Lacrimal sac ciliated HPV16 positive, adenosquamous carcinoma-A case report of a unique histological variant at this site and a review of the literature

ABSTRACT

A 47-year-old female developed a reddish swelling of the right medial canthus over 3 months. On examination, a red, firm mass, involving the right medial canthal and extending into the inferior fornix was present and the globe was displaced upwards and inwards. A staging MRI scan confirmed a lacrimal sac lesion with anterior orbit extension. After an equivocal biopsy, the patient underwent debulking surgery. Histology showed a lacrimal sac invasive adenosquamous carcinoma, comprising poorly differentiated squamous carcinoma and invasive adenocarcinoma areas arranged in a tubulo-glandular pattern. The adenocarcinoma harboured numerous cilia. p16 showed block positivity of both components and micro-dissected tissue from both areas showed the presence of HPV16 DNA by PCR. This is the first description of ciliated adenosquamous carcinoma of the lacrimal sac and this finding is placed into the context of what is known about ciliated head and neck adenosquamous carcinomas and the role of high-risk HPV.

KEYWORDS:

• Lacrimal sac
• adenosquamous carcinoma
• ciliated adenosquamous carcinoma
• human papillomavirus
• HPV

Acknowledgments

We’d like to thank the Scottish HPV, Reference Laboratory, Royal Infirmary of Edinburgh, UK, for carrying out the HPV PCR analysis and Harriet Whiteley, Orbital Clinical Nurse Specialist, Ophthalmology Dept, Royal Hallamshire Hospital, Sheffield for obtaining the consent from the patient to submit this case report for publication.

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The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

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Funding

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