Lacrimal Sac Inverted Papilloma

Abstract

Inverted papilloma (IP), as the name suggests, is coined from the histological appearance of the epithelium inverting into the stroma. It is usually unilateral, with a male preponderance. Although it is more common in the sixth and seventh decades of life, isolated cases have been reported in the paediatric age group. Majority of the papillomas originate from the mucosal lining of the sino-nasal tract, occurring commonly in the ethmoids, lateral wall of the nasal fossa and the maxillary sinus. IP may arise primarily from the nasolacrimal duct (NLD) and the lacrimal sac, as they have similar mucosal lining. NLD and the lacrimal sac may be affected secondarily due to extension from the adjacent nasal mucosa or sinuses. Early detection gives the best chance of cure. High index of suspicion can lead to diagnosis during an unsuspected DCR, when the lacrimal sac epithelium is abnormal. An endoscopic resection, in collaboration with an otolaryngologist, may be the best approach on such cases.