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| Year : 1987 | Volume
: 33
| Issue : 1 | Page : 41-2 |
Pleomorphic adenoma of the lacrimal gland (a case report).
Desouza CC, Ogale SB, Shah KL, Sane SY
How to cite this article:
Desouza C C, Ogale S B, Shah K L, Sane S Y. Pleomorphic adenoma of the lacrimal gland (a case report). J Postgrad Med 1987;33:41 |
Pleomorphic adenomas of the lacrimal glands are epithelial tumours, usually benign but can become malignant. When the mass is found to be adherent to the roof of the orbit, it is suspected to be malignant.
Other sites for pleomorphic adenomas are salivary glands and sweat glands of the skin. In our experience, the commonest causes of unilateral proptosis are mucocoeles of the frontal and ethmoid paranasal sinuses. We have encountered only one case of a pleomorphic adenoma of the lacrimal gland causing proptosis. The same is being reported here.
A 35 year old male was admitted with the complaints of swelling in the right eye which caused it to protrude over a period of eight months. The patient was mentally retarded and gave no complaints of diminished vision, diplopia, headaches, nasal discharge or nasal obstruction. Clinically, visual acuity, visual fields, fundi and extra-ocular motility were normal. No abnormality was detected in the ear, nose and throat. The patient had significant proptosis of the right eye which was pushed downwards [Fig. 1]. A hard nodular mass was felt behind the right eyelid and appeared adherent to the roof of the orbit. However, its extent could not be determined on palpation.
Roentgenograms of the paranasal sinuses were found normal but a calcific opacity was seen in the right orbital cavity.
A CT scan revealed a hyperdenses mass restricted to the orbital cavity with no destruction of the roof of the orbit. A classical Lynch's incision was taken and as soon as the periosteum was elevated a little further laterally, the tumor was encountered. It was encapsulated, adherent to the periosteum and was totally excised with a part of the orbital periosteum. Post-operatively, the proptosis had disappeared and no recurrence was found during the 6 months of follow-up. Histopathological examination revealed a pleomorphic adenoma of the lacrimal gland with no evidence of malignancy [Fig. 2].
Pleomorphic adenomas occur in the fourth or fifth decade of life. They are essentially benign but can undergo malignant change. This tumour grows very slowly; cases have been reported with a decade long history.1 It has a tendency to recur if the tumour is not removed with its capsule. Over 50 per cent recur after about 10 years, following surgery.[2] The salivary glands are the commonest sites for pleomorphic adenomas.
On histopathology, epithelial and connective tissue elements are seen which show pleomorphism. This epithelial tumour is derived from the ducts of the gland and shows a double layer of cuboidal cells. The innermost layer of cells may undergo metaplasia resembling myxomatous, fibroblastic, cartilagenous or even osseous tissue with areas of hyalinization. A pseudo capsule is formed, consisting of condensation of connective tissue and may be adherent to the periosteum. This may be invaded by the tumour and if the pseudocapsule is not incompletely removed on excision, recurrence usually follows.
We wish to thank the Dean, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay for allowing us to publish this material.
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