Primary Ductal Adenocarcinoma of the Lacrimal Gland

The poor prognosis of lacrimal gland adenocarcinoma: a clinical study and literature review

PURPOSE

The incidence of lacrimal gland adenocarcinoma is low. This study was designed to analyze the clinical and prognostic characteristics of lacrimal gland adenocarcinoma.

METHODS

This was a clinical study and literature review; 25 patients diagnosed with lacrimal gland adenocarcinoma by histopathology were enrolled and their medical history data were collected.

RESULTS

The incidence of bone destruction and surrounding tissue invasion was 52% and 44%, respectively. The incidence of distant metastasis of lacrimal gland adenocarcinoma was about 50%. The 5-year overall survival rate of death or metastasis was 33.5%. Age, sex, laterality, tumor size, pathology type, bone destruction, nerve or perineural invasion, invasion of peripheral tissue, T stage, AR, Her-2 and treatment had no significant correlation with lacrimal adenocarcinoma's prognosis (P > 0.05), while the higher expression of Ki-67 may have higher risk of death or metastasis (P = 0.020).

CONCLUSION

The incidence of bone destruction and distant metastasis of lacrimal adenocarcinoma is high and the imaging examination is necessary to assess the risk of distant metastasis. The 5-year survival rate of death or metastasis is 33.5% and the high expression of Ki-67 predicts poor prognosis of lacrimal adenocarcinoma.

Epithelial lacrimal gland tumors in dogs and cats: Is the human WHO classification appropriate for animals?

Lacrimal gland tumors (LGTs) in dogs and cats are rare neoplasms that can affect either the nictitans (NLG) or the main lacrimal gland (MLG). A consistent classification scheme for canine and feline LGTs is lacking; however, the importance of a classification scheme for LGTs has been emphasized in the human literature, and an update to the World Health Organization (WHO) classification has recently been published. The aim of this study was to investigate the occurrence of different subtypes of canine and feline LGTs in accordance with the human WHO classification system. Epithelial LGTs (n = 46 tumors; 38 dogs, 8 cats) were reviewed and immunophenotyping for p63, CK14, SMA, calponin, CKAE1/AE3, and CK19 was performed. Consistent with previous literature reports, lacrimal carcinomas outnumbered adenomas in dogs and cats. Based on the WHO classification of human LGTs, the most common subtypes identified in dogs were pleomorphic, ductal, adenoid cystic, and epithelial-myoepithelial carcinoma. In cats, a lower number of subtypes was observed, and adenocarcinoma "not otherwise specified" (NOS) was the most frequent diagnosis. An uncommon case of feline epithelial-myoepithelial carcinoma was also observed. The application of the human WHO-LGT classification scheme to canine and feline tumors increased the diversity of diagnoses and allowed for the identification of numerous subtypes. Further studies to identify possible correlations between pathological subtypes and prognosis are warranted.

De novo adenocarcinoma of the lacrimal gland: Case report

Adenocarcinoma of the lacrimal gland is an epithelial malignancy with an incidence according to the literature of 5-7%. It is clinically revealed by an upper palpebral mass often associated with an inflammatory exophthalmos. It is a high-grade malignancy and there are no pathognomonic clinical or radiological signs. The Core 14G needle biopsy technique is now the simplest procedure to remove tissue from the mass to be analyzed. This allows a precise histological and immunohistochemical study, to establish a diagnosis of certainty and to institute a rapid and adequate therapeutic management in order to improve the prognosis. We report the case of a de novo lacrimal gland adenocarcinoma diagnosed in a 55-year-old patient. The patient presented with a subpalpebral mass, located in the superior-external angle of the globe, which was very inflammatory. The radiological work-up revealed a left intra-orbital tumor process, extra-conical, developed at the expense of the lacrimal gland, in contact with the external wall of the orbit with local cortical effractions. The anatomopathological examination of the specimen obtained by Core 14G needle biopsy, under local anesthesia and on an outpatient basis, was in favor of a moderately differentiated and infiltrating adenocarcinoma of the lacrimal gland. The extension workup did not reveal a metastatic focus. A total exenteration was performed with complementary postoperative radiotherapy. The patient was followed up after 2 years without recurrence.

