Abstract: Objective To report a series of 5 primary lacrimal sac tumors and present an algorithm in managing this rare condition.Methods A retrospective review of the clinical,radiological,and pathological records of 5 patients with primary lacrimal sac tumors was conducted.Results Of the five patients,all had epiphora or mass above the medial canthal tendon.Four had bloody epiphora.Three cases of computerized tomography,one case of dacryocystography,B ultrasonic as well magnetic resonance.There was extension into the anterior ethomoid air cells in only one case.The commonest tumor was squamous cell carcinoma(two cases),followed by one case of transitional cell carcinoma,basal cell carcinoma,undifferentiated carcinoma.Treatment modalities included surgery,radiotherapy,one patient had a relapse,En bloc resection was performed using a lateral rhinotomy,medial maxillectomy.but four patients remained without evidence of recurrent tumor.Conclusion Bloody epiphora,chronic dacryocystitis that irrigates freely and mass above the medial canthal tendon are main signs of malignant lacrimal sac tumor.Early diagnosis with malignant lacrimal sac tumor is possible combining with adjunctive examination and biopsy specimen.It can be distinguished with ethomoid carcinoma combining with clinical performance and dacryocystography,computerized tomography as well magnetic resonance.The treatment of malignant lacrimal sac tumors is en bloc resection and postoperative irradiation.

Key words: lacrimal sac tumor, malignant tumor, diagnosis, treatment