Intraoperative biopsy during dacryocystorhinostomy in a patient with lacrimal sac MALT lymphoma mimicking dacryocystitis: A case report&nbsp;

Yunoki,Tatsuya; Tachino,Hirohiko; Morita,Yuka; Okuno,Noriko; Hayashi,Atsushi

doi:10.3892/mi.2026.309

May-June 2026 Volume 6 Issue 3

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

May-June 2026 Volume 6 Issue 3

Full Size Image

Case Report Open Access

Intraoperative biopsy during dacryocystorhinostomy in a patient with lacrimal sac MALT lymphoma mimicking dacryocystitis: A case report

Authors:
- Tatsuya Yunoki
- Hirohiko Tachino
- Yuka Morita
- Noriko Okuno
- Atsushi Hayashi
View Affiliations / Copyright

Affiliations: Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930‑0194, Japan, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama 930‑0194, Japan, Department of Pathology, Academic Assembly Faculty of Medicine, University of Toyama, Toyama 930‑0194, Japan

Copyright: © Yunoki et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
Article Number: 25
|
Published online on: March 11, 2026

https://doi.org/10.3892/mi.2026.309
Expand metrics +

Abstract

Lacrimal sac primary tumors are uncommon and often mimic inflammatory conditions, rendering preoperative diagnosis difficult. The present study describes the case of an 83‑year‑old female patient presenting with left‑sided epiphora and mucopurulent discharge. Based on the clinical findings, dacryocystitis was strongly suspected. Computed tomography dacryocystography revealed only a mild filling defect, with no radiological evidence suggestive of a neoplastic lesion. However, during endoscopic dacryocystorhinostomy, a well‑defined polypoid lesion was observed within the lacrimal sac. A lesion biopsy revealed a mucosa‑associated lymphoid tissue lymphoma. No metastasis was observed in other organs, and the patient has been under observation for 24 months post‑operatively without recurrence. The present case report highlights the importance of obtaining an adequate tissue biopsy for definitive diagnosis when any mass‑like or elevated lesion is encountered within the lacrimal sac, even in the absence of suspicious pre‑operative findings. The intraoperative careful inspection of the entire lacrimal sac is essential in order to avoid missing malignant tumors and to enable early diagnosis.

View Figures

View References

1	Ryan SJ and Font RL: Primary epithelial neoplasms of the lacrimal sac. Am J Ophthalmol. 76:73–88. 1973.PubMed/NCBI View Article : Google Scholar
2	Stefanyszyn MA, Hidayat AA, Pe'er JJ and Flanagan JC: Lacrimal sac tumors. Ophthalmic Plast Reconstr Surg. 10:169–184. 1994.
3	Krishna Y and Coupland SE: Lacrimal sac tumors-A review. Asia Pac J Ophthalmol (Phila). 6:173–178. 2017.PubMed/NCBI View Article : Google Scholar
4	Ali MJ, Singh S, Naik MN, Kaliki S and Dave TV: Interactive navigation-guided ophthalmic plastic surgery: The utility of 3D CT-DCG-guided dacryolocalization in secondary acquired lacrimal duct obstructions. Clin Ophthalmol. 11:127–133. 2017.PubMed/NCBI View Article : Google Scholar
5	Wang YH, Jiang WH, Tu YH, Zhou GM, Wu WC and Yu B: Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses. Int J Ophthalmol. 15:1765–1771. 2022.PubMed/NCBI View Article : Google Scholar
6	Segura-Rivera R and Pina-Oviedo S: Marginal zone lymphoma of extranodal sites: A review with an emphasis on diagnostic pitfalls and differential diagnosis with reactive conditions. Hum Pathol. 156(105683)2025.PubMed/NCBI View Article : Google Scholar
7	Fiorentino V, Pizzimenti C, Pierconti F, Lentini M, Ieni A, Caffo M, Angileri F, Tuccari G, Fadda G, Martini M and Larocca LM: Unusual localization and clinical presentation of primary central nervous system extranodal marginal zone B-cell lymphoma: A case report. Oncol Lett. 26(408)2023.PubMed/NCBI View Article : Google Scholar
8	Chen GP, Lu ZZ, Lu GZ, Zhou Y and Wu SG: An epidemiological study on survival in lymphoma of mucosa-associated lymphoid tissue: A comparative analysis by primary tumor location. J Invest Surg. 38(2523858)2025.PubMed/NCBI View Article : Google Scholar
9	Kitaguchi Y, Takahashi Y, Mupas-Uy J, Takahashi E and Kakizaki H: Primary marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue of the lacrimal sac found with epiphora: A case report. Case Rep Ophthalmol. 7:148–154. 2016.PubMed/NCBI View Article : Google Scholar
10	Singh S and Ali MJ: Lymphoproliferative tumors involving the lacrimal drainage system: A major review. Orbit. 39:276–284. 2020.PubMed/NCBI View Article : Google Scholar
11	Sabundayo MS, Takahashi Y and Kakizaki H: Lacrimal sac lymphoma: A series of Japanese patients. Eur J Ophthalmol. 29:678–684. 2019.PubMed/NCBI View Article : Google Scholar
12	Wakasaki T, Yasumatsu R, Tanabe M, Yoshikawa H, Jiromaru R, Hashimoto K, Matsuo M, Fujimura A and Nakagawa T: Lacrimal sac tumors: A single-institution experience, including new insights. In Vivo. 37:1219–1225. 2023.PubMed/NCBI View Article : Google Scholar
13	Singh S and Ali MJ: Primary malignant epithelial tumors of the lacrimal drainage system: A major review. Orbit. 40:179–192. 2021.PubMed/NCBI View Article : Google Scholar
14	Knežević M, Stojković M, Jovanović M, Stanković Z and Rašić DM: A 7-year prospective study of routine histopathological evaluation of the lacrimal sac wall incisional biopsy specimens obtained during external dacryocystorhinostomy in adults and a review of the literature. Med Oncol. 29:396–400. 2012.PubMed/NCBI View Article : Google Scholar
15	Anderson NG, Wojno TH and Grossniklaus HE: Clinicopathologic findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg. 19:173–176. 2003.PubMed/NCBI View Article : Google Scholar
16	Lee-Wing MW and Ashenhurst ME: Clinicopathologic analysis of 166 patients with primary acquired nasolacrimal duct obstruction. Ophthalmology. 108:2038–2040. 2001.PubMed/NCBI View Article : Google Scholar
17	Banks C, Scangas GA, Husain Q, Hatton MP, Fullerton Z and Metson R: The role of routine nasolacrimal sac biopsy during endoscopic dacryocystorhinostomy. Laryngoscope. 130:584–589. 2020.PubMed/NCBI View Article : Google Scholar
18	Koturović Z, Knežević M and Rašić DM: Clinical significance of routine lacrimal sac biopsy during dacryocystorhinostomy: A comprehensive review of literature. Bosn J Basic Med Sci. 17:1–8. 2017.PubMed/NCBI View Article : Google Scholar
19	Heindl LM, Jünemann AG, Kruse FE and Holbach LM: Tumors of the lacrimal drainage system. Orbit. 29:298–306. 2010.PubMed/NCBI View Article : Google Scholar
20	Zhao HS, Shi JT and Wei WB: Clinical analysis of primary malignant lacrimal sac tumors: A case series study with a comparison to the previously published literature. J Craniofac Surg. 34:e115–e120. 2023.PubMed/NCBI View Article : Google Scholar