Lacrimal Gland Pleomorphic Adenoma

Abstract

We read with great interest the recent report by McNab and Satchi1McNab A.A. Satchi K. Recurrent lacrimal gland pleomorphic adenoma: clinical and computed tomography features.Ophthalmology. 2011; 118: 2088-2092Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar describing 5 cases of recurrent pleomorphic adenoma of the lacrimal gland. The clinical and radiographic features, as well as treatment strategies, were described. Although the authors described the reported lesions as “recurrent,” we believe these lesions to be more accurately described as persistent lesions. Recurrence describes a pathologic entity that resurfaces in a given anatomic location following complete eradication of the original lesion. Thus, there is no clear evidence that any of the 5 cases described represent true recurrent disease. Specifically, there is no histopathologic evidence of an intact pseudocapsule with negative margins in any of the described cases. The authors describe a case in which complete tumor excision is best described as plausible (case 2) with “macroscopically intact removal of a pleomorphic adenoma from the orbital lobe of the lacrimal gland. Histopathology records were not available to confirm whether excision had been complete.”1McNab A.A. Satchi K. Recurrent lacrimal gland pleomorphic adenoma: clinical and computed tomography features.Ophthalmology. 2011; 118: 2088-2092Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar The other cases described either had partial excision (cases 1, 4, 5) or only an incisional biopsy was performed (case 3).1McNab A.A. Satchi K. Recurrent lacrimal gland pleomorphic adenoma: clinical and computed tomography features.Ophthalmology. 2011; 118: 2088-2092Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar We believe this series more correctly portrays the clinical and radiographic presentation of persistent, rather than recurrent, pleomorphic adenoma of the lacrimal gland. It is well established that persistent pleomorphic adenoma carries a risk of malignant transformation into malignant mixed tumor (pleomorphic adenocarcinoma), which portends a poor survival rate. Persistent tumor can be encountered in longstanding disease commonly seen in untreated patients, patients who undergo incisional biopsy only, or patients who have had incomplete tumor excision. True recurrent disease after a patient has had complete excision via lateral orbitotomy with an intact pseudocapsule, and histopathologic confirmation of negative margins would be a rare event. The authors provided an informative clinical case series and novel radiographic findings in patients with persistent pleomorphic adenoma of the lacrimal gland. Their report underscores the importance of a high degree of suspicion for this lesion and emphasizes the need for complete surgical excision to avoid potential malignant transformation, disfiguring craniofacial surgeries, or death. Recurrent Lacrimal Gland Pleomorphic Adenoma: Clinical and Computed Tomography FeaturesOphthalmologyVol. 118Issue 10PreviewTo report the clinical and computed tomography (CT) features of recurrent lacrimal gland pleomorphic adenoma (LGPA). Full-Text PDF Author replyOphthalmologyVol. 119Issue 6PreviewWe thank Drs Pointdujour and Shinder for their interest in our article on recurrent lacrimal gland pleomorphic adenoma and its clinical and computed tomographic features.1 We think that the general readership understands our use of the term “recurrent,” which is very widely used to denote the sort of clinical presentation described in our patients. The term “recurrent” is widely used in medicine to denote regrowth of tumor at the original site when the original tumor has been removed in the past and that removal has clearly been incomplete. Full-Text PDF