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

## TL;DR

A rare case of lacrimal sac lymphoma was diagnosed during surgery, emphasizing the need for biopsies in unusual lacrimal sac lesions.

## Contribution

Highlights the importance of intraoperative biopsy for diagnosing lacrimal sac tumors that mimic inflammation.

## Key findings

- Intraoperative biopsy confirmed mucosa-associated lymphoid tissue lymphoma in a lacrimal sac lesion.
- No metastasis was detected, and the patient remained recurrence-free for 24 months post-surgery.
- Computed tomography dacryocystography failed to detect neoplastic features preoperatively.

## 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.