Lacrimal sac adenocarcinoma managed with androgen deprivatio
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Although tumors of the lacrimal gland are not rare, tumors of the lacrimal sac area. Within the malignant subset of lacrimal sac tumors, adenocarcinoma ranks as one of the least common histologies. Cases of lacrimal sac adenocarcinomas have been previously presented in the literature, mainly through isolated case reports. Surgery and radiation therapy are the primary treatment modalities and orbital exenteration is often required.

An 82-year-old male presented with a painless right orbital mass. Pathology following partial resection was consistent with primary lacrimal sac adenocarcinoma positive for androgen receptors (AR). Magnetic resonance imaging (MRI) scan showed an orbital mass with extension into the nasolacrimal apparatus and intraconally between the medial and inferior recti. Staging positron emission tomography/computed tomography (PET/CT) showed one hypermetabolic right sided lymph node in addition to the known orbital mass. Orbital exenteration and external beam radiation therapy were offered as the primary treatment modality however the patient refused. He subsequently received four years of androgen deprivation monotherapy, before stopping due to sexual side effects, with no progression of local or metastatic disease and some local regression documented on MRI at 5 years.

Lacrimal sac adenocarcinoma is commonly found to be AR-positive on pathology. This case shows that ADT can serve as an effective treatment modality for those patients that defer primary surgical management.