High-definition dacryoendoscopic features of a canalicular squamous papilloma

Excerpt

Canalicular papillomatosis is a rare disorder arising from one of the canalicular walls from a stalk attached to the epithelium. A systemically healthy male patient, aged 48 years, presented with swelling at the medial end of the left lower lid associated with epiphora of a 6 month duration. The swelling was not associated with any pain or discharge. Examination of the lacrimal system revealed a large, dilated puncta with small reddish brown lesion in the vertical canaliculus (Fig. 1a). A diagnostic high-definition dacryoendoscopy (HD-DEN) was performed (Fibertech, Japan). HD-DEN showed a grossly enlarged punctum and the vertical canaliculus (Fig. 1b) with a brownish red mass lesion on the medial wall of the vertical canaliculus (Fig. 1b, c). The ampulla was grossly dilated (Fig. 1b, c). Further diagnostic exploration revealed the mass lesion to involve the entire horizontal canaliculus up to the distal end, where it completely occupied the canalicular lumen (Fig. 1d, e), and hence further view was not possible. The upper canaliculus showed edematous mucosa with complete obliteration of the distal canaliculus. Since there was an extensive involvement, potential risk of seeding the nasal cavity along with high suspicion of a malignancy because of the pigmented nature and vascularity, the entire canaliculus was excised en bloc along with a dacryocystectomy. Histopathological evaluation showed an extensive polypoidal proliferation and papillary fronds of the stratified squamous epithelium of the canaliculus with the underlying stroma showing proliferation of thin-walled vascular channels and lymphoplasmacytic infiltration (Fig. 1f). There was no evidence of cellular atypia or koilocytosis. Histopathological features were consistent with an extensive squamous papilloma of the canaliculus. There were no recurrences at 6 month follow-up.

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