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   Table of Contents      
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 31-33

Pleomorphic adenoma of palpebral part of lacrimal gland: A rare case report


1 Department of Ophthalmology, Al-Ameen Medical College Bijapur, Bijapur, Karnataka, India
2 Department of Ophthalmology, Shri B M Patil Medical College, Bijapur, Karnataka, India
3 Department of Medicine, Shri B M Patil Medical College, Bijapur, Karnataka, India

Date of Web Publication8-May-2017

Correspondence Address:
Sushma A Hosamani
Department of Ophthalmology, Al.Ameen Medical College and Hospital, Bijapur, Karnataka
India
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DOI: 10.4103/1858-6538.205799

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  Abstract 

The aim of this study is to report a case of pleomorphic adenoma of palpebral part of lacrimal gland. A 38-year-old female was admitted with the complaints of swelling in the left upper eyelid which was gradual in onset and progressive in nature for 4 years. A firm nodular mass was seen protruding from left superior temporal region of orbit causing mild ptosis. Blood examination showed raised erythrocyte sedimentation rate. Ultrasound was typically hypoechoic well-capsulated mass. Under general anesthesia, the tumor was totally excised with anterolateral orbitotomy. Histopathological examination revealed a pleomorphic adenoma of the lacrimal gland with no evidence of malignancy. Postoperatively, mild ptosis was present and the patient was advised to use lubricating eye drops. Follow-up showed no recurrence. Pleomorphic adenoma (benign mixed tumor) of the lacrimal gland accounts for approximately 12–25% of all lacrimal tumors. Among these, 90% are orbital and only 10% are palpebral part of lacrimal gland tumor. It should be excised completely with a margin of normal tissue as incomplete resection may lead to recurrence. Incisional biopsy is believed to increase the risk of recurrence due to disruption of the pseudocapsule and tumor spillage.

Keywords: Lacrimal gland, lateral orbitotomy, pleomorphic adenoma


How to cite this article:
Hosamani SA, Biradar S, Warad V G. Pleomorphic adenoma of palpebral part of lacrimal gland: A rare case report. Albasar Int J Ophthalmol 2017;4:31-3

How to cite this URL:
Hosamani SA, Biradar S, Warad V G. Pleomorphic adenoma of palpebral part of lacrimal gland: A rare case report. Albasar Int J Ophthalmol [serial online] 2017 [cited 2021 Jul 29];4:31-3. Available from: https://www.bijojournal.org/text.asp?2017/4/1/31/205799


  Introduction Top


Pleomorphic adenomas of the lacrimal glands are epithelial tumors, usually benign but can become malignant. According to a clinical series from Wills Eye Hospital, lacrimal gland tumors represent almost 10% of space occupying orbital lesion.[1] Among them, 20% are epithelial tumors and 80% are either inflammatory or lymphatic lesions. Of the epithelial tumors, 55% are benign and 45% are malignant lesions. Among benign lesions, pleomorphic adenomas account for only 18%.[1] The tumor should be excised completely with a margin of normal tissue as incomplete resection may lead to recurrence. Incisional biopsy is believed to increase the risk of recurrence due to disruption of the pseudocapsule and tumor spillage.[2],[3],[4] Here, we report a rare case of pleomorphic adenoma of the palpebral part of lacrimal gland.


  Case Report Top


A 38-year-old female was admitted with the complaints of swelling in the left upper eyelid which was gradual in onset and progressive in nature for 4 years. A firm nodular mass was seen protruding from left superior temporal region of orbit causing mild ptosis [Figure 1]. Extraocular movements were normal and visual acuity was 20/30 in right eye and 20/20 in left eye. Anterior segment was within normal limits, and fundus was normal in both eyes. Blood examination showed normal counts except raised erythrocyte sedimentation rate. Ultrasound was typically hypoechoic well-capsulated mass. Fine needle aspiration cytology was performed elsewhere which showed features of mixed cell adenoma. Under general anesthesia, the tumor was totally excised with anterolateral orbitotomy. Lesion was excised intact along with the capsule [Figure 2]. We also excised a part of normal lacrimal gland tissue. Histopathological examination revealed a pleomorphic adenoma of the lacrimal gland with no evidence of malignancy [Figure 3]. Postoperatively, mild ptosis was present and the patient was advised to use lubricating eye drops. Follow-up after 5 years showed no recurrence.
Figure 1: Clinical appearance of lesion

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Figure 2: Intraoperative appearance of the lesion

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Figure 3: Histological appearance