Primary Malignant Orbital Tumors

Objective  Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design  In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting  Outpatient and inpatient hospital settings. Participants  Patients with diagnosed primary orbital malignancies. Main Outcome Measures  Descriptive outcomes. Results  Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions  Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.

Primary De novo ductal adenocarcinoma of the lacrimal gland

BACKGROUND

Primary ductal adenocarcinoma of the lacrimal gland is a rare and aggressive malignant epithelial lacrimal gland neoplasm, morphologically and phenotypically resembles salivary duct carcinoma, and both strongly resemble infiltrating ductal carcinoma of breast.

METHOD

Retrospective Chart review of cases of malignant lacrimal gland tumors from 2013 July to 2020 July. Authors describe the clinico radiological, morphological and immunohistochemical features of primary ductal adenocarcinoma (PDA) of lacrimal gland. Extensive review of literature of PDA of lacrimal gland and salivary gland ductal carcinoma has been performed.

RESULTS

Retrospective chart review of the last 7 years yielded 22 malignant lacrimal gland neoplasms of which 4 cases demonstrated features of primary ductal adenocarcinoma of lacrimal gland, 2/4 cases showed an evidence of a pre existing pleomorphic adenoma and 2 were found to be de novo ductal adenocarcinomas. PDA of lacrimal gland showed expression of CK7, CK19, AR, HER2, cyclin D1 and were negative for CK5/14, CK 20, ER, PR, PSA, TTF-1, S-100 and SMA. Expression of GCDFP-15 was noted in one case. The presence of multiple events of loco-regional recurrences and/or distant metastasis necessitated a multidisciplinary approach.

CONCLUSIONS

Authors have expressed the need of clinical correlation; thorough tissue sampling and extensive immunohistochemical work up in identification of de novo PDA's and their molecular subtypes. A multi-institutional study might help in formulating the diagnostic criteria, identification of actionable targets, and thus study the role of targeted therapy in this rare and aggressive tumor which may result in better patient outcomes.

Sclerosing Signet Ring Cell Carcinoma of the Lacrimal Gland: A Potentially New Primary Entity

An 88-year-old man presented with diplopia, limitation of extraocular movements, and a firm palpable mass in the superolateral orbit. Biopsy revealed a sclerosing signet ring cell carcinoma with histopathologic features mimicking those of a primary signet ring cell (histiocytoid) carcinoma of the eyelid of eccrine or apocrine gland origin, a metastasis from an invasive lobular breast carcinoma or a metastatic diffuse-type gastric carcinoma. An extensive panel of immunohistochemical stains and molecular genetic analyses unequivocally failed to establish a precise diagnosis. Electron microscopy demonstrated features of a primary lacrimal gland lesion with intracytoplasmic lumens and zymogen granules typical of lacrimal secretory pyramidal cells. A thorough initial systemic work-up failed to reveal a primary visceral malignancy. Fifteen months of follow-up have failed to detect the emergence of another primary malignancy. To the best of our knowledge, a tumor with the morphology of the current lesion has not been previously described in the major or accessory lacrimal glands.

Primary ductal adenocarcinoma of the lacrimal gland: A review and report of five cases

Primary ductal adenocarcinoma (PDA) is a rare epithelial tumor of the lacrimal gland. Herein we report 5 cases and review 29 published cases of PDA of the lacrimal gland. Among these 5 cases, the most common clinical presentation was painless swelling and/or proptosis of their eye. The size of the lesions ranged from 1.6 to 2.5 cm. Histopathologic examination revealed proliferations of ductal or gland-like cells with vesiculated pleomorphic nuclei and prominent nucleoli. Tumor cells stained positive for epithelial and apocrine differentiation markers. Immunohistochemistry for human epidermal growth factor 2 was positive in 2 of the 4 cases. Four of the five patients were alive at the last follow-up visit. One died with bone metastases, which were diagnosed 25 months after exenteration and then survived an additional 51 months. On reviewing of twenty-nine previously published cases of PDA, the mean age of diagnosis was 58 years, with a male predominance (75%). Fifteen patients (54%) had distant metastases, 1 (4%) had local recurrence, and 10 (37%) suffered from a PDA-related death. PDA is a high-grade aggressive epithelial tumor of the lacrimal gland. Although rare, awareness and recognition of this malignancy are important to help determine prognosis and treatment options.

A Case of Lacrimal Gland Ductal Carcinoma With Regional Lymph Node Metastasis

Ductal carcinoma of the lacrimal gland is a very rare and aggressive neoplasm, with clinical and histopathologic similarities to salivary ductal carcinoma. Of the 25 previously reported cases, 2 patients had metastases to local lymph nodes confirmed on pathologic examination. The authors now report the clinical presentation, histopathologic and immunohistochemical features, and the treatment of a third patient with lacrimal gland ductal carcinoma with spread to local lymph nodes. In contrast to ductal carcinoma, lymph node involvement has not been reported in the largest series of adenoid cystic carcinoma, a much more common lacrimal gland malignancy. This case highlights the need for possible lymph node surveillance in patients with lacrimal gland ductal carcinoma.

Primary ductal adenocarcinoma of the lacrimal gland with changing genetic analysis mutations

Primary ductal adenocarcinoma of the lacrimal gland is a rare but highly aggressive epithelial malignancy with a poor prognosis. Early diagnosis, along with genetic testing of these tumors, is imperative for proper management. We present a case of a 54-year-old man with decreasing vision over the past three years and increasing proptosis in his right eye over the past three months, secondary to a lacrimal gland mass diagnosed as primary ductal adenocarcinoma. The diagnosis was made using histological and immunohistochemical profiles (positivity for cytokeratin AE1/3, CAM5.2, androgen receptor, human epidermal growth factor receptor 2, and gross cystic disease fluid protein 15) seen in previous cases, alongside a tumor genetic profile that showed actionable mutations. Uniquely in this case, after failing traditional chemotherapy, repeat biopsy revealed a change in genetics with the malignancy no longer showing actionable mutations. These findings show that these immunohistochemical findings can act as diagnostic biomarkers, while genetic testing can reveal actionable mutations for targeted therapy.

Primary ductal adenocarcinoma of lacrimal gland: Two case reports and review of the literature

A 64-year-old male presented with progressive proptosis of the left eye for 3 months. Orbital computed tomography (CT) demonstrated a 3.9 cm infiltrative mass over the superotemporal quadrant of the left orbit. Pathology of biopsy revealed a ductal adenocarcinoma of lacrimal gland with positive immunohistochemical staining for androgen receptor (AR), cytokeratin-7 (CK7), and gross cystic disease fluid protein 15 (GCDFP-15). The patient received orbital exenteration and adjuvant chemoradiotherapy. No recurrence or metastasis was noted 27 months after treatment. Another case was a 64-year-old male who came for proptosis of the right eye and diplopia for 3 weeks. Orbital CT revealed a 5 cm infiltrated right superotemporal orbital mass with destruction of the lateral and inferior orbital walls. Biopsy showed primary ductal adenocarcinoma of lacrimal gland with positive immunohistochemical staining for CK7, AR, and epidermal growth factor receptor. The patient underwent exenteration and concomitant chemoradiotherapy. However, lung and neck metastasis was noted 21 months after surgery. Collectively, 26 cases in the literature were reviewed. The mean age was 57 years old and male was prevalent (73%). Most immunohistological staining showed positive for AR (46%), CK7 (46%), Ki-67 (38%), and GCDFP-15 (35%). More than half of the patients developed metastasis and one-third of the patients died of disease. Early diagnosis, treatment, and long-term follow-up are required for this aggressive tumor.

