Roentgen appearance of lacrimal-gland tumors.

Abstract

tumors of the lacrimal glands frequently cause changes in the adjacent bone structures that are recognizable roentgenographically. Some authors (1, 3, 6) have stated that roentgenograms rarely show appreciable changes in the presence of these tumors. Jones and Pfeiffer (4), on the other hand, have published a report—the only one of its kind—emphasizing the importance of such changes in the diagnosis and prognosis of lacrimal-gland tumors. The purpose of this paper is to re-emphasize the important role of roentgen evaluation of these lesions. Pathology The lacrimal gland lies in a shallow fossa in the superolateral portion of the orbit behind the superior orbital rim (Fig. 1). This fossa represents an indentation in the roof of the orbit that can better be appreciated by palpation than by inspection of the dried skull. Epithelial tumors of the lacrimal gland appear similar to salivary-gland tumors and are classified as (a) mixed tumors, (b) carcinomas—adenoid-cystic type, and (c) carcinomas—miscellaneous types (8). Mixed tumors are slowly expanding benign neoplasms that exert local pressure against the adjacent bone. Frequently tumor nodules are found in the capsule and, unless these are completely removed, recurrences are common. Carcinomas, either of the adenoid-cystic or of the miscellaneous types, however, tend to invade adjacent bony structures early. This invasion is not limited to the lacrimal fossa but may extend superiorly through the orbital roof intracranially, laterally into the sphenoid, malar or temporal bones, or medially toward the apex of the orbit. Metastasis to the skull and lungs is a frequent occurrence in the later stages. The prognosis of lacrimal-gland tumors depends on the histologic changes and the extent of the growth (2). Benign mixed tumors, if completely removed with the capsule intact, have a favorable prognosis. In contrast, carcinomas, either of the adenoid-cystic or miscellaneous type, have been almost universally fatal. The prognosis of lacrimal-gland tumors is much more serious than of the histologically similar salivary-gland tumors (5, 7). This difference is due to the immediate proximity of the lacrimal gland to bone and a tendency to early bone invasion. In addition, the difficult surgical approach and hesitancy in performing an early radical operation contribute to the poor prognosis. Methods and Results The present study is based on 12 patients with lacrimal-gland tumors whose ages ranged from fourteen to seventy-nine years. Their clinical histories are summarized in Table I. The most frequent presenting symptoms were proptosis, diplopia, and blurred vision, which were related to an expanding mass in the lacrimal fossa. Four patients had benign mixed tumors. Three of these are well five, fourteen, and twenty-three years after the initial excision; the fourth patient died of unrelated disease without local recurrence six years after operation.