A 60-year-old man was seen in the hospital with a history of conjunctival mantle cell lymphoma (MCL), which had been biopsied elsewhere. The patient had no complaints, and his examination had unremarkable results. A magnetic resonance image of the head, performed as part of a full systemic work-up, revealed lacrimal sac and nasolacrimal duct thickening and opacification on both sides. A biopsy of the right lacrimal sac disclosed lymphocytes expressing CD20, CD5, B-cell lymphoma 2, cyclin D1, and SOX-11 proteins, yielding a diagnosis of bilateral MCL of the lacrimal system (Figure). Cases of MCL arise from pregerminal naive B cells expressing aberrant cyclin D1 resulting from the translocation t[11;14](q13;q32).1 Bilateral involvement of the lacrimal sac and nasolacrimal duct is extremely rare.2,3
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Cruz AAV, Gomes DM, Chahud F. Bilateral Mantle Cell Lymphoma of the Lacrimal Sac and Nasolacrimal Duct. JAMA Ophthalmol. 2020;138(12):e202394. doi:10.1001/jamaophthalmol.2020.2394
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