Nasolacrimal metastasis from heptocellular carcinoma masquerading as dacryocystitis.

A 69-year-old man presented with a "lump" on his nose, after antibiotic therapy and warm compresses failed to resolve his presumed dacryocystitis. Because this disorder displayed atypical features (no tenderness, no redness, evidence of the greatest expansion of the nasolacrimal system inferior to the lacrimal sac fossa), a neoplastic process was considered. Orbital CT showed a mass obliterating the nasolacrimal system and maxillary sinus. Evaluation of the biopsy specimen revealed metastatic hepatocellular carcinoma of the orbit, making this case the first documentation of this disorder in the nasolacrimal system. Postoperative evaluations revealed an occipital lobe metastasis, and the patient died several months later from his intracranial disease. Clinicians should be aware of this entity, and the presence of atypical features warrants careful evaluation with specific consideration of neoplastic disease.