Tumors arising in the palpebral lobe of the lacrimal gland

Clinician's approach for spectrum of orbital diseases: An overview

Purpose

To study the varied clinical presentation and outcome of management of orbital diseases and to ascertain the concordance of FNAC with histopathology.

Materials and Methods

This is a prospective interventional study wherein each patient's clinical presentation was noted. Outcome of management was evaluated based on symptomatic relief, regression of signs, noting any intraoperative or postsurgical complication, recurrence, and cosmetic result in terms of surgical scar.

Results

Neoplasia was commonest 33/76; (43.42%), followed by infective and inflammatory conditions 21/76; (27.63% cases), thyroid-associated orbitopathy accounting for 12/76 cases (15.78%), whereas cystic lesions and vascular malformations were 4/76 (5.26%) each. Other disorders constituted a mere 2.65%. Proptosis was the commonest mode of presentation. It was seen in seventy out of seventy-six patients (92.1%). In 86.3% of the cases, there was successful surgical outcome. Of 22 surgically managed cases, recurrence was noted in three cases (13.6%). 90% concordance was seen with histopathology in cases where FNAC was done prior to surgery for diagnosing nature of disease.

Conclusions

Majority of orbital and adnexal conditions can be provisionally diagnosed based on imaging; however, an adjunct invasive investigation such as FNAC or biopsy may be required. In the present study, in seven cases (9.2%) FNAC was needed, whereas in two cases (2.63%) biopsy was needed. A definitive diagnosis was confirmed by histopathology in 22 surgically managed cases and by excision biopsy in two. 22/76 (28.94%) of the cases needed surgical treatment, and other cases required conservative or palliative approach.

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.

Orbital Lobe and Palpebral Adenomas of the Lacrimal Gland Behave as Distinct Entities

AIMS

To assess whether orbital lobe and palpebral adenomas of the lacrimal gland are biologically similar, based upon a comparison of the age at presentation and at first symptom. The size of the excised tumor in the 2 groups is also examined and considered in relation to age at surgery.

METHODS

Review of clinical details and histopathology reports for patients with biopsy-proven lacrimal gland pleomorphic adenomas, under the care of Moorfields Eye Hospital. The age at presentation and at earliest symptoms were calculated for each patient. Where available, estimates of tumor volume were obtained from the 3 orthogonal measurements taken during histopathological examination.

RESULTS

One hundred eighty-seven patients (100 male patients; 53%) presented at an average age of 48 years (median, 46.8; range, 11-88): the average age for 144 patients with orbital lobe tumors (mean, 48 years; median, 47.8; range, 11-88) was similar to that for 43 patients with palpebral tumors (mean, 46 years; median, 46.8; range, 24-81) (p = 0.45). The average age at first symptom(s) in the 2 groups is similar (orbital 45 years, palpebral 44 years; p = 0.63). In contrast, there is a very highly significant difference in estimated tumor volumes, with the mean for orbital lobe pleomorphic adenomas being 5.4 ml (median, 4.9 ml; range, 1.5-13.6) and that for palpebral being 0.91 ml (median, 0.7 5 ml; range 0.11-3.61) (p = 1.42 × 10-25).

CONCLUSIONS

As expected, excised palpebral adenomas-readily palpable in the eyelid-are very much smaller than orbital lobe tumors, that tend to be impalpable. If pleomorphic adenomas in the 2 locations were biologically identical, they should arise at the same time and have similar growth rates-which would mean that orbital pleomorphic adenomas ([PAs] being, on average, 6 times the size of palpebral PAs) should present several decades later. The age at presentation and age at first symptom are, however, almost identical in the 2 groups. These observations provide incontrovertible evidence that, in their biological behavior, palpebral and orbital PAs are distinct entities-either arising at different ages (with orbital tumors arising much earlier in life) or having different growth rates (palpebral PAs being slower).

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.

