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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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2
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Goh LY, Limbachia K, Moonim M, Morley AMS. Primary lacrimal sac melanoma: a case report describing the novel use of fine needle aspiration cytology (FNAC) for diagnosis, together with literature review and immunotherapy treatment update. Orbit 2024; 43:270-279. [PMID: 36069101 DOI: 10.1080/01676830.2022.2119264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Primary lacrimal sac melanoma (PLSM) is exceedingly rare and associated with high morbidity and mortality. Unfortunately, PLSM often presents insidiously resulting in delayed detection and poor prognosis. A 69-year-old Black man was suspected of having a lacrimal sac tumour following presentation with a left sided watery eye, bloody tears, and a lacrimal mass. Due to the patient's implantable pacemaker, defibrillator, and high anticoagulation, an ultrasound-guided FNAC was performed instead of incisional biopsy, revealing a PLSM. Diagnosis was confirmed following complete tumour resection with free flap reconstruction and neck dissection. Unfortunately, disease progression ensued despite further neck dissection and three cycles of both pembrolizumab and iplimumab. This is the first description of FNAC to accurately diagnose PLSM and highlights its use as an accurate, rapid, and minimally invasive technique that may allow an earlier screening diagnosis of lacrimal sac tumours. We also discuss the outcome of immunotherapy in recent similar cases.
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Affiliation(s)
- Li Yen Goh
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ketan Limbachia
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Mufaddal Moonim
- Department of Histopathology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ana M S Morley
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
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3
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Vinciguerra A, Rampi A, Giordano Resti A, Barbieri D, Bussi M, Trimarchi M. Melanoma of the lacrimal drainage system: A systematic review. Head Neck 2021; 43:2240-2252. [PMID: 33843111 DOI: 10.1002/hed.26705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/02/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
Melanoma of the lacrimal drainage system (LDSM) is a rare and subtle condition that is frequently misdiagnosed. In the present work, we conducted a systematic review investigating the clinical features, management, and prognosis of LDSM. A structured search, according to PRISMA criteria, was performed in April 2020 and updated in February 2021 on Pubmed, EMBASE, Cochrane, and SCOPUS. The articles found underwent a double-reviewer selection and the main data were extracted. After complete screening, 30 articles reporting 38 cases were included. The time from the first symptom to medical contact ranged from 1 month to 4 years. Surgery was the treatment proposed to all patients, with a variable extension of resection. LDSM is a rare disease that is burdened by poor prognosis. Early diagnosis is crucial, even if difficult to achieve. Surgery and radiotherapy are standardized treatments, while targeted therapy and immunotherapy are attractive prospects.
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Affiliation(s)
- Alessandro Vinciguerra
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Rampi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Ophthalmologic Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Barbieri
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Shao JW, Yin JH, Xiang ST, He Q, Zhou H, Su W. CT and MRI findings in relapsing primary malignant melanoma of the lacrimal sac: a case report and brief literature review. BMC Ophthalmol 2020; 20:191. [PMID: 32408870 PMCID: PMC7222429 DOI: 10.1186/s12886-020-01356-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary lacrimal sac melanoma is an extremely rare condition with fewer than 50 cases reported so far. Clinically, its symptoms resemble those of dacryocystitis, leading to frequent misdiagnosis. During diagnosis, imaging examination is often performed to differentiate tumors from inflammation. In this report, we present a case of primary lacrimal sac melanoma and summarize the CT and MRI characteristics of lacrimal sac melanoma. CASE PRESENTATION We report a 50-year-old female patient who had undergone a dacryocystectomy for the left lacrimal sac mass. Postoperative pathological examination confirmed the presence of primary malignant melanoma. Three months later, a lump in the lacrimal sac area was found. The patient underwent CT and MR examinations. CT scan demonstrated a partially well-defined soft mass in the fossa of left lacrimal sac extending into the nasolacrimal duct and anterior ethmoid sinus. MRI revealed an intermediate signal intensity on T1 and iso-or hyper-signal on T2 weighted images. Histopathological examination on biopsy confirmed recurrence of primary lacrimal sac melanoma. DISCUSSION AND CONCLUSIONS None has described the CT and MR findings of primary lacrimal sac melanoma so far. Typically, MR images show hyperintensity signal on T1-weighted images and hypointense signal on T2-weighted images owing to the paramagnetic properties of melanin. In contrast to previous reports and the present case, most cases do not present these typical signals. Thus, reporting such radiological findings is important to create awareness on variant images of primary lacrimal sac melanoma. This will reduce misdiagnosis and mistreatment.
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Affiliation(s)
- Ju-Wei Shao
- Department of Radiology, the Fourth Affiliated Hospital of Kunming Medical University, 176 Qing Nian Street, Kunming, People's Republic of China
| | - Jian-Hua Yin
- Department of Radiology, the First Hospital of Kunming, Kunming, People's Republic of China
| | - Shu-Tian Xiang
- Department of Radiology, the Fourth Affiliated Hospital of Kunming Medical University, 176 Qing Nian Street, Kunming, People's Republic of China
| | - Qian He
- Department of Radiology, the Fourth Affiliated Hospital of Kunming Medical University, 176 Qing Nian Street, Kunming, People's Republic of China
| | - Hong Zhou
- Department of Pathology, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Wei Su
- Department of Radiology, the Fourth Affiliated Hospital of Kunming Medical University, 176 Qing Nian Street, Kunming, People's Republic of China.
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Matsuo T, Tanaka T, Yamasaki O. Lacrimal Sac Malignant Melanoma in 15 Japanese Patients: Case Report and Literature Review. J Investig Med High Impact Case Rep 2019; 7:2324709619888052. [PMID: 31747798 PMCID: PMC6873277 DOI: 10.1177/2324709619888052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background. Primary malignant melanoma of the lacrimal sac is
rare. A patient with lacrimal sac melanoma was presented, and 14 Japanese
patients with lacrimal sac melanoma in the literature were reviewed.
Case Presentation. A 78-year-old Japanese man was presented
with painless swelling of the lacrimal sac on the left side. Dacryocystectomy
revealed diffuse infiltration with large epithelioid cells, sometimes with
pigments, which were positive for cocktail mix of antibodies to tyrosinase,
melan A (MART-1), and HMB45, leading to pathological diagnosis of melanoma. One
month later, positron emission tomography (PET) revealed 2 high-uptake sites
(SUVmax = 10.29 and 15.38) at the levels of medial canthus and
nasolacrimal duct, but no abnormal uptake in the other site of the body. The
lesion had the BRAF V600E mutation. He began to take daily oral dabrafenib (BRAF
inhibitor) and trametinib (MEK inhibitor), leading to no abnormal uptake on PET
in half a year. He had stable disease in good physical status with small and
weak uptake sites of lymph nodes on PET 1 year later. Results.
In the review of 15 Japanese patients, including this patient, local recurrence
was noted in 4 patients, regional lymph node metastasis only in 3, distant
metastasis in 6, and no metastasis in 6. Five patients died within 2 years and
the others were alive in short follow-up periods. Conclusions.
Chemotherapy was the standard for local recurrence or metastasis. Emerging
molecular target drugs, as shown in the present patient, would change the
strategy for management of lacrimal sac melanoma.
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Affiliation(s)
- Toshihiko Matsuo
- Okayama University Graduate School of Interdisciplinary Science and Engineeing in Health Systems, Okayama City, Japan.,Department of Ophthalmology, Okayama University Hospital, Okayama City, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Japan.,Melanoma Center, Okayama University Hospital, Okayama City, Japan
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Khanna RK, Fontaine A, Lemacon JM, Moriniere S, Pisella PJ. Hemolacria revealing a primary nasolacrimal duct melanoma. Can J Ophthalmol 2019; 54:e70-e73. [DOI: 10.1016/j.jcjo.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 11/15/2022]
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Primary Lacrimal Sac Melanoma With Metastatic Cervical Disease: A Review of the Literature and Case Report. J Oral Maxillofac Surg 2017; 75:1438-1441. [DOI: 10.1016/j.joms.2017.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 02/03/2023]
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Krishna Y, Coupland SE. Lacrimal Sac Tumors--A Review. Asia Pac J Ophthalmol (Phila) 2017; 6:173-178. [PMID: 28399337 DOI: 10.22608/apo.201713] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/20/2017] [Indexed: 12/15/2022] Open
Abstract
Tumors of the lacrimal sac are rare but their recognition and early management are imperative, as they are locally invasive and potentially life-threatening. Because of their rarity, large clinical studies with statistically significant data on the natural course, management, and prognosis of these neoplasms are unavailable. Current practices are therefore based on a few case series and a small number of isolated case reports. Most tumors are primary and of epithelial origin (60-94%), of which 55% are malignant. Lacrimal sac tumors typically present with epiphora and a palpable mass over the medial canthus and are thus often erroneously diagnosed as chronic dacryocystitis. A full history with clinical and diagnostic workup is essential to plan treatment, which is often multi-disciplinary. Statistically significant associations have been shown with higher tumor staging and size with increased metastatic risk and lower survival rates. Management usually involves complete surgical resection with adjuvant radiotherapy and/or chemotherapy for malignant lesions. Long-term follow-up is required, as recurrences and metastases can occur many years after initial treatment.
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Affiliation(s)
- Yamini Krishna
- Department of Cellular Pathology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England
| | - Sarah E Coupland
- Department of Cellular Pathology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England
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