Mixed Papilloma of the Lacrimal Sac as a Cause of Hemolacria.

Inverted papillomas (IPs) derived from the lacrimal sac are a rare pathology, with only seven cases reported in the literature.1,2 "Mixed" endophytic and exophytic papillomas of the lacrimal sac are even more rare, with no reports in the literature. We present the case of a 55-year-old man who presented to the clinic with unilateral hemolacria. Multiple imaging modalities revealed a mass in the lacrimal sac, which was subsequently surgically excised by an otolaryngologist and oculoplastic surgeon. Pathologic analysis of the specimen demonstrated both exophytic and endophytic growth patterns, suggestive of a mixed papilloma subtype. This case highlights the importance of prompt, accurate diagnosis and interdisciplinary management, as patients require regular clinical follow-up to monitor recurrence and malignant transformation.