Clinico-radiological features of primary lacrimal gland pleomorphic adenoma: an analysis of 37 cases

Bone alterations in head and neck pleomorphic adenoma: Scoping review

OBJECTIVES

Bone destruction adjacent to salivary gland tumors has been regarded as an indirect sign of malignancy. This scoping review explores possible bone changes due to head and neck pleomorphic adenoma and identifies risk factors for bone destruction.

METHODS

Articles on bone alterations in head and neck pleomorphic adenoma were searched online using PubMed, Scopus and Scholar, according to PRISMA-ScR guidelines. Only histopathologically confirmed pleomorphic adenomas were included. Extracted data were age, gender, location and size of tumor, duration of symptoms, type of bone erosion and recurrency status.

RESULTS

The search resulted in 145 pleomorphic adenomas with adjacent bone alterations. The majority caused expansile bone changes, such as cortex erosion (61.4%) and scalloping (31.0%). Extensive bone destruction was reported in 11 cases (full thickness erosion in 3.4% and bone marrow invasion in 4.1%). Significant risk factors for aggressive bone destruction were tumor size and duration of symptoms (OR = 1.08; 95% CI 1.02-1.14 and OR = 1.03; 95% CI 1.00-1.05).

CONCLUSIONS

Although mostly bone erosion or scalloping is observed, larger or longstanding pleomorphic adenomas have the capacity of developing more extensive bone destruction, without malignant transformation. However, bone destruction is very rare in pleomorphic adenoma and more likely indicates the presence of malignancy.

Presumed Lacrimal Gland Pleomorphic Adenoma With Extensive Ossification and Necrosis

Calcification within pleomorphic adenomas of the lacrimal gland is well recognized but uncommon, being seen more readily in lacrimal gland carcinomas. Bony formation, ossification, in pleomorphic adenomas of the lacrimal glands is even rarer. Together with extensive sclerosis, or "coagulative necrosis," ossification and necrosis should alert the clinician to the risk of malignant transformation. However, both can mimic carcinomatous change, leading to misinterpretation of malignancy in an otherwise benign lacrimal gland neoplasm. We present 2 case reports of patients with clinically presumed pleomorphic adenomas of the lacrimal gland whose histopathology demonstrated lacrimal gland ossification and necrosis without features of malignancy or invasive disease.

Recurrence rate of pleomorphic adenoma of the lacrimal gland: systematic review and meta-analysis

PURPOSE

The aim is to increase the understanding of lacrimal gland pleomorphic adenoma's recurrence rate and the factors that influence it.

METHODS

A systematic search of PubMed, SCOPUS, Cochrane Library, and CINAHL was conducted following PRISMA guidelines. The data in the included studies were extracted and analyzed.

RESULTS

Twenty-two studies were included representing 963 patients from 12 different countries. The pooled analysis of the recurrence rate was 8.83% (95% CI: 5.08-13.50). In the event of recurrence, there was a 75.17% (95% CI: 65.98-82.94) chance of benign recurrence and a 28.35% (95% CI: 19.66-38.41) chance of malignant recurrences, with malignant recurrence occurring almost exclusively after a benign recurrence. The results showed that 47.09% (95% CI: 24.60 to 70.22) of recurrent tumors had a ruptured pseudocapsule and 6.35% (95% CI: 0.82 to 16.54) had an intact pseudocapsule with a significant difference between the two. Of the recurrent tumors, 51.50% (95% CI: 9.28 to 92.39) were biopsied compared to 8.83% (95% CI: 3.40 to 16.49) of the total; the difference between these two proportions was also found to be significant.

CONCLUSION

There was a statistically significant difference in the rates of recurrence between tumors that were either biopsied or had a ruptured pseudocapsule compared to those that did not. This evidence adds additional support for excisional biopsy being the procedure of choice for LGPA and reinforces the importance of keeping the pseudocapsule intact during surgical resection.

Proptosis Revealing a Rare Lacrimal Gland Tumor: A Case of Chondroid Syringoma in a 35-year-old Patient

Lacrimal gland chondroid syringoma is a very rare tumor with classic clinico-radiological symptoms that should be familiar to clinicians for appropriate patients’ management as the tumor has potential for recurrence and malignant transformation. We report herein a case of chondroid syringoma in a 35-year-old patient presenting with progressive painless proptosis for 2 years. He underwent complete surgical removal of the tumor, with subsequent clinical improvement of his symptoms.

Palpebral Pleomorphic Adenomas of the Lacrimal Gland

AIMS

To report the characteristics and management for patients with palpebral pleomorphic adenoma of the lacrimal gland.

METHODS

The records for patients with palpebral pleomorphic adenoma seen at Moorfields Eye Hospital between 1978 and 2019 were reviewed for demographics, presentation, imaging, histopathology, management, and outcome.

