Docetaxel-induced histologic changes in the lacrimal sac and the nasal mucosa
Bita Esmaeli1, Michael A Burnstine, M Amir Ahmadi
1Department of Plastic Surgery, the University of Texas, MD Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Purpose:
To identify histopathologic changes in the lacrimal sac and the nasal mucosa caused by docetaxel in 3 patients with canalicular narrowing and nasolacrimal duct obstruction.
Methods:
Small case series. Lacrimal sac and nasal mucosal specimens were obtained at the time of dacryocystorhinostomy or during silicone intubation to correct epiphora in 3 patients receiving docetaxel. Histologic evaluation was performed.
Results:
Extensive fibrotic changes in the stroma of the lacrimal sac and the nasal mucosa were the prominent histologic features in all 3 patients. A biopsy specimen was taken from the lower portion of the nasal mucosa (near the inferior turbinate) in one patient at the time of silicone intubation and showed both clinical and histologic evidence of keratinization with marked epidermalization of the surface epithelium, thickening, and parakeratosis of the squamous epithelium.
Conclusions:
Nasolacrimal duct obstruction secondary to treatment with docetaxel may be in part due to stromal fibrosis in the mucosal lining of the lacrimal drainage apparatus.
Insights
Docetaxel chemotherapy can cause nasolacrimal duct obstruction due to extensive fibrosis in the lacrimal sac and nasal mucosa. This stromal fibrosis may contribute to the blockage of the tear drainage system.
Area of Science:
- Ophthalmology
- Oncology
- Pathology
Background:
- Docetaxel is a chemotherapy agent used to treat various cancers.
- Nasolacrimal duct obstruction (NLDO) is a common complication affecting the tear drainage system.
- Canalicular narrowing and NLDO have been anecdotally linked to docetaxel treatment.
Observation:
- A case series of 3 patients receiving docetaxel presented with canalicular narrowing and NLDO.
- Histopathologic examination of lacrimal sac and nasal mucosal specimens was performed.
- Specimens were obtained during dacryocystorhinostomy or silicone intubation procedures.
Findings:
- Prominent stromal fibrotic changes were observed in the lacrimal sac and nasal mucosa of all 3 patients.
- One patient exhibited keratinization, epidermalization, thickening, and parakeratosis of the nasal mucosal epithelium.
- These fibrotic changes suggest a direct impact of docetaxel on the ocular adnexa and nasal lining.
Implications:
- Docetaxel-induced NLDO may be significantly attributed to stromal fibrosis within the lacrimal drainage apparatus.
- Understanding these histopathologic changes is crucial for managing chemotherapy-related ocular side effects.
- Further research is warranted to elucidate the precise mechanisms and potential interventions.
