Lacrimal Gland Mass Research Articles

Epibulbar osseous choristoma manifesting as a lacrimal gland mass: A case report

A 13-year-old girl was referred for assessment of a right-sided epibulbar lesion, which was suspected to be a lacrimal gland mass. The patient was asymptomatic with no ocular or systemic history. On assessment, a hyperemic, firm, and ill-defined mass was noted in the superotemporal epibulbar plane in the lacrimal gland area. An excisional biopsy was performed, with the histology confirming the lesion to be an osseous choristoma. We highlight a varied presentation of an epibulbar osseous choristoma, which should be included in the differential diagnosis of such a presentation in the lacrimal gland area in the pediatric population.

#1494 Immunotactoid glomerulopathy: a comprehensive analysis of three cases

Abstract Background Immunotactoid glomerulopathy (ITG) is an uncommon cause of glomerular disease encountered in approximately 0.06% of native kidney biopsies. This fibrillary disease is strongly associated with haematologic disorders, including lymphoma (mainly chronic lymphocytic leukaemia/small lymphocytic lymphoma), monoclonal gammopathy, and multiple myeloma. It is usually managed with oral steroids and/or treatment of an underlying lymphoproliferative disorder. Here, we report three cases of ITG, all female patients with varying severity of the disease, timing of malignancy and required treatment. Case Scenarios: Case 1: A 76-year-old lady with no significant medical background presented in May 2020 with confusion and progressive peripheral oedema. She had AKI (serum creatinine 210 µmol/L from baseline 68 µmol/L) and a sodium of 104 mmol/l. Urine PCR was 1182 mg/mmol. She was admitted to the ITU, where hyponatraemia was managed with a good clinical response. Blood screening showed negative immune, myeloma and virology screens. Complement was low. A renal biopsy showed a diagnosis of ITG. She had an extensive malignancy screen, but no malignancy was detected. She was started on prednisolone 60 mg once daily and eventually weaned off the drug by March 2021, as she maintained remission of her disease. Two years after her initial presentation, she was seen by the ophthalmologist for a right lacrimal gland mass. This was excised, and a biopsy revealed a MALT Lymphoma. Case 2: A 50-year-old lady with splenomegaly being investigated under the haematology service was referred to our renal clinic for proteinuria in June 2019. Her serum creatinine was within normal limits, and her UPCR was 302 mg/mmol. She had no paraprotein in her blood, low serum immunoglobulins, low C3 and a negative viral screen. Perindopril, initiated by her GP, was up-titrated. Renal biopsy revealed features in keeping with Immunotactoid Glomerulopathy, and completed haematological investigations revealed Chronic Lymphocytic Leukaemia. Her UPCR peaked at 842 mg/mmol before reducing to 190 mg/mmol within a year after treatment with Veneclotax and Rituximab after not tolerating FCR (Fludarabine, Cyclophosphamide, Rituximab) Chemotherapy. Case 3: A 69-year-old lady presented to the renal clinic with proteinuria in September 2018. She had a background of breast cancer diagnosed in 2007 (She had surgical resection followed by radiotherapy). Her 24-hour urine protein was 2g, and UPCR was 155 mg/mmol. Serum creatinine was 81 µmol/l and eGFR 66 ml/min. P- ANCA was positive, while PR3 and ANA were negative. She had bilateral leg oedema due to long-standing lymphedema. The biopsy report showed immunotactoid glomerulopathy. Regular surveillance of previous breast cancer with mammography and CT-CAP has shown no evidence of malignancy recurrence, hepatitis virology and paraprotein were negative, and C3/C4 were within normal limits. She had improved UPCR and maintained normal kidney function on full-dose Losartan. Conclusion Immunotactoid Glomerulopathy is a rare form of glomerular disease with a strong association with lymphoproliferative malignancies, which may precede, occur concomitantly or present years after the initial diagnosis. This common association highlights the need for diligence in screening for malignancy in each case, and it is a reason for careful follow-up of these patients. Treatment of underlying disorders is associated with positive renal outcomes, and in some cases, there is a good response to steroids.

Schwannoma- A Rare Cause of Proptosis

Schwannoma  a tumor of cranial and peripheral nerves is rarely found in the orbit and if present causes proptosis. We report a rare cause of unilateral proptosis . A 15 year old boy reported with a 10 months history of unilateral proptosis. Ophthalmic and slit lamp examination revealed no other abnormality except for a dystopia, 3mm inferiorly and 1.5mm medially of left eye. On palpation a small, non-tender rubbery nodular swelling in the left supero-temporal region was found. MRI was suggestive of a lacrimal gland mass with a hyper intense area in the region of left lacrimal gland. Complete excision biopsy was done which reported a Schwannoma of lacrimal nerve. This case emphasis on two important points.First how to approach and manage a rare cause of unilateral proptosis and also that Schwannoma of lacrimal nerve has a very good prognosis after complete surgical excision and a good follow up.

