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Case Reports in Otolaryngology
Volume 2015, Article ID 123694, 5 pages
Case Report

Inverted Papilloma Originating Primarily from the Nasolacrimal Duct: A Case Report and Review of the Pertinent Literature

1Department of Otorhinolaryngology, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR, UK
2Department of Otorhinolaryngology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
3Department of Ophthalmology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
4Department of Cellular Pathology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK

Received 16 September 2015; Accepted 29 October 2015

Academic Editor: Abrão Rapoport

Copyright © 2015 Hussein Z. Walijee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Inverted papilloma (IP) is an uncommon, benign yet aggressive neoplasm characterised by high recurrence rates and tendency towards malignant transformation. The majority of IP cases originate in the ethmoid region, lateral wall of the nasal fossa, and maxillary sinus. The authors report a case of an IP originating primarily from the nasolacrimal duct (NLD). Case. A 69-year-old Caucasian gentleman presented with a lump in his right medial canthal region, epiphora, and discharge bilaterally. Radiological investigation revealed a well-defined, heterogeneous mass within the proximal NLD eroding the bony canal, protruding into the middle meatus and into the right orbit. The tumour was excised en bloc utilizing a combined external and endoscopic approach based on its location. Histology revealed hyperplastic ribbons of basement membrane-enclosed epithelium growing endophytically into the underlying stroma with no evidence of invasive malignancy. The patient made an uneventful recovery with unchanged visual acuity and normal extraocular movements. Conclusion. The case demonstrates variability within the sinonasal tract that IP can develop and the individuality of each case necessitating tailored operative techniques for complete excision whilst minimising recurrence rates. We also present a combined endoscopic approach for the en bloc resection of a NLD IP with no clinical recurrence at 15-month follow-up.