Case Report: Adenocarcinoma of the Lacrimal Gland Presenting as an Abduction Deficit

SIGNIFICANCE

It is imperative to follow the clinical guidelines for abduction deficits to ensure prompt diagnosis of potentially serious etiologies and monitor only those in which a microvascular etiology is most likely. This case reports highlights a rare diagnosis of a malignant tumor of the lacrimal gland presenting as an abduction deficit.

PURPOSE

Tumors of the lacrimal gland can cause abduction deficits, which may mimic an abducens nerve palsy. Abducens nerve palsies are often encountered by optometrists. This case report highlights the appropriate workup of an abduction deficit and reviews the literature of adenocarcinoma not otherwise specified.

CASE REPORT

A 67-year-old white man was transferred to the optometry clinic with a presumed ischemic abducens palsy. He was found to have an isolated left abduction deficit without vascular risk factors that prompted neuroimaging revealing a mass of the lacrimal gland. After an en bloc resection, a diagnosis of adenocarcinoma not otherwise specified was made. The patient underwent aggressive surgical exenteration followed by radiation.

CONCLUSIONS

Using the guidelines for evaluation of an abduction deficit, this serious malignancy was diagnosed. An adenocarcinoma not otherwise specified of the lacrimal gland is rare, and there are limited data on its clinical course, prognosis, and treatment. Recurrence and metastases occur at high rates; therefore, prompt diagnosis and aggressive intervention are crucial.

Adenocarcinoma of the lacrimal gland: a case report

BACKGROUND

Primary ductal adenocarcinomas of the lacrimal gland are very rare. This neoplasm shares some histological and immunohistochemical similarities with salivary duct carcinoma.

CASE PRESENTATION

Here, we present a case of a 55-year-old Moroccan man with lacrimal gland adenocarcinoma. He underwent orbital exenteration with lymph nodes dissection and ipsilateral parotidectomy. After surgery, he was lost to follow-up and died 13 months later.

CONCLUSIONS

Lacrimal gland tumors are rare but highly aggressive salivary gland tumors. Complete excision with adjuvant radiotherapy is recommended.

An Androgen Receptor-positive Carcinoma of the Lacrimal Drainage System Resembling Salivary Duct Carcinoma: Case Report and Review of the Literature

Carcinomas of the lacrimal drainage apparatus are rare and due to their aggressive behavior, they usually require extensive surgical treatment. We report a unique case of a 60-year-old man presenting with proptosis found to have a mass in the lacrimal drainage system on magnetic resonance imaging. Histology revealed a high-grade carcinoma with morphologic features of salivary gland duct carcinoma. Immunohistochemistry showed an extensive positive staining to androgen receptor. This is the first report of salivary gland-like duct carcinoma of the lacrimal drainage apparatus. Androgen receptor should be included in the immunohistochemical panel for the diagnostic work-up of lacrimal drainage system carcinomas, which resemble salivary gland duct carcinoma. This finding could have important diagnostic and therapeutic implications.

Lacrimal gland ductal carcinomas: Clinical, Morphological and Genetic characterization and implications for targeted treatment

PURPOSE

Ductal carcinomas (DCs) of the lacrimal gland are very rare but aggressive malignancies. We investigated DC of the lacrimal gland for potentially clinically actionable targets in the search for new therapeutic options.

METHODS

Case 1: A 77-year-old man, presented with diplopia and xerophtalmia; case 2: A 53-year-old man, presented with headache, proptosis and chemosis and case 3: A 73-year-old man, presenting with chemosis and a corneal abscess. All three cases were characterized morphologically including immunohistochemistry and genetically with fluorescence in situ hybridization (FISH) and one case with next-generation sequencing (NGS) of cancer relevant genes.

