Inverted papilloma arising primarily from the lacrimal sac

A 24-year-old female was referred with epiphora and a non-tender swelling within the right lacrimal fossa, present for 6 months. There were no previous episodes of dacryocystitis. Computed tomography showed a homogenous mass within the lacrimal fossa without contrast enhancement. Pathology following resection of the whole lacimal sac revealed the presence of an inverted papilloma (IP) with a sharp transition between the papilloma and the normal lacrimal duct epithelium. In situ hybridisation was positive for low risk HPV subtypes. An IP is a benign but infiltrative epithelial neoplasm with malignant potential characterised by a high recurrence rate. Majority of cases arise from the nasal wall and paranasal sinuses. In this case report, we demonstrate an IP confined to the lacrimal sac with clear-cut pathology proof, which implicates the lacrimal sac as a primary site of origin.