developed a recurrence of the adenocarcinoma of the lacrimal sac after 1 year of primary treatment. Patients' demographic data were analyzed and reviewed from published articles on lacrimal sac tumors. We assessed patients clinically, followed by radiological evaluation. We also analyzed the biopsy technique, treatment modality, and recurrence. An oncologist reviewed all patients to prepare a plan for adjuvant treatment. Results Ten patients with lacrimal sac tumors were included in this study. Swelling in the medial canthal region was the most common presenting feature (100%), followed by epiphora (60%) and pain (30%). Open biopsy was preferred over fine-needle aspiration biopsy. Incisional biopsy or complete excisional biopsy was performed for all suspected malignancies. Malignant tumors were found in 7 (70%) cases, and benign tumors in 3 (30%) cases. Non-Hodgkin's lymphoma (NHL) (40%) was the most common malignant lacrimal sac tumor. Mucosa-associated lymphoid tissue lymphoma was 75%, and diffuse large B-cell lymphoma was 25% among the cases of NHL. Patients with epithelial malignancy were treated with external beam radiation therapy, while NHL patients were treated with chemotherapy (CHOP regimen). Recurrence was noted in 1 case (10%) of epithelial malignancy after 1 year of treatment. Conclusion Successful management of lacrimal sac tumors requires a high index of suspicion, as these are fatal tumors, often misdiagnosed as dacryocystitis. Nonepithelial malignancies are more predominant than epithelial malignancies, and hematolymphoid tumors are most frequent.
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Affiliation(s)
- Syeed Mehbub Ul Kadir
- Training and Academy, Sheikh Fajilatunnessa Mujib Eye Hospital and Training Institute, Gopalgonj, Bangladesh,*Syeed Mehbub Ul Kadir,
| | - Riffat Rashid
- Department of Ocular Oncology and Oculoplasty, Ispahani Islamia Eye Hospital and Institute (IIEHI), Dhaka, Bangladesh
| | - Sadia Sultana
- Department of Ocular Oncology and Oculoplasty, Ispahani Islamia Eye Hospital and Institute (IIEHI), Dhaka, Bangladesh
| | - Murtuza Nuruddin
- Department of Ocular Oncology and Oculoplasty, Chittagong Eye Infirmary and Training Complex (CEITC), Chittagong, Bangladesh
| | - Mst. Sayedatun Nessa
- Department of Pathology, Northern International Medical College and Hospital, Dhaka, Bangladesh
| | - Mukti Rani Mitra
- Department of Ophthalmology, Dhaka Medical College, Dhaka, Bangladesh
| | - Golam Haider
- Medical Education, Bangladesh Eye Hospital and Institute, Dhaka, Bangladesh
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Makino K, Nakajima K, Tsutsumi S, Toriyama A, Nonaka S, Okura H, Matsuzaka K, Nagao T, Izumi H, Tomita S, Ishii H. Mucoepidermoid carcinoma of the lacrimal gland in a patient with the CRTC1-MAML2 fusion gene. Radiol Case Rep 2021; 16:3643-3646. [PMID: 34630791 PMCID: PMC8493510 DOI: 10.1016/j.radcr.2021.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) of the lacrimal gland (LG) is a rare entity. A 47-year-old woman was aware of periorbital swelling for 3 months. At presentation, the patient showed periorbital swelling in the right eye. CT scan showed an isodense mass in the anterior superolateral part of the orbit. MRI delineated the mass as enhancing, extra-conal tumor appearing isointense on T1-weighted sequences, and to be of mixed intensity on T2-weighted sequences. The tumor was totally resected. Microscopically, the tumor tissue was comprised of squamous, epithelioid cells, and cells with plump and clear cytoplasm. Necrosis, neural invasion, or mitotic figures were not observed. Immunohistochemical examination revealed intense staining for cytokeratin 7. A subset of the cells was positively stained with periodic acid-Schiff and mucicarmine stains. Genetic analysis revealed the presence of the CRTC1-MAML2 fusion. The CRTC1-MAML2 fusion may be a useful indicator for the prognosis and planning of adjuvant therapy.
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Affiliation(s)
- Kensaku Makino
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kei Nakajima
- Clinical Pathophysiology, Tokyo Dental College, Tokyo, Japan
| | - Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akane Toriyama
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Senshu Nonaka
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hidehiro Okura
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Izumi
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shigeki Tomita
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
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Abstract
Purpose: To perform a literature review on the primary malignant epithelial tumors (PMET) involving the lacrimal drainage system (LDS).Methods: The authors performed a PubMed search of all articles published in English on primary malignant epithelial tumors of the lacrimal sac and the nasolacrimal duct. Data analyzed include prevalence, demographics, clinical presentation, histopathological subtypes, management modalities, outcomes, and recurrence rates.Results: Malignant epithelial tumors of the lacrimal sac are commonly diagnosed in the fifth to seventh decades of life (mean age: 58 years) and have no gender predilection. Typical clinical presentation includes epiphora (84%) and lacrimal fossa mass lesion (78%). Pain (9%) and blood-stained epiphora (4%) were inconsistent findings. Among the PMET, squamous cell carcinomas (SCCs) were the most common (61%) followed by transitional cell carcinomas (TCC; 15%), and mucoepidermoid carcinoma (MEC; 7%). Complete surgical excision followed by radiotherapy (59%) was the preferred modality of management, and only 18% required orbital exenteration. Of the 331 tumors with available treatment details, 85% survived at a mean follow-up of 33 months. The overall recurrence rate following treatment was 20% (65/331). MECs of the lacrimal sac had the best while adenoid cystic carcinoma had the worst prognosis.Conclusion: Blood-stained epiphora was not the classical presentation for primary epithelial malignancies of the LDS. No validated staging system exists for lacrimal drainage tumors. There is a need for consistent and detailed reporting in the literature, more so on the histological subtypes and their management.
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Affiliation(s)
- Swati Singh
- Ophthlamic Plastics services, L.J. Eye Institute, Ambala, India
| | - Mohammad Javed Ali
- Govindram Sekhsaria Institute of dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Ramberg I, Toft PB, Heegaard S. Carcinomas of the lacrimal drainage system. Surv Ophthalmol 2020; 65:691-707. [PMID: 32304675 DOI: 10.1016/j.survophthal.2020.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022]
Abstract
Malignant tumors of epithelial origin are the most frequent neoplasms of the lacrimal drainage system (LDS). A total of 539 cases are reported in the literature from 1960 to 2019. LDS carcinoma is a disease of the middle-aged and elderly population, with a median age at diagnosis of 57 years. Overall, there is a slight male predominance. Reported risk factors are chronic inflammation, LDS papilloma, and infection with oncogenic viruses. Symptoms of an LDS carcinoma resemble those of benign, inflammatory diseases, with epiphora from obstruction of the LDS as the most frequently encountered symptom. The median time from symptoms to diagnosis is 12 months and even longer for patients reporting epiphora as the only initial symptom. This diagnostic delay leads to a substantial fraction of patients with locally advanced tumors and lymph node spread at the time of diagnosis. Surgery with adjuvant radiotherapy is the treatment of choice for most patients; however, the extension and aggressiveness of the disease and the patient's general health and preferences determine the definite treatment. Five-year overall survival is reported to range from 61 to 87.6%. A large tumor size and positive lymph node status correlate with a decreased overall and disease-free survival.
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Affiliation(s)
- Ingvild Ramberg
- Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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