RESULTS

Forty-three patients (25 male; 58%) with palpebral pleomorphic adenoma were identified, presenting at a mean age of 46 years (median 46.4 years; range 24-81 years) with symptoms for an average of 31 months (median 18.0 months; range 1 month to 17 years). The commonest symptom was a painless upper lid lump (37 patients; 86%), although 4 patients (9%) had a localized ache, and 1 (2%) had episodic epiphora. A moderately-mobile, firm round mass (like a "chick-pea") was readily palpable in 39/43 (91%) patients, and significant ptosis and upper lid swelling was noted in 6 cases (14%). Imaging was reviewed in 35 patients, 28 (80%) having a well-defined homogeneous mass in front of the orbital rim, on the anterior pole of the lacrimal gland. With the exception of 8 tumors removed from the actual palpebral lobe using a conjunctival incision, all others were excised intact through an upper eyelid skin-crease incision. Histopathology confirmed an intact pseudocapsule in 39/43 (91%) and 10 (23%) had a mild chronic lymphocytic inflammation within the tumor and/or neighboring lacrimal gland. There were no tumor recurrences at an average follow-up of 40 months (median 9.1; range 2 weeks to 230 years).

CONCLUSION

Most palpebral pleomorphic adenomas are discovered as an upper lid lump and a few first become manifest as upper lid swelling with ptosis. To avoid inadvertent incisional biopsy, they should be recognized preoperatively-especially as most are readily palpable as a hard lump superotemporally, often freely mobile in the suborbicularis plane (anterior to the tarsus and main lacrimal gland). Excision, generally easiest through a transcutaneous route, was judged intact in all cases and confirmed in 91% of histological reports, with no recurrent tumors.

Adenoid cystic carcinoma of the palpebral lobe of the lacrimal gland - case report and literature review

Epithelial tumors of the lacrimal gland are rare and usually develop in the orbital lobe. We report the exceedingly rare occurrence of a primary adenoid cystic carcinoma in the palpebral lobe of the lacrimal gland. A 26-year-old female was referred for evaluation of a gradually enlarging mass in the lateral upper eyelid, previously diagnosed as a chalazion. Computed tomography revealed a heterogeneous round lesion anterior to the orbital rim. Excisional biopsy was compatible with an adenoid cystic carcinoma. After excluding distant metastasis, and as the patient refused adjuvant radiotherapy, a second surgical procedure, with wide local excision, was indicated. Follow-up showed no recurrence. This case highlights the importance of performing a thorough clinical examination when diagnosing any lateral upper eyelid mass. A high index of suspicion for malignant tumors of the lacrimal gland should always be maintained, and a complete excision with histological analysis should be preferred whenever possible.

Overview of benign and malignant lacrimal gland tumors

PURPOSE OF REVIEW

The goal of this article is to review the key clinical and radiological features, treatment strategies, and prognosis of lacrimal gland tumors.

RECENT FINDINGS

Debulking of the orbital lobe of the lacrimal gland may offer improved control rates in dacryoadenitis without compromise of tear film function. Contrary to previous belief, careful biopsy of the lacrimal gland prior to excision does not appear to increase the risk of recurrence in cases with suspected pleomorphic adenoma. Low-dose radiation (4 Gy) in two 2-Gy fractions appears to be effective and well tolerated in indolent non-Hodgkin lymphoma of the ocular adnexa with high local control rate. Eye-sparing surgery for adenoid cystic carcinoma (ACC) leaving minimal or no tumor residual in the orbit followed by adjuvant radiation therapy or chemoradiotherapy may provide good local control and long-term survival outcomes. Intra-arterial chemotherapy has been found to decrease recurrence and improve survival in ACC and can also be used as part of an eye-sparing treatment strategy. The development of targeted drugs may offer palliation for patients with unresectable or metastatic disease in lacrimal gland carcinoma.

SUMMARY

This article offers an update on diagnosis, management, and prognosis of the major lacrimal gland lesions.

Lacrimal gland pleomorphic adenoma and malignant epithelial tumours: clinical and imaging differences

AIMS

To investigate the clinical and imaging features of primary and recurrent lacrimal gland pleomorphic adenoma (LGPA), as well as lacrimal gland malignant epithelial tumours (LGMET).

METHODS

Retrospective comparative case series from September 2000 to September 2016 in a single tertiary institution. Medical records of cases with histopathologically proven primary LGPA (PLGPA), recurrent LGPA (RLGPA) and LGMET were reviewed.

RESULTS

Sixty-four patients with LGPA (55 primary and nine recurrent) and 36 patients with LGMET underwent surgical excision in the study period. There was no significant difference in terms of age, gender or laterality. In terms of symptom duration, that of LGMET (7.1 months) was significantly shorter than PLGPA (23.9 months), which in turn was significantly shorter than RLGPA (127.1 months). Proptosis was the most common presenting symptom among all three groups. On CT, LGMET and RLGPA were significantly more likely to have ill-defined margins (p<0.001) and be heterogeneous (p<0.001) than PLGPA. RLGPAs (56%) were significantly more likely to have calcification than LGMET (34%), which in turn was more likely to have calcification than PLGPA (13%); LGMET (40%) and RLGPA (33%) were significantly more likely to have bony invasion than PLGPA (2.2%). On MRI, LGMETs (55%) were significantly more likely to have a tail or wedge sign indicating infiltration into the posterior orbit than PLGPA (0%) or RLGPA (0%).

CONCLUSION

Our study adds important information regarding differentiating clinical and radiological features between malignant and benign epithelial lacrimal gland tumours that would aid in their management.