Diagnostic Pitfalls: A Case Series of 5 Patients with Lacrimal Gland Mass

Background: The orbit is infamous to harbor various mass lesions, out of which lacrimal gland tumors contribute to about 10% of all tumors. The peak incidence is in the middle-aged adults who present with upper eyelid mass. These tumors have a high morbidity and mortality rate due to their misdiagnosis. The diagnosis is still a dilemma on clinical examination and even its very difficult to get a specific diagnosis after imaging. Thus, biopsy can be an important tool to help in diagnosis and their suitable treatment. Objective: To provide specific, accurate and definitive diagnosis by correlating clinico-radiological findings with pathological examination to optimize management. Methods: We present a case series of 5 patients who presented with lacrimal gland mass with or without proptosis, defective vision, diplopia or restricted motility. These were evaluated radiologically which provide differential diagnosis that leads to a diagnostic challenge and their further management. So to reach a definitive diagnosis they were then correlated with histopathology with or without immunohistochemical stains by taking biopsy from the mass. Result and Conclusion: In our case series, we concluded that to make a confirmative diagnosis of the lacrimal gland tumors, the clinical and radiological findings should be correlated with the histopathological examination with or without immunohistochemical stains by biopsy and thus helps in rationalizing their further treatment.

Ultrasonography of Lacrimal Gland involvement in systemic Sarcoidosis

Lacrimal gland lesions generally present as palpable masses in the superolateral aspects of the orbits. Approximately 50% of lacrimal gland masses are inflammatory lesions, 25% are lymphoid lesions or lymphoma, and the other 25% are salivary gland type tumors. Although there are overlaps and exceptions, features such as laterality, portion of gland involvement, presence or absence of bony findings, enhancement pattern, and clinical presentation are valuable in differentiating among lacrimal gland lesions. The 3D ultrasound has been used to define lacrimal gland shape, size, density, structural features the pattern of blood supply, as well as the anatomic and topographic position in the orbit. The study was conducted in the B- and 3D-modes of ultrasonography with color and energy Doppler mapping on both sides.

An Unusual Lacrimal Gland Mass

ABSTRACT Aim and objective The present report describes an atypical presentation of a lacrimal gland mass in a young male patient. Symptomatology favored a benign mass that was proven to be malignant on histopathology. Background Adenoid cystic carcinoma is the most common epithelial malignancy of the lacrimal gland. The usual presentation of adenoid cystic carcinoma is in either sex at about an average 40 years of age with range from 6 to 79 years. The patient usually complains of a superotemporal orbital mass with rapid progression usually within a year. Uncommonly, these masses may present with longer history as is described in present case report. Case description A 17-year-old male patient of Indian origin presented with a mass in the superotemporal part of the right orbit for the last 5 years and 6 months. A firm and smooth orbital mass, approximately 20 mm × 15 mm, was present in superotemporal orbit that was nontender and nonpulsatile. A clinical diagnosis of lacrimal gland pleomorphic adenoma was strongly suggested by the clinical as well as radiological features. The orbital mass was excised en bloc by a right transseptal anterior orbitotomy. Histopathological examination of the excised mass revealed features characteristic of lacrimal gland adenoid cystic carcinoma. Conclusion Lacrimal gland adenoid cystic carcinoma can simulate pleomorphic adenoma and can present with history over 5 years. Hence, it should always be kept as a clinical possibility in patients with the painless superotemporal orbital mass and early excision of such orbital masses for appropriate diagnosis and management is vital. Clinical significance The duration of 5½ years at presentation in well-localized lacrimal gland adenoid cystic carcinoma is the longest period ever reported. The present article recommends keeping the differential diagnosis of adenoid cystic carcinoma in all patients with the clinically benign superotemporal orbital mass. How to cite this article Gupta P, Kaur S, Zadeng Z, et al. An Unusual Lacrimal Gland Mass. Clin Rhinol An Int J 2019;12(2 and 3):49–51.

Masses of the Lacrimal Gland: Evaluation and Treatment.

Lacrimal gland lesions account for approximately 9 to 10% of all biopsied orbital masses. Potential causes include nongranulomatous and granulomatous inflammation, autoimmune disease, lymphoproliferative disorders, benign epithelial proliferation, malignant neoplasia, and metastatic disease. Inflammatory lesions and lymphoproliferative disorders are the most common and may be unilateral or bilateral; they may also be localized to the orbit or associated with systemic disease. Both benign and malignant epithelial lacrimal gland masses tend to be unilateral and involve the orbital lobe, but a more rapid onset of symptoms and periorbital pain strongly suggest malignant disease. On orbital imaging, both inflammatory and lymphoproliferative lesions conform to the globe and surrounding structures, without changes in adjacent bone, whereas epithelial lacrimal gland masses often show scalloping of the lacrimal gland fossa. Malignant epithelial lacrimal gland tumors can also have radiographic evidence of bony invasion and destruction. Masses of the lacrimal gland may be due to a broad range of pathologies, and a good working knowledge of common clinical characteristics and radiographic imaging findings is essential for diagnosis and treatment. All patients with inflammatory, lymphoproliferative, and epithelial neoplastic lesions involving the lacrimal gland require long-term surveillance for disease recurrence and progression.

