Purpose: Malignant tumor occurred primarily in the lacrimal passage is a rare condition. Here, we present a case of malignant melanoma arising in the lacrimal sac.
Case: The patient was a 61-year-old woman who noticed bloody lacrimation in her left eye three months earlier. When she visited a previous doctor, because lacrimal sac tumor was suspected, the patient was referred to Department of Ophthalmology, Tokyo Medical University Hospital. Induration was observed on the skin corresponding to the left lacrimal sac, and lacrimal endoscopy revealed that the lacrimal sac was filled with a black exudate. Because atypical cells containing melanin granules were detected by cytology using the irrigation fluid, percutaneous lacrimal sac biopsy was performed, leading to the diagnosis of malignant melanoma. Positron emission tomography-computed tomography revealed an abnormal accumulation from the lacrimal sac to the nasal cavity but no abnormality in other organs. Operative treatment was then determined to be difficult; therefore, heavy ion radiotherapy and systemic chemotherapy were performed. After treatment, the tumor did not tend to increase and no clear metastasis to other organs was observed at 1 year after initial visit to our hospital; the patient made no additional visits afterward.
Conclusion: Although extremely rare, malignant melanoma may occur in the lacrimal passage, including the lacrimal sac; therefore, it is necessary to differentiate the condition from dacryocystitis, etc.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 124: 931-936, 2020.