Abstract
The authors present an unusual case of malignant transformation of metachronous bilateral Schneiderian inverted papilloma (IP) of the lacrimal sac. Such pathology has been sparingly covered in prior published literature, in particular with little formal discussion surrounding its optimal management. We describe the clinical presentation, course and management in a 35-year-old male with histopathological diagnosis of Squamous cell carcinoma (SCC) arising within IP. He underwent radical surgery, including orbital exenteration and medial maxillectomy. Our patient re-presented with IP in the contralateral side and subsequent malignant transformation to SCC with disseminated disease. Unfortunately he succumbed to disease approximately 20 months following initial surgery. This case raises several important questions with regard to appropriate treatment. In particular, we discuss the various management options with special consideration given to the contentious topic of orbital exenteration in such patients. We emphasise two particular controversial issues, namely, oncological efficacy of orbital preservation and the functional compromise that may result in the preserved eye.
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References
Barnes L (2002) Schneiderian papillomas and nonsalivary glandular neoplasms of the head and neck. Mod Pathol 15(3):279–297
Krouse J (2000) Development of a staging system for inverted papilloma. Laryngoscope 110:965–968
von Buchwald C, Bradley PJ (2007) Risks of malignancy in inverted papilloma of the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 15(2):95–98
Montalban A, Liétin B, Louvrier C, Russier M, Kemeny JL, Mom T, Gilain L (2010) Malignant lacrimal sac tumors. Eur Ann Otorhinolaryngol Head Neck Dis 127(5):165–172
Suárez C, Ferlito A, Lund VJ, Silver CE, Fagan JJ, Rodrigo JP, Llorente JL, Cantù G, Politi M, Wei WI, Rinaldo A (2008) Management of the orbit in malignant sinonasal tumors. Head Neck 30(2):242–245
Rahman I, Cook AE, Leatherbarrow B (2005) Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol 89(10):1335–1340
Satchi K, McNab AA (2009) Orbital spread of eyelid and periocular cutaneous cancer. Int Ophthalmol Clin 49(4):223–236
Roche P, Timon C (2012) Orbital exenteration in periorbital malignancies. Surgeon 10(4):189–193
Soysal HG (2010) Orbital exenteration: a 10-year experience of a general oncology hospital. Orbit 29(3):135–139
Brar ST, Meyer D (2011) Diagnosis and management of mucoepidermoid carcinoma of the lacrimal duct. Orbit 30(1):34–36
Islam S, Thomas A, Eisenberg RL, Hoffman GR (2012) Surgical management of transitional cell carcinoma of the lacrimal sac: is it time for a new treatment algorithm? J Plast Reconstr Aesthet Surg 65(2):e33–e36
Rasmussen ML (2010) The eye amputated—consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life. Acta Ophthalmol 88 Thesis 2:1–26
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Islam, S., Eisenberg, R.L. & Hoffman, G.R. Malignant transformation of metachronous bilateral Schneiderian inverted papilloma of the lacrimal sac: management considerations and the contentious issue of orbital exenteration. Eur Arch Otorhinolaryngol 271, 1857–1860 (2014). https://doi.org/10.1007/s00405-013-2632-8
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DOI: https://doi.org/10.1007/s00405-013-2632-8