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  Discussion Top


Pleomorphic adenomas occur in the fourth or fifth decade of life. They are essentially benign epithelial (12%) lesion. This tumor grows very slowly; cases have been reported with a decade long history.[5] Herein, we are reporting a slow-growing mass in the left eye upper lateral side of the eye in a 38-year-old lady which was painless and causing no significant visual disturbances. It is interesting to look at the incidence of risk of malignant transformation in long-standing cases and tumor recurrence after surgical excision. However, our case on orbital imaging showed well-defined round or oval mass in the lacrimal fossa without bony erosions suggesting the benign nature of the tumor. Over 50% recur after about 10 years following surgery.[5] Other sites for pleomorphic adenomas are salivary glands and sweat glands of the skin. Patients affected with lacrimal gland tumor present with long history of painless proptosis. Recently, Currie and Rose [6] evaluated the long-term risk of recurrence after excision of pleomorphic adenoma of lacrimal gland for 5 years follow-up and found no recurrence in tumor when completely excised with an intact capsule or when capsule breached while excision or after complete excision of previous incompletely excised tumor. Benign tumors, show cellular cords extending outward into a “pseudocapsule,” formed by compression of the surrounding tissues.[7] Resection must therefore be directed toward their intact excision, with removal of an adequate margin of the surrounding tissues.[7],[8] Diagnosis of palpebral lobe tumors is usually straightforward.[2],[9] Patients give a short history of a painless, mobile, hard mass in the lateral aspect of the upper eyelid. Radiological evidence of calcification within benign lesions of the lacrimal fossa is rare [10] and is more common with carcinomas.[11] Postoperatively, mild ptosis was present and patient was advised to use lubricating eye drops. These complications generally result from the lateral orbitotomy and the occasional need for resection of structures neighboring the tumor, rather than being a direct consequence of the extent of pleomorphic adenoma. Follow-up after 5 years showed no recurrence in our case similar to other [7] reports. With its lower complication rate, it is a safe treatment for pleomorphic adenomas of the palpebral part of lacrimal gland.

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 montgomery lecture, part 1. Ophthalmology 2004;111:997-1008.  Back to cited text no. 1
    
2.
Auran J, Jakobiec FA, Krebs W. Benign mixed tumor of the palpebral lobe of the lacrimal gland. Clinical diagnosis and appropriate surgical management. Ophthalmology 1988;95:90-9.  Back to cited text no. 2
    
3.
Wright JE, Stewart WB, Krohel GB. Clinical presentation and management of lacrimal gland tumours. Br J Ophthalmol 1979;63:600-6.  Back to cited text no. 3
    
4.
Font RL, Gamel JW. Epithelial tumors of the lacrimal gland: An analysis of 265 cases. In: Jakobiec FA, editor. Ocular and Adnexal Tumors. Birmingham, AL: Aesculapius; 1978. p. 787-805.  Back to cited text no. 4
    
5.
Desouza C, Ogale SB, Shah KL, Sane SY. Pleomorphic adenoma of the lacrimal gland (a case report). J Postgrad Med 1987;33:41-2.  Back to cited text no. 5
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6.
Currie ZI, Rose GE. Long-term risk of recurrence after intact excision of pleomorphic adenomas of the lacrimal gland. Arch Ophthalmol 2007;125:1643-6.  Back to cited text no. 6
    
7.
Zimmerman LE, Sanders TE, Ackerman LV. Epithelial tumors of the lacrimal gland: Prognostic significance of histologic types. Int Ophthalmol Clin 1962;2:337-67.  Back to cited text no. 7
    
8.
Jakobiec FA. Tumors of the lacrimal gland and lacrimal sac. In: Anderson RL, editor. Symposium of Diseases and Surgery of the Lids, Lacrimal Apparatus and Orbit. (Trans New Orleans Acad Ophthalmol). St. Louis: Mosby; 1982. p. 190-202.  Back to cited text no. 8
    
9.
Parks SL, Glover AT. Benign mixed tumors arising in the palpebral lobe of the lacrimal gland. Ophthalmology 1990;97:526-30.  Back to cited text no. 9
    
10.
Portis JM, Krohel GB, Stewart WB. Calcifications in lesions of the fossa of the lacrimal gland. Ophthal Plast Reconstr Surg 1985;1:137-44.  Back to cited text no. 10
    
11.
Wright JE, Rose GE, Garner A. Primary malignant neoplasms of the lacrimal gland. Br J Ophthalmol 1992;76:401-7.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Palpebral Pleomorphic Adenomas of the Lacrimal Gland
Kaveh Vahdani,Geoffrey E. Rose
Ophthalmic Plastic & Reconstructive Surgery. 2021; 37(2): 125
[Pubmed] | [DOI]



 

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