Clinical significance of routine lacrimal sac biopsy during dacryocystorhinostomy: A comprehensive review of literature.

Zoran Koturović,Miroslav Knežević,Dejan M Rašić

doi:10.17305/bjbms.2016.1424

Zoran Koturović, Miroslav Knežević + Show 1 more

Open Access

https://doi.org/10.17305/bjbms.2016.1424

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Abstract

The main purpose of this paper is to provide the information about the incidence and types of pathology of secondary acquired obstructions of the lacrimal excretory outflow system caused by primary lacrimal sac non-neoplastic and neoplastic lesions. After a thorough literature search, 17 case-control studies were found and selected, data were extracted and categorized, to evaluate specific lacrimal sac pathology mimicking inflammation. A total of 3865 histopathologically examined lacrimal sac wall biopsy specimens from 3662 patients, taken during dacryocystorhinostomy for clinically presumed primary chronic dacryocystitis, were analyzed. The most common reported histopathological finding was non-specific chronic inflammation with or without fibrosis (94.15% of cases). Lacrimal sac-specific pathologies were present in 226 (5.85%) cases. Unsuspected lacrimal sac-specific pathologies were present in 55/226 (24.34%) cases. Almost 45% of primary lacrimal sac malignant neoplasms were not suspected, preoperatively and intraoperatively. Tumor-like lesions of the lacrimal sac were the most common pathology found: (1) lacrimal stones-dacryoliths, (2) pyogenic granuloma, (3) granulation tissues, (4) reactive lymphoid hyperplasia, and (5) lacrimal sac-specific inflammation (Wegener's granulomatosis and sarcoidosis). Neoplastic pathology was found in 55/3865 (1.42%) lacrimal sac wall biopsy specimens; of those, malignant cases were 2.24 times more frequent than benign. Lymphoma was the most common preoperatively unsuspected or intraoperatively unexpected neoplastic pathology. This analysis of the relevant literature highlights the value of routine lacrimal sac biopsy during surgery for clinically presumed primary acquired nasolacrimal duct obstruction.

Highlights

Disorders of the lacrimal drainage system causing epiphora are a common problem in ophthalmology and, in the vast majority of cases, are primary or secondary acquired disorders
The following keywords were used: Lacrimal sac, lacrimal sac histopathology, lacrimal sac specific pathology, Zoran Koturović et al.: Routine lacrimal sac biopsy during dacryocystorhinostomy lacrimal sac pathology revealed later by histopathology; and (10) Preoperatively and intraoperatively unsuspected primary malignant lacrimal sac neoplasm revealed by histopathology
The main purpose of this paper is to provide information about the incidence and types of pathology of SALDO caused by primary lacrimal sac non-neoplastic and neoplastic lesions

Summary

Introduction

Disorders of the lacrimal drainage system causing epiphora are a common problem in ophthalmology and, in the vast majority of cases, are primary or secondary acquired disorders. They occur in adulthood and are caused by non-specific pathology [1,2,3]. Idiopathic chronic inflammation, with or without fibrosis, occurs in clinically presumed primary acquired nasolacrimal duct obstruction (PANDO) [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. Neoplastic causes are of special clinical interest (Figure 1) [22,23,24,25,26].

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