Epiphora as the only symptom of ectopic olfactory neuroblastoma

Olfactory neuroblastoma (ONB) is a rare malignant neoplasm which often presents with nasal obstruction and epistaxis. An ectopic presentation of this neoplasm most commonly occurs in the maxillary or ethmoid sinus. We present the case of a man in his late 60s with the incidental finding of a lesion in the nasolacrimal duct, whose only symptom was epiphora. Endoscopic biopsy and subsequent final pathology following surgery confirmed a 3.5 cm ONB. The patient also had an ethmoidectomy completed, with adjuvant radiotherapy deferred in exchange for serial endoscopic examination surveillance. Our case is a unique example of epiphora as the only symptom of an ectopic ONB.