Dr. Jayesh D. Modhwadia, M06119, Dr. Shreya Shah, Dr. Saurabh N Shah, Dr. Mihir Mehta
A 58-year-old woman, diagnosed with primary obstruction of the nasolacrimal system with lacrimal sac fistula with irregular everted edges was clinically suspected of lacrimal sac neoplasm. The patient underwent fistulectomy and marginal excision of surrounding skin. During surgery, an incisional biopsy was obtained from the posterior wall of the lacrimal sac. All the samples were sent for pathological examination which revealed basal cell carcinoma of the lacrimal sac. 2 weeks later, the diseased sac and surrounding tissue were excised, using frozen sections to ensure adequate tumor-free margins. The lacrimal sac tumor was diagnosed as basal cell carcinoma. No tumor recurrence was detected in 8 months of follow-up. It is recommended that lacrimal sac biopsy should be performed in old patients with an enlarged lacrimal sac and nasolacrimal system obstruction especially with fistula suggestive of skin involvement by tumour if any.