Clinical Management of Acinic Cell Carcinoma of the Lacrimal Gland

To report a case of acinic cell carcinoma occurred in the lacrimal gland. A 59-year-old man was admitted because of sudden blurring of vision, progressive proptosis of the left eye, and mild double vision in left and down directions of the gaze (Hess-Lancaster test). His medical history detailed controlled bilateral keratoconus and open angle glaucoma. On examination, the best corrected visual acuity decreased from 8/20 till 1/50 in one week. There was a swelling of the left upper eyelid. A hard and tender mass was palpated in the superior temporal left orbit. Ultrasound scan showed an extraconal solid mass, situated in the superior lateral corner of the orbit. Computed tomography and magnetic resonance imaging (MRI) revealed a mass of two centimeters in diameter, with round well-defined outline, within the lacrimal gland. We performed an enucleoresection of the mass, via a coronal approach and a lateral orbitotomy by a piezosurgical device. The lesion appeared nodular, brownish, measuring about 2 × 1.5 cm. Histopathological findings were consistent with acinic cell carcinoma with a microcystic, focally papillary-cystic growth of pattern. Follow-up MRI outcomes led to removal of the residual lacrimal gland for suspicion of recurrence. No tumor recurrences where detected at 7-year follow-up.

Apocrine mixed tumor of the eyelid: a case report

Background

Apocrine mixed tumor is usually found in parotid glands. Its cutaneous counterpart is rare and its occurrence in the eyelids is even rarer.

Case presentation

This study reports an apocrine mixed tumor of the upper left eyelid in a 68 year-old lady with a history of breast cancer. This mass appeared about 3 years ago, as a slowly growing small nodule, and was completely excised. On microscopic examination, an encapsulated mass with epithelial and mesenchymal features was seen. The epithelial component presented tubular, cystic and infundibular structures while the mesenchymal component was fibrous in some areas and myxoid in others. Plasmacytoid hyaline cells, lipomatous change and focal calcification were appreciated focally. Immunohistochemical studies showed stromal staining for CD10, S-100, α-SMA and p63. Luminal cell layer of the epithelial component was positive for EMA, CK-7 and GCDFP-15 markers. The capsule was unbreached and no satellite lesions were appreciated. No evidence of relapse was evident after 16 months of follow-up.

Conclusions

The diagnosis of eyelid tumors of adnexal origin can be challenging because they are rare and display a wide range of morphological patterns, as the tumor cells might differentiate along any line of the folliculosebaceous-apocrine system. Immunohistochemistry helps improve the accuracy of assessment.

Lacrimal gland pleomorphic adenoma: an inconceivable diagnosis in a child

Pleomorphic adenoma is the most common epithelial tumour of the lacrimal gland in adults. It is rare in children less than 10 years. The low incidence in children can lead to low index of suspicion and increased likelihood of misdiagnosis. Incomplete treatment can lead to malignant transformation or recurrence. High index of suspicion is necessary for prompt diagnosis in children younger than 10 years. We describe a rare case of lacrimal gland pleomorphic adenoma (LGPA) in a 7-year-old child. Only four cases have so far been reported in the literature in children younger than 10 years. We emphasise the importance of CT scan and ultrasound-guided fine needle in the diagnosis of LGPA in children.

Epitheloid hemangioendothelioma of the palpebral lobe of the lacrimal gland

PURPOSE

To describe a case of an epitheloid hemangioendothelioma which is a tumor of endothelial origin with borderline malignancy between hemangioma and angiosarcoma and which is very rare in the orbit.

METHODS

Clinical features, results of imaging and histopathological studies and postoperative clinical course of a 22-year-old female patient who presented with a gradual swelling of the left upper eyelid were reviewed.

RESULTS

Magnetic resonance imaging studies suggested a solid lesion with moderate contrast enhancement in the palpebral lobe of the lacrimal gland. A short course of systemic corticosteroid therapy failed to resolve the lesion. Excisional biopsy of the tumor yielded the diagnosis of epitheloid hemangioendothelioma of the lacrimal gland. The tumor was composed of nests of epitheloid cells, some forming CD31 positive intracytoplasmic vascular channels containing erythrocytes. CD34 and EMA were also positive and desmin, SMA, p63, S100, Factor VIII and HHV-8 were negative on immunohistochemical studies. During 44 months of follow-up, there has been no recurrence or systemic metastasis.

CONCLUSION

Epitheloid hemangioendothelioma can occur in the palpebral lobe of the lacrimal gland as a hard, painless, immobile mass. Simple excisional biopsy of the tumor, assumed to have an intermediate malignancy grade, without further local or systemic therapy provided a disease-free 3-year survival.

Primary epithelial tumors of the lacrimal gland; a retrospective analysis of 22 patients

This study analyzed the clinical and histopathological aspects, treatment and prognosis of 22 patients with primary epithelial tumors of the lacrimal gland treated in a single institution over 25 years. 191 lacrimal gland lesions retrieved from the archives of the Department of Pathology, Erasmus University Medical Center, were retrospectively reviewed. The clinical and surgical pathology files of 22 primary epithelial neoplasms (16 benign; 6 malignant tumors) were studied. All benign tumors were pleomorphic adenomas; 50% of the malignant neoplasms were adenoid cystic carcinomas. The mean time from complaint to diagnosis was 3 years for benign tumors and 6 months for malignancies. Most benign tumors were treated by local excision; no recurrences occurred. Treatment of malignant tumors varied but generally involved extensive surgery with postoperative radiotherapy. 50% of these patients showed regional and/or distant metastasis. 33% of patients with malignancy died of their disease. Most primary epithelial tumors of the lacrimal gland are pleomorphic adenomas. They have a long duration of symptoms before diagnosis, are treated by limited surgery and recur infrequently. Malignant tumors have a short duration of symptoms, are sometimes mistaken for inflammatory disease, and are, even in case of aggressive surgery, characterized by a high rate of local recurrence and metastasis.

Subconjunctival prolapse of the palpebral lobe of the lacrimal gland occurring in association with occult orbital fat herniation

INTRODUCTION

Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be a disfiguring and sometimes uncomfortable problem, usually caused by lacrimal gland enlargement or associated orbital lobe displacement. However, we present two novel cases associated with occult orbital fat herniation.

METHOD

Retrospective interventional case series of two middle-aged/elderly male patients presenting with unilateral prolapse of the palpebral lobe of the lacrimal gland and no clinically apparent orbital fat prolapse. Neither patient had proptosis, globe displacement or diplopia, but both were aware of a subconjunctival mass in the lateral fornix causing a cosmetic concern.

RESULTS

Imaging in both cases revealed a normal sized lacrimal gland with a prominent orbital fat pocket behind this. This fat was excised through an upper-eyelid skin crease approach with temporary detachment of the levator muscle in one case, and through a trans-conjunctival incision in the other. In both cases fat excision resulted in retro-placement of the palpebral lobe of the lacrimal gland such that it was no longer visible. Neither patient experienced any additional dry eye post-operatively.

CONCLUSION

Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be associated with occult orbital fat herniation, revealed on imaging. Localised orbital fat excision is an effective means of treating this condition.

Lacrimal fossa lesions: pictorial review of CT and MRI features

A wide range of disease process involve the lacrimal gland/fossa. In this pictorial review, we use histology-proven cases to illustrate conditions that affect the lacrimal gland/fossa. CT and MRI features of neoplastic, inflammatory, infiltrative, and developmental conditions are discussed.

An eyelid sialoblastoma-like tumor with a sarcomatoid myoepithelial component

Nonround cell tumors are rare in children and often difficult to diagnose. This article describes an 18-month-old child who presented with a mass on the outer aspect of the left eyelid. This mass was incompletely excised. Histologically, the tumor had nests of basaloid and relatively round cells with immature acinar or ductular structures similar to those seen in a conventional sialoblastoma, but these nests were embedded in a malignant spindle cell stroma. This stroma on immunohistochemistry was marked with S-100 and cytokeratin, which, in combination with the pertinent ultrastructural evidence, indicated a myoepithelial differentiation. Overall histologic features suggested a tumor similar to a sialoblastoma with sarcomatoid transformation of the myoepithelial component, hitherto not described in literature. This tumor probably arose from the palpebral lobe of the lacrimal gland. Postsurgery, the patient received chemotherapy (6 cycles of ifosfamide, vincristine, and doxorubicin hydrochloride [Adriamycin]) and local radiotherapy in view of residual disease. Three months after completion of the treatment (1 year after surgery), the patient is well, without any local disease. Awareness of this unusual histology of sialoblastoma will help in avoiding misdiagnosis and also refine treatment-related issues on this rare tumor.