RESULTS

Cases 1 and 3 were composed of large, rounded, irregular cystic nodules of carcinoma cells with prominent central comedonecrosis, whereas case 2 had a scirrhous morphology. High expression of CK7, CK19, EMA, p53 and HER2 was characteristic for all three tumours. Androgen receptor was intensely positive in case 1, in scattered cells in case 2 and negative in case 3, whereas oestrogen and progesterone receptor were consistently negative. Genetically, a hemizygous deletion and a point mutation in PTEN were identified in case 1, whereas HER2 amplification was found in cases 2 and 3.

CONCLUSION

This study identified a spectrum of genetic events and pattern of protein expression in DC of the lacrimal gland similar to a subset of carcinomas of the breast and ductal carcinomas of the salivary glands. For therapeutic purposes, aberrations in several components of especially the HER2 signalling pathway could alleviate the effect of HER2-directed therapy illustrating an inadequacy of isolated HER2 testing.

Androgen receptor-positive ductal adenocarcinoma of the nasolacrimal duct: A case report

Purpose

Primary ductal adenocarcinoma arising in the structures of the lacrimal apparatus is extremely rare, and the entity is considered a lacrimal counterpart of salivary duct carcinoma, of which the majority are known to express androgen receptor (AR). Less than 10 cases of AR-positive carcinomas of lacrimal gland or lacrimal sac have been described.

Observations

We present a primary ductal adenocarcinoma with AR expression involving the nasolacrimal duct of a middle-aged patient who had suffered from right eyelid swelling, diplopia and epiphora for 4 months. Although the tumor histologically resembled oncocytic carcinoma, electron microscopic examination did not show cytoplasmic accumulation of mitochondria, which excluded the diagnosis of oncocytic carcinoma with AR positivity.

Conclusions and importance

We concluded that this is the first case of AR-positive ductal adenocarcinoma arising from nasolacrimal duct. It is possible that some of the previously documented oncocytic carcinomas of the lacrimal drainage system may include ductal adenocarcinomas with oncocytic features.

Management of Lacrimal Gland Carcinoma: Lessons From the Literature in the Past 40 Years

PURPOSE

To review the published literature on management strategies for lacrimal gland carcinomas.

METHODS

Review of relevant articles in PubMed published in English from the year of 1970 through September 2014.

RESULTS

A review of literature suggests that treatment strategies for adenoid cystic carcinoma of lacrimal gland are varied, but local control does not necessarily prevent future delayed distant relapse. Tumor size and histologic features of lacrimal gland carcinoma seem to be important prognostic features. With improved imaging modalities providing better tumor diagnosis and staging, and availability of more focused radiation delivery techniques, multimodality globe sparing management of lacrimal gland carcinomas may be possible in selected cases. The availability of targeted drugs based on the molecular signature of an individual lacrimal gland carcinoma may offer possible targeted treatments for patients with nonresectable or metastatic disease.

CONCLUSION

Given the rarity of lacrimal gland carcinoma, multi-institutional studies and consistent reporting of size and histologic type of tumors in the literature may be prudent. Particularly, multimodality globe-sparing treatment strategies should be studied further.

GCDFP-15, AR, and Her-2 as biomarkers for primary ductal adenocarcinoma of the lacrimal gland: a Chinese case and literature review

PURPOSE

Primary ductal adenocarcinoma (PDA) of the lacrimal gland is a rare malignant epithelial tumor, and its clinicopathological characteristics are still unclear. This study aimed to report a novel case of PDA of the lacrimal gland in the People's Republic of China, as well as to determine its histopathological and immunohistochemical characteristics to support early diagnosis and direct further therapy.

PATIENT AND METHODS

Clinical data (including ocular examination, computed tomography, magnetic resonance imaging, positron emission tomography, mammography, and serum tumor marker examination) and treatment of a 49-year-old woman with a left lacrimal gland mass, which was diagnosed as PDA of the lacrimal gland, were reported. Histopathological and immunohistochemical studies were performed. Eleven papers regarding this uncommon neoplasm were reviewed.

