Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1940-1945
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1940
Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system: A case report
Zi-Gang Che, Ting Ni, Zhen-Chang Wang, De-Wang Wang
Zi-Gang Che, Zhen-Chang Wang, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Zi-Gang Che, Ting Ni, Department of Radiology, Nanjing Tongren Hospital, Southeast University Medical College, Nanjing 211102, Jiangsu Province, China
De-Wang Wang, Department of Pathology, Nanjing Tongren Hospital, Southeast University Medical College, Nanjing 211102, Jiangsu Province, China
Author contributions: Che ZG drafted the manuscript; Ni T reviewed the literature and contributed to manuscript drafting; Wang DW made a pathological diagnosis; Wang ZC reviewed the manuscript; all authors issued final approval for the version to be submitted.
Supported by The National Natural Science Foundation of China, No. 61931013, No. 61527807 and No. 62041103; Nanjing Medical Science and technique Development Foundation, No. QRX17207.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Chang Wang, MD, PhD, Chief Doctor, Professor, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing 100050, China. cjr.wzhch@vip.163.com
Received: November 5, 2020
Peer-review started: November 5, 2020
First decision: December 28, 2020
Revised: January 8, 2021
Accepted: January 22, 2021
Article in press: January 22, 2021
Published online: March 16, 2021
Abstract
BACKGROUND

Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.

CASE SUMMARY

A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.

CONCLUSION

This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

Keywords: Amyloidosis, Lacrimal sac, Nasolacrimal duct obstruction, Dacryolith, Computed tomography, Endoscopy, Case report

Core Tip: Localized amyloidosis is a very rare cause of nasolacrimal duct obstruction and dacryocystitis. It has been reported that amyloidosis in nasolacrimal excretory system may be invasive or present as a pseudo-dacryolith with clear boundary in liquid or colloidal forms. However, massive dacryolithiasis can also be formed and obstruct the nasolacrimal excretory system as a consequence. Computed tomography examination can be a noninvasive tool for preoperative evaluation in case of incapability of dacryocystorhinostomy and nasal endoscopy of fully displaying deeper structures of nasolacrimal excretory system.