A Case of Adult Orbital Lymphatic Malformation in the Lacrimal Gland

PURPOSE: When there is a mass in the superior temporal orbit area, a lacrimal gland tumor should be suspected. We report a rare case of orbital lymphatic malformation that was histologically diagnosed in a patient with typical clinical features of the lacrimal gland. CASE SUMMARY: A 55-year-old female with no underlying disease and no ophthalmic history visited our clinic with a right upper eyelid edema associated with an enlarged painless eyelid mass 1 month prior to her visit. The patient stated that she discovered the mass 1 year previously.The palpebral lobe of the lacrimal gland protruded slightly with congestion of the surrounding conjunctiva. Enhanced computed tomography showed a 3 cm well-defined heterogeneous mass in the right lacrimal gland area and several well-defined round calcifications within the mass. Orbital tissue or bone involvement was not observed. The pleomorphic adenoma of the lacrimal gland was the most clinically suspicious, so complete resection of the mass was performed using lateral orbitotomy. Histopathologically, lymphangioma (lymphatic malformation) originating from the lacrimal gland was diagnosed. CONCLUSIONS: Orbital lymphatic malformation can occur in the lacrimal gland. The present case showed that differential diagnosis can reveal the presence of an adult lacrimal gland tumor.

Clinical analysis for the diagnosis and treatment of 25 cases with primary lacrimal gland epithelial tumor / 中国基层医药

Objective To explore the clinical manifestation,imaging features and treatment of primary lacri-mal gland epithelial tumor.Methods The clinical data of 25 cases with primary lacrimal gland epithelial tumors were retrospectively studied.Results All of 25 primary lacrimal gland epithelial tumor cases received surgical treatment. Fourteen primary orbital tumors cases were male and 11 cases were female.The mean age was 44 years old (ranged 23 to 65).The mean hospital stay was 12d(ranged 7 to 20).Among 25 primary lacrimal gland epithelial tumor cases, 11 cases were benign tumors which included 4 inflammatory pseudotumor,11 pleomorphic adenoma.Fourteen cases were malignant tumors which included 4 malignant pleomorphic adenoma,6 adenoid cystic carcinoma and 4 adenocar-cinoma.After opeation,visual acuity improved in 9 cases,unchanged 10 cases,decreased 6 cases.The patients were followed up for 16 -48 months(mean 27 months).There were 4 malignant tumors recurrence after operation and received radical operation.While 2 patients were lost and 2 patients died of tumor metastasis,the other 21 patients survived with tumor -free.Conclusion Primary lacrimal gland epithelial tumors have different clinical and imaging appearances.Combination of ultrasound,CT and MRI is important to ascertain the character,range and degree of primary lacrimal gland epithelial tumors.Surgical excision is the main and effective treatment for primary lacrimal gland epithelial tumors,while gamma knife treatment is safe and effective for malignant,unresectable,recurrences tumors.

A Case of Carcinoma Ex Pleomorphic Adenoma at 1st Operation

PURPOSE: To report a case of carcinoma ex pleomorphic adenoma observed during the patient's first operation. CASE SUMMARY: A 63-year-old female presented with proptosis and ptosis that was aggravated 1 year prior. On preoperative CT image, a 32 x 20 x 21 mm-sized well demarcated mass (suspected as pleomorphic adenoma) was observed and was removed entirely by anterolateral orbitotomy. The excised mass surface was uneven but the capsule appeared intact on gross examination. Hard, yellow-colored and soft, dark-colored materials were found concurrently on cross section. The histological examination showed malignant cells as part of the soft material and was diagnosed as carcinoma ex pleomorphic adenoma. CONCLUSIONS: We report a case of carcinoma ex pleomorphic adenoma of the lacrimal gland that presented with malignant change during the patient's first operation. Supposedly, during the process of mass growth, minimal rupture occurred causing malignant transformation. Clinically, although a mass is believed benign based on imaging, the possibility of malignant transformation of a tumor increasing rapidly or enlargement causing development of rapid proptosis should be considered.

Pleomorphic Adenoma of the Lacrimal Gland in a Child

PURPOSE: To report one case of pleomorphic adenoma of the lacrimal gland in a child. CASE SUMMARY: A 7-year-old boy presented with a 2-month history of an exophthalmos and mild ptosis of the left eye; there were no other ophthalmologic problems. Orbit MRI revealed a well-defined mass in the left lacrimal gland and a defect in the orbital roof due to pressure erosion. Tumor resection was performed via a lateral orbitotomy and a biopsy was requested. The biopsy revealed tumor tissue that was composed of epithelial elements with variably sized duct formation. Focal squamous metaplasia and keratin production was also observed. CONCLUSIONS: Pleomorphic adenoma of the lacrimal gland should be considered as a differential diagnosis of a lacrimal gland mass in a child.

The Clinical and Histopathologic Review of Lacrimal Gland Tumors

We performed retrospective review of charts in 26 patients who had been confirmed to have lacrimal gland tumor at korea University Guro hospital from March, 1984 to March, 1996 for evaluating the correlation between clinical findings and histopathologic diagnosis. This study was focused on incidence of lacrimal gland tumors, age, sex, symptoms and signs and ists duratio, radiologic findings, presence and location of metastases, and prognosis. There were 6 cases of benign mixed tumor(23%), 6 cases of malignant mixed tumor(23%), 4 cases of adenoid cystic carcinoma(15.4%), 4 cases of inflammatory pseudotumor(15.4%) and 6 cases of pseudolymphoma(23%). The characteristics of clinical findings of malignant lacrimal gland tumor were pain (70%), the duration of symptom less than 6 months (90%) and bony destruction detected in radiologic findings(75% of malignant mixed tumor and 50% of adenoid cystic carcinoma). All cases of malignant tumor patients had local or distant metastasis. Among them, 2 cases of malignant mixed tumor and 2 cases of adenoid cystic carcinoma had pulmonary metastasis and were died of pulmonary metastasis. This study showed good correlations between clinical diagnosis and pathologic diagnosis, and will help in making early diagnosis and treatment of malignant lacrimal gland tumors.