RESULTS

Histopathologically, most of the tumor cells featured abundant granular eosinophilic cytoplasm, while few of them had a frothy appearance. The mass showed breast ductal carcinoma-like structural features, which most commonly demonstrated central necrosis, while less of these features showed cord-like infiltration. Immunohistochemically, the tumor cells were positive for GCDFP-15, CK 18 (++), AR (90%), Her-2 (+++), P53 (100%), and Ki-67 (with a proliferation index approximately 60%), while they were negative for ER, PR, P63, calponin, and CD 117.

CONCLUSION

This was the first Chinese case of PDA of the lacrimal gland that had been reported. We suggested that GCDFP-15, AR, and Her-2 should be tested as biomarkers for ductal adenocarcinoma of lacrimal gland to confirm diagnosis, guide therapy, and further predict prognosis.

Single bone metastasis from adenocarcinoma of the lacrimal gland: a case report

ABSTRACT 

Malignant tumors of the lacrimal gland are rare, and single bone metastases from lacrimal gland carcinoma are an exceptional event. We present the case of a 71-year-old man with a history of lumbar pain and left exophthalmos. Surgical resection of the lacrimal lesion and a bone biopsy gave a final histopathological diagnosis of primary ductal adenocarcinoma of the lacrimal gland with bone metastasis. The pathological tissue from both procedures was positive for androgen receptor expression. The patient underwent embolization and radiotherapy in association with total androgen blockade. After 20 months, the patient is still asymptomatic and has maintained the partial response at L1 with no progression to other sites. Our patient would appear to have a better prognosis and the disease a more indolent clinical course than the other cases of ductal adenocarcinoma of the lacrimal gland reported in the literature.

Primary ductal adenocarcinoma of the lacrimal gland, associated with abundant intracytoplasmic lumens containing some eosinophilic hyaline globules: cytological, histological and ultrastructural findings

A primary ductal adenocarcinoma (PDA) of the lacrimal gland is a rare distinct subtype of an epithelial tumor arising in the lacrimal gland. PDA is the counterpart of salivary duct carcinoma (SDC) resembling an invasive ductal carcinoma (IDC) of the breast. In our case, PDA revealed histopathological and immunohistochemical results corresponding to SDC. Interestingly, the tumor cells showed intracytoplasmic vacuoles containing dense eosinophilic hyaline globules at light microscopy. Ultrastructurally, the tumor cells exhibited microvilli-lined intracytoplasmic lumen containing homogenous electron-dense secretory products. A previous study demonstrated that numerous intracytoplasmic lumens of tumor cells are favored breast malignant tumor, similar to the histopathology of PDA, rather than benign lesion. This characteristic finding may be meaningful to diagnose high grade epithelial tumors including PDA.

Cancer of the orbit and adnexa

The diagnosis and treatment of orbital and periorbital malignancies are challenging. These tumors can result in blindness, death, and significant cosmetic deformities. Herein, we present the most common ocular malignancies and a systematic approach to diagnosis. Further, we integrate the seventh edition American Joint Committee on Cancer staging system, biomarkers, and multidisciplinary approaches to treatment.

Cystic Carcinoma Ex Pleomorphic Adenoma of the Lacrimal Gland

In a 48-year-old male patient, a well-circumscribed, round tumor in the lacrimal fossa was detected by CT. During total excision of the tumor, a wall of the tumor ruptured, resulting in leakage of the fluid contents. The wall of the tumor formed a cyst that contained residual yellowish fluid. Histologically, the cyst wall included an adenocarcinomatous component and a focus of pleomorphic adenoma. The tumor was diagnosed as a carcinoma ex pleomorphic adenoma of the lacrimal gland. The carcinoma cells showed positive immunoreactivity for androgen receptor and BRST-2, indicating that the tumor was equivalent to a salivary duct carcinoma. Postoperatively, the patient underwent involved field irradiation. This case demonstrates that a carcinoma ex pleomorphic adenoma of the lacrimal gland may develop in a cyst.