Atypical Presentations of Pleomorphic Adenoma of the Lacrimal Gland

PURPOSE

To report 3 cases of pleomorphic adenoma of the lacrimal gland with atypical features.

METHODS

The medical records, radiographic imaging, operative reports, and tumor histopathology of 3 patients with unusual presentations of pleomorphic adenoma of the lacrimal gland were reviewed.

RESULTS

All 3 patients were females ranging in age from 18 to 64 years. The first patient presented with abrupt orbital inflammation mimicking orbital cellulitis. The second patient presented with a painful subcutaneous nodule. The last patient demonstrated calcification with bony erosion on orbital imaging. Orbitotomy was performed in all cases. Histopathologic evaluation of all specimens with light microscopy was consistent with pleomorphic adenoma of the lacrimal gland.

CONCLUSIONS

Pleomorphic adenoma is the most common epithelial tumor of the lacrimal gland. A higher degree of suspicion must be present to make the correct diagnosis in cases with atypical features. Pleomorphic adenoma may present abruptly with orbital inflammation mimicking orbital cellulitis, as a painful subcutaneous nodule, or demonstrate calcification with bony erosion on orbital imaging. Complete surgical excision of the lesion within its pseudocapsule is recommended to prevent local recurrences and, although less likely, the possibility of malignant transformation.

Pleomorphic adenoma in the palpebral lobe of the lacrimal gland misdiagnosed as chalazion

We reported a case of pleomorphic adenoma of the lacrimal gland involving the palpebral lobe in young teenage girl of Asian origin. The presentation at young age group is rare, which initially misdiagnosed as a large chalazion. The benign tumor with its intact pseudocapsule was removed through lateral orbitotomy together with the suspicious looking orbital lobe.

Imaging of the Lacrimal Gland

The lacrimal gland is situated superolateral to the eye and produces tears that moisten, lubricate, and protect the delicate corneal and conjunctival epithelium. Anatomically related to the orbit but embryologically and functionally more closely related to the salivary glands, radiological imaging has proven invaluable in delineation and differentiation of the unique range of pathological processes affecting the lacrimal gland. This article details traditional and new imaging techniques used in investigating such pathology and discusses the imaging findings and patterns of spread characteristic of various neoplastic, inflammatory, and structural processes ranging from benign adenomas, adenocarcinomas, and lymphomas to sarcoidosis, Mickulicz's syndrome, histiocytosis, and benign dacrocysts.

A Rare Case of Atypical Chondroid Syringoma of the Lower Eyelid and Review of the Literature

A 46-year-old man presented with a painless firm mass in the eyelid margin of the left lower eyelid, which had been present for 9 years. Biopsy nine years previously had not established a diagnosis. We performed excisional biopsy of the lesion and lateral advancement skin flap for reconstruction of the skin defect. Histopathologic and immunohistochemical findings were consistent with atypical chondroid syringoma with eccrine differentiation. The systemic metastatic work-up was negative, and no recurrence or metastasis was present at 30-month follow-up. Chondroid syringoma is a rare skin tumor that occurs, very rarely, in the eyelids, especially the lower eyelid. Only 26 cases of chondroid syringoma in the periorbital area, including our case, have been reported, with various characteristics. Chondroid syringomas are classified as two types, the apocrine type characterized by tubular and cystic branching lumina lined by two layers of epithelial cells, and the eccrine type, which has small tubular lumina lined by a single layer of epithelial cells. The tumor can have benign, atypical, and malignant variants. Our patient had the atypical variant, which is characterized by benign cytological features, as well as the presence of infiltrative margins and/or satellite nodules. Even benign chondroid syringomas, if incompletely excised, can recur with malignant transformation; thus, complete excision and regular follow-up is recommended for all chondroid syringomas.

