Epithelial tumors of the lacrimal gland A comparison of the pathologic and clinical behavior with those of the salivary glands

Abstract

Abstract Considering the present state of knowledge of the histologic variations of epithelial tumors of the salivary glands in relation to their clinical course, the present concepts of the nature and behavior of similar tumors in the lacrimal gland, as gathered from the literature, are most inadequate. A series of 116 cases of epithelial tumors of the lacrimal gland was studied histologically. The histopathologic features as found in this series were considered to be identical to those found by Foote and Frazell [6] in the salivary glands. Benign mixed tumors were the most frequent (58.6 per cent), as compared to 80 per cent in the parotid gland. Thirty-three per cent of the lacrimal lesions were carcinomas as compared with 10 per cent in the parotid gland. Adenoid cystic carcinoma was the most frequent (25 per cent), whereas, the remainder were about equally divided between malignant mixed tumors (8.6 per cent) and other carcinomas (7.8 per cent). Other types of salivary gland tumors were not found in the lacrimal gland. The adenoid cystic variety of carcinoma is much more common in the lacrimal gland than in the parotid gland (ratio of 1:2.7 in the lacrimal gland and 1:31 in the parotid gland). However, in the tumors of the other salivary glands, as well as those in the mouth and pharynx, this ratio was found to be similar. The differences in the clinical characteristics in the two areas are chiefly because of the anatomic location. The lacrimal gland tumors tend to give more obvious clinical findings and tend to be attacked surgically earlier. In both areas the malignant tumors have significantly more rapid and often fatal clinical courses. In both areas the benign mixed tumors are truly benign, no deaths were reported in the Foote and Frazell series and only one from locally infiltrative growth in the present series of lacrimal gland lesions. These tumors do tend to recur with invasive growth in both sites if not completely removed. Characteristically, these tumors often recur years after the initial removal. The recurrence rate is higher in the present series than in the Foote and Frazell series (23 per cent versus 4.2 per cent) probably because of the more difficult surgical approach and a resultant higher percentage of incomplete removal. In both areas the carcinomas have a poor prognosis with high mortality. The prognosis of carcinoma of the lacrimal gland seems to be poorer than that in the parotid glands, not only because of the more difficult surgical approach, but also because of the higher frequency of adenoid cystic carcinoma. Another factor in the poorer prognosis is the great tendency of lacrimal gland tumors, both benign and malignant, to invade the bone of the lacrimal fossa. The management of these lesions in both sites is surgical excision. Simple excision is usually adequate for the benign mixed tumor, if care is taken to resect all of the capsule. In patients with diffuse invasive benign tumors, wider excision must be done. In all carcinomas of the lacrimal gland and in repeated infiltrative recurrences, exenteration of the orbit is indicated. If bony infiltration is present, resection of the frontal bone must be done.