A discussion of malignancy of the lacrimal sac is disregarded almost entirely in textbooks on pathology, regardless of whether these be on general pathology or related wholly to ophthalmic pathology. One such textbook states: "Carcinoma of the tear sac is rarely primary, usually secondary, infiltrative from the paranasal sinus, and may also appear as adenocarcinoma." In contradistinction, I have never found a certain secondary carcinoma; all were primary, and none arose from the nasal accessory sinuses. Extension from the lacrimal sac to the sinuses is the common sequence, never the opposite. One can hardly consider a case to be malignancy of the lacrimal sac when this is a part of tremendous orbital and periorbital extension, originating elsewhere.
If it were not for Duke-Elder's1 consideration of this subject, one might think the condition rare. I have had, up to this present moment, seven cases of malignancy of the lacrimal sac.
SPAETH EB. Carcinomas in the Region of the Lacrimal Sac. AMA Arch Ophthalmol. 1957;57(5):689-693. doi:10.1001/archopht.1957.00930050701009