Epithelial lacrimal gland tumors: a clinicopathological study of 18 cases

OBJECTIVE

The aim of this study was to report the clinicopathological features of 18 epithelial tumors of the lacrimal gland treated in a single institution.

STUDY DESIGN AND SETTING

Clinical data and treatment were recorded and histological features reviewed.

RESULTS

Twelve tumors (66.7%) were adenoid cystic carcinoma (ACC), 5 (27.8%) pleomorphic adenoma (PA), and 1 (5.5%) carcinoma ex pleomorphic adenoma. All patients with ACC presented with advanced clinical stage, and most were treated by wide surgical resection followed by adjuvant radiotherapy. No recurrence was observed in 4 cases of ACC; however, 7 patients died from persistence of disease or by local and/or distant recurrence. All PA patients were successfully treated by surgical resection.

CONCLUSIONS

Epithelial lacrimal gland tumors are mainly PA and ACC, and malignancies are more common than benign tumors. Although ACC presented typically with advanced clinical stage, 33% of the patients survived without tumor recurrence or metastasis.

Adenokarzinom des Tr�nensackes nach endonasaler Dakryozystorhinostomie

Primary adenocarcinoma of the nasolacrimal drainage system is a highly uncommon diagnosis, which is presumably derived from malignantly transformed glandular cells that are interspersed amongst the epithelium of the nasolacrimal duct. The patients usually present with unspecific orbital or sinus-nasal symptoms. An appropriate therapeutic regime consists of a preferably early, radical resection and local postoperative radiation therapy. This brief contribution deals with an especially uncommon case of a carcinoma of the nasolacrimal drainage system. On his first presentation, the 62-year old patient complained about right sided epiphora which had been present over the last few weeks. Eight years prior to presentation, he had been treated for a nasolacrimal duct stenosis by endoscopic dacryocystorhinostomy on this side. Diagnostic imaging revealed a soft tissue mass in the right nasolacrimal duct which was removed by a combined extra-endonasal approach. The final histopathological evaluation was adenocarcinoma. Following postoperative radiotherapy, the patient has been free of disease for 42 months. The occurrence of adenocarcinoma of the nasolacrimal drainage system in the setting of previous surgery may provide a new insight into the clinical spectrum of the natural history of this disease.

Magnetic resonance imaging of unilateral lacrimal gland lesions

PURPOSE

To report the findings on magnetic resonance imaging (MRI) of various benign and malignant unilateral lacrimal gland lesions.

METHODS

This is a retrospective noncomparative interventional case series. Thirty-one consecutive patients with a unilateral lacrimal gland lesion were analyzed. The preoperative MRI findings were correlated with the pathology results. The main outcome measures were anatomic extent, configuration, margins, angulation, internal features on T1- and T2-weighted images (with respect to extraocular muscles and cerebral gray matter), contrast enhancement of the lesion and adjacent bone change on MRI.

RESULTS

Of the 31 patients, 21 had chronic dacryoadenitis, 3 had lymphoid tumors, and 7 had epithelial tumors including pleomorphic adenoma (3), adenoid cystic carcinoma (3), and pleomorphic adenocarcinoma (1). The results of the patients with chronic dacryoadenitis demonstrated involvement of the orbital lobe alone in 13 patients (62%), involvement of both orbital and palpebral lobes in 8 (38%), a molded configuration with ill-defined margins, sharp angles in 13 (62%), round angles in 8 (38%), lack of bone change, an isointense internal signal on T1-weighted images, a hypointense signal on T2-weighted images, and moderate contrast enhancement. The patients with lymphoid tumors demonstrated involvement of the orbital lobe, a molded configuration with ill-defined margins and sharp angles, lack of bone change, an isointense internal signal on T1-weighted images, an isointense signal on T2-weighted images, and moderate contrast enhancement. Those with epithelial tumors showed involvement of the orbital lobe, a well-circumscribed oval configuration, and round angles. Pleomorphic adenoma demonstrated smooth margins, bone expansion in two patients, and no bone change in one. Adenoid cystic carcinoma and pleomorphic adenocarcinoma showed irregular margins and bone destruction. All epithelial tumors demonstrated an isointense internal signal on T1-weighted images, a hyperintense signal on T2-weighted images, and moderate contrast enhancement.

CONCLUSIONS

It is difficult to uniformly correlate the MRI features and histopathologic findings in lacrimal gland lesions. However, MRI seems to be useful in determining the etiology of a unilateral lacrimal gland lesion. Internal tissue features on T1- and T2-weighted images of MRI are most helpful in categorizing these lesions. Although the number of patients is small, our findings suggest that there are differences in orbital MRI findings of inflammatory lesions and lymphoid tumors as compared to benign and malignant epithelial tumors in the lacrimal gland fossa.

Adenoid cystic carcinoma of the lacrimal gland

Adenoid cystic carcinoma (ACC) of the lacrimal gland is a rare tumor from the epithelial structure. It is rare in children. The authors report a case of ACC in a girl child. Extensive excision of the tumor is advised to prevent later recurrences. Local control can be better achieved by a combination of radiochemotherapy as ACC has been shown to recur event after 10 years.

Pleomorphic adenoma of the lacrimal gland: case report

Lacrimal gland tumours are rare. We present a case of a lacrimal gland pleomorphic adenoma in a 19-year-old man. The tumour was removed and he has made an uncomplicated recovery, with no sign of recurrence after nine months of follow-up. We will keep him under long-term review.

Ultrastructural study of primary lacrimal adenocarcinoma

PURPOSE

Primary adenocarcinoma of the lacrimal gland is a rare malignant tumor of the orbit. Up to now, there has been no presentation of its ultrastructural features. The histopathological findings and fine structures of one case of adenocarcinoma of the lacrimal gland are described in the present work.

METHODS

The patient was a 59-year-old Japanese man with proptosis that had persisted for one month. A tumor was extirpated, and the tissues were prepared for light and electron microscopic examination.

RESULTS

Electron microscopic examination demonstrated that the tumor cells had well-developed microvilli and lumens. These ultrastructure features are similar to those seen in adenocarcinomas at other sites.

CONCLUSIONS

These observations suggest that the accurate diagnosis of rare malignant adenocarcinoma depends not only on routine techniques such as light microscopy of hematoxylin-eosin and PAS-diastase stained slides, but also on electron microscopic findings.

Epithelial tumors of the lacrimal glands: a clinicopathologic study

We report the clinicopathologic features of epithelial tumors of the lacrimal gland apparatus, which are rare and therefore represent a major challenge for diagnosis and treatment. Histologic material from 22 lesions was studied by light microscopy, histochemistry, and immunohistochemistry. A comparison with major and minor salivary gland tumors was performed to analyze the relative distribution of these tumors and to establish whether salivary glands and lacrimal gland tumors are similar or different in their pathologic appearance and clinical behavior. There were three benign pleomorphic adenomas and 19 malignant tumors. The gender distribution was equal. The ages of the patients ranged from 10 to 73 years (mean age, 46 years). Among the malignant tumors, adenoid cystic carcinoma was the most common (nine cases), followed by mucoepidermoid carcinoma (three cases). There were two cases each of malignant mixed tumor and adenocarcinoma. All mucoepidermoid carcinomas and the adenocarcinomas were histologically high grade. There also was one case each of salivary duct carcinoma, spindle cell carcinoma, and oncocytic adenocarcinoma. Of 14 patients in whom clinical follow-up was available, seven had distant metastases and four died of their disease. The only case occurring in a child was an adenoid cystic carcinoma that recurred locally after 14 years. The clinical and pathologic features of lacrimal gland tumors resemble those lesions that arise in the intraoral minor salivary glands. The greater relative proportion of malignant cases in this series probably reflects a selection bias.

Lacrimal gland tumors and simulating lesions. Clinicopathologic and MR imaging features

The lacrimal gland region can be involved in a wide spectrum of orbital pathology, including inflammatory, lymphoproliferative, and epithelial tumors. This article focuses on benign and malignant epithelial tumors of lacrimal gland and simulating lesions. The clinical presentations, MR imaging, and pathologic findings of lacrimal gland tumors are reviewed.