Bilateral lacrimal system involvement by sclerosing extramedullary hematopoietic tumor

A 60-year-old man with myelofibrosis and extramedullary hematopoiesis was referred for evaluation of "swollen lacrimal glands." Examination disclosed bilateral firm, immobile, nontender masses in the lacrimal sac fossa with no associated signs of inflammation. MRI of the orbits disclosed lobulated enhancing mass lesions involving the lacrimal sacs and nasolacrimal ducts bilaterally, with bony scalloping of the lacrimal sac fossa and expansion of the bony walls of the nasolacrimal ducts. Incisional biopsy and subsequent debulking of the tumors confirmed sclerosing extramedullary hematopoiesis lesions. To the authors' knowledge, involvement of the lacrimal drainage system with such tumors has not been previously described.