Sheffield 2026 Presented e-posters Thursday

Lacrimal drainage apparatus malignancy is rare, clinicians must maintain a high index of suspicion to avoid missing this life threatening diagnosis. We aim to highlight this through a literature review and a case of a 46year old male diagnosed with NK/T cell lacrimal sac and mucosal lymphoma on biopsy at time of dacryocystorhinostomy (DCR).

Case presentation and targeted literature review.

Our patient presented with sinusitis and recurrent dacryocystitis managed with antibiotics and DCR. Pre-operative imaging did not identify any abnormality suggestive of diagnosis other than rhinosinusitis and dacryocystitis. Abnormal thickened and friable appearance of tissues at time of surgery prompted biopsy and a diagnosis of EBV positive NK/T cell lymphoma of the lacrimal sac and nasal mucosa was made. He was managed in a multidisciplinary team with chemotherapy and radiotherapy. Lymphoma accounts for approximately 11 % of lacrimal malignancies the majority being B-Cell type. EBV-positive extranodal NK/T cell lymphoma of nasal type is a very rare and often aggressive malignancy. Diagnosis is often delayed due to non-specific symptoms. As in our patient the most common presenting symptoms of lacrimal lymphoma are epiphora, swelling in the lacrimal sac region and acute dacryocystitis which can be indistinguishable from primary acquired nasolacrimal duct obstruction (PANDO ). Traditional red flag signs such as swelling above the medial canthal tendon or haemolacria are possible but are seen in the minority of cases.

Our case highlights the importance of a thorough examination and a low threshold for biopsy if lacrimal sac abnormality is suspected.