Lacrimal sac tumours are a rare, presenting insidiously with symptoms of nasolacrimal duct obstruction and medial canthal swelling, with up to 43% found incidentally at time of dacryocystorhinostomy. Inverting papillomas are an uncommon, histologically benign neoplasm of Schneiderian epithelium, characterised by high recurrence rates and a propensity towards malignant transformation.
We describe a case of nasoepithelial papilloma arising in the lacrimal sac, highlighting the importance of subspecialist histopathological input and a multidisciplinary surgical approach in managing these unusual tumours.

Review of the patient records, and a review of the relevant literature.

A 72 year old female patient attended with a 2 year history of right medial canthal swelling and epiphora. On performing an endonasal dacryocystorhinostomy, a lacrimal sac mass lesion was noted and biopsied. The biopsy and further imaging revealed a diagnosis of inverting Schneiderian papilloma, and a wide excision was performed with a combined transnasal and transfacial approach. The patient remains disease free at 1 year, with annual surveillance endoscopy scheduled to monitor for recurrence.

While Scheiderian papillomas are an uncommon lacrimal sac tumour, recurrences are frequent, especially in association with incomplete excision. An aggressive surgical approach, with thorough histological evaluation and close post-operative surveillance are recommended.