Lacrimal sac adenocarcinoma managed with androgen deprivation

PURPOSE: To describe a case of primary lacrimal sac adenocarcinoma treated primarily with androgen deprivation therapy (ADT) with good clinic response. OBSERVATIONS: An 82-year-old male presented with a painless right orbital mass. Pathology following partial resection was consistent with primary lacrimal sac adenocarcinoma positive for androgen receptors (AR). Magnetic resonance imaging (MRI) scan showed an orbital mass with extension into the nasolacrimal apparatus and intraconally between the medial and inferior recti. Staging positron emission tomography/computed tomography (PET/CT) showed one hypermetabolic right sided lymph node in addition to the known orbital mass. Orbital exenteration and external beam radiation therapy were offered as the primary treatment modality however the patient refused. He subsequently received four years of androgen deprivation monotherapy, before stopping due to sexual side effects, with no progression of local or metastatic disease and some local regression documented on MRI at 5 years. CONCLUSIONS AND IMPORTANCE: Lacrimal sac adenocarcinoma is commonly found to be AR positive on pathology. Our case shows that ADT can serve as an effective treatment modality for those patients that defer primary surgical management.