Follow-up with serum IgG4-monitoring in 8 patients with IgG4-related disease diagnosed by a lacrimal gland mass.

The diagnostic criteria for IgG4-related disease were previously published and serum IgG4 measurement has been reimbursed by national health insurance in Japan since 2012. Eight patients diagnosed with IgG4-related disease based on lacrimal gland masses were retrospectively reviewed. The 8 patients were 3 men and 5 women ranging in age from 52 to 77 (median, 63) years at the initial visit and their follow-up period ranged from 0.25 to 11 (median, 7) years. Bilateral and unilateral involvement were noted in 4 patients each; 2 on the right side and 2 on the left side in those with unilateral involvement. Serum IgG4 was high in 5 of 8 patients at the initial visit. Five patients with no systemic signs were followed without treatment, whereas oral steroids were administered and tapered in the other 3 patients who exhibited systemic signs. One patient with a history of radiation for MALT lymphoma in bilateral lacrimal glands developed IgG4-related disease in the left lacrimal gland 10 years later and was followed without treatment. Nine years later, her serum IgG4 level increased to 1500 mg/dL and paracardiac lesions, found on positron emission tomography, were confirmed to be MALT lymphoma by needle biopsy, leading to systemic chemotherapy. The other 7 patients had neither local recurrence nor additional systemic signs. Serum IgG4 monitoring may be useful to detect systemic complications in IgG4-related ophthalmic disease and markedly high serum IgG4 levels may indicate new lymphoma at other sites.

A case of simple bilateral dacryops: A review of literature

Dacryops, is a clinical entity of unknown aetiology. Here we present the clinical features and radiological presentation of a bilateral dacryops as a unique case. A 36year old woman presented with unilateral lid swelling, since 7years non-perceptible but obvious on reflex tear secretion. However, she had no complaints of pain, redness, discharge. On examination, vision was normal and lacrimal ducts were patent. Mass in the left eye was noted on reflex tear secretion such as exposure to air/chewing. No signs of inflammation present. Tear film tests were normal. Fundus, routine blood parameters and serum ACE was negative. Ultrasonography of the orbits showed well defined hypoechoiec cystic lesion along lateral aspect of left globe and CT showed bilateral predominantly cystic lesion more prominent on left compared to right. Bilateral Dacryops, is unusual. Thus it becomes essential that clinicians are aware of this condition and consider it as one of the differential diagnosis of the lacrimal gland masses. A case of bilateral dacryops detected incidentally, was investigated and followed up. Dacryops, or a lacrimal gland ductal cyst, is a rare clinical entity, whose bilateral presentation is unusual. It is essential that we as clinician’s are aware of this condition and consider it as a differential diagnosis of the lacrimal gland masses.

Bilateral lacrimal gland enlargement as a clinical manifestation of sarcoidosis

Sarcoidosis is an inflammatory disorder of unknown etiology. The main characteristics of sarcoidosis are non-caseating granulomas which can be formed in affected organs. Eye and its adnexal tissues can also be involved. In the early stages of sarcoidosis, the clinical picture may be mild and not always specific. Although the early signs of sarcoidosis are lung associated, we present a clinical case with diffuse enlargement of the lacrimal glands as a first sign of systemic sarcoidosis. A 21-years-old woman presented to the ophthalmological center with a 2-weeks history of having swollen, painful upper eyelids. Primary eye examination revealed palpable tender masses in the locations of the lacrimal glands. Characteristic for sarcoidosis X-ray findings and blood tests demanded lacrimal gland and lung biopsy for diagnosis verification. In spite sarcoidosis of lacrimal glands is a rare condition, it has to be taken into consideration in the differential diagnosis of lacrimal gland masses.

Apocrine Hidrocystoma Presenting as a Lacrimal Gland Mass

ëª©ì  눈물샘에 발생한 ì•„í¬í¬ë¦°ë•€ìƒ˜ë‚­ì¢ 1예를 경험하였기에 이를 ë³´ê³ í•˜ê³ ìž 한다. 증례요약 51세 여자 환자가 내원 2ë „ ì „ì— 처음 발생된 좌측 위눈꺼풀 ì¢ ê´´ë¥¼ 주소로 내원하였다. 초진 시 좌측 위눈꺼풀 외측의 눈물샘 부위에 ë§Œì ¸ì§€ëŠ” 무통성 ì¢ ê´´ê°€ 관찰되었으며, 세극등현미경검사에서 좌측 위눈꺼풀 결막에 경계가 잘 지어진 분홍색 ì¢ ê´´ê°€ 관찰되었다. 안와 ì „ì‚°í™”ë‹¨ì¸µì´¬ì˜ì—ì„œ 좌안의 상이측 결막에 8 x 9 x 9 mm 크기의 조영증강이 된 ë¹„êµì  경계가 ë¶„ëª í•œ ì¢ ê´´ê°€ 관찰되었다. 국소 마취하에 좌측 위눈꺼풀의 눈물샘 부위에 발생한 낭성 ì¢ ê´´ì— 대해 ì ˆì œ ìƒê²€ìˆ ì„ ì‹œí–‰í•˜ì˜€ê³ , 병리조직학검사에서 ì•„í¬í¬ë¦°ë•€ìƒ˜ë‚­ì¢ ìœ¼ë¡œ 확인되었다. ìˆ í›„ 1ë „ê¹Œì§€ 재발 소견은 관찰되지 않았다. ê²°ë¡ ì•„í¬í¬ë¦°ë•€ìƒ˜ë‚­ì¢ ì€ 눈물샘 부위에 발생하는 경우가 극히 드물어 국내에서는 첫 ë³´ê³ ì´ë©°, 눈물샘 부위 ì¢ ê´´ì˜ 감별진단에서 ê³ ë ¤ë˜ì–´ì•¼ í•˜ê² ë‹¤. Keywords: Hidrocystoma, lacrimal gland, Orbital diseases

Case Report: Facial mixed fungal infection in a poorly responding non-Hodgkin’s lymphoma patient with suspected immunodeficiency

A male child presented with left lacrimal gland and right submandibular masses that were diagnosed as high grade B-cell non-Hodgkin's Lymphoma. Immunodeficiency was suspected, mostly due to secondary to Epstein Barr virus infection. Chemotherapy was started and gradual regression was observed in the size of the lesions forming a central necrosis and facial wound. Cultures from this wound showed mixed gram negative growth of Pseudomonas aeruginosa, and Escherichia coli. Two days later, a follow up swab of the wound was taken and showed fungal growth of mixed Candida tropicalis and Cryptococcus laurentii which was treated with two antifungals (fluconazole and liposomal amphotericin B). After a second chemotherapy cycle, the facial necrotic lesion increased in size and the patient's general condition markedly deteriorated with multi-organ system failure secondary to septic shock by candidemia. Candida glabrata, which is non-Candida albicans fungus was the fungus that appeared in the patient's blood culture. Caspofungin was prescribed in addition to liposomal amphotericin B. two days later, the follow up blood culture revealed growth of methicillin resistant Staphylococcus aureus and the pulmonary condition of the patient then deteriorated gradually. Six days later, the patient developed multi-organ dysfunction syndrome secondary to sepsis. We conclude that we mixed fungal infection in not uncommon among immunocompromised patients, candidemia is fatal even if treated with the correct antifungals.

Clinicopathologic features of biopsied lacrimal gland masses in 95 Korean patients.

To investigate the clinicopathologic features of lacrimal gland masses biopsied in a tertiary referral hospital in Korea. Records from 95 Korean patients who underwent lacrimal gland mass biopsy were retrospectively reviewed. Data included demographics, clinical presentation, imaging findings, histopathologic diagnosis, and associated systemic disease. The median age was 52.0years (range, 16-76years), and 51 patients (53.7%) were female. Thirty-three patients (34.7%) had bilateral disease. The histopathologic diagnoses were as follows: chronic dacryoadenitis (52.6%, n = 50;29 non-specific and 21 immunoglobulin G4-related disease (IgG4-RD)), lymphoproliferative disease (25.5%, n = 24; 18 lymphoma and six lymphoid hyperplasia), benign epithelial tumour (13.7%, 13 pleomorphic adenoma), malignant epithelial tumour (3.2%, three adenoid cystic carcinoma), dacryops (3.2%, n = 3), solitary fibrous tumour (1.1%, n = 1), and xanthogranulomatous inflammation (1.1%, n = 1). Patients with chronic dacryoadenitis were significantly more likely to be younger (mean 47.5years), have bilateral involvement (52.0%), and have a longer symptom period (mean 15.6months) than those with lymphoproliferative disease (60.0years, 25.0%, and 6.7months, respectively; p < 0.05, each comparison). Patients with IgG4-related dacryoadenitis were significantly more likely to have bilateral involvement (85.7%) and have associated systemic involvement (52.4%) than those with non-specific dacryoadenitis (37.9 and 0%, respectively; p < 0.05, each comparison). Sixteen patients (16.8%) had associated systemic involvement: 11 with IgG4-RD and 5 with lymphoma. Chronic dacryoadenitis and lymphoproliferