Transitional cell carcinomas of the lacrimal sac are rare with less than 55 cases reported in the literature. These tumors typically present with a medial canthal mass and epiphora.
Here we describe a 63-year-old male who presented originally with complaints of dry eye and chronic epiphora. Over the next six months the patient noted the onset of a right medial canthal mass with tenderness and purulent lacrimal reflux. The patient was scheduled for surgery, and a lacrimal sac mass was identified. After excisional biopsy, the mass was diagnosed as transitional cell carcinoma and the patient subsequently underwent right lacrimal sac excision and medial maxillectomy. He was treated post-operatively with chemotherapy and radiation and has undergone subsequent reconstruction for lid malposition and lacrimal obstruction. There has been no recurrence of the cancer over a five-year period, with no evidence of distant metastasis.
Transitional cell carcinomas of the lacrimal sac can be aggressive and in general carry a poor prognosis. Physicians should have a high index of suspicion in patients presenting with medial canthal mass to avoid delayed diagnosis.

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