Nasolacrimal tumors

Nasolacrimal tumors, in other words, tumors involving the nasolacrimal drainage apparatus are uncommon and have a variety of histologies. They are a more common cause of a lacrimal sac mass than an inflammatory cause.

Clinical presentation

Clinical presentation of nasolacrimal tumors are typically fairly non-specific, often resulting in delayed diagnosis . Typical presentations include :

• dacryocystitis
• epiphora
• epistaxis
• mass in the region of the nasolacrimal sac

Pathology

A number of histologies are encountered including :

• squamous cell papilloma
• squamous cell carcinoma (most common) 
• transitional cell papilloma
• transitional cell carcinoma
• oncocytoma
• adenocarcinoma
• adenoid cystic carcinoma
• malignant melanoma

Additionally, the nasolacrimal apparatus can be involved by direct spread from adjacent cutaneous or sinonasal tumors.

Radiographic features

Due to the small caliber of the nasolacrimal duct, symptoms may be present before easily detectable radiographic abnormalities become evident. When larger, these tumors are difficult to distinguish these from cutaneous or sinonasal tumors with direct extension into the region.

CT

When evident on imaging, most masses appear as soft tissue lesions involving the medial canthus region. Masses of the nasolacrimal duct may demonstrate bony remodeling and widening of the lacrimal bony canal .

MRI

The appearance on MRI is usually non-specific with a moderately enhancing mass in the region of the medial canthus . Careful examination of the infraorbital canal is warranted to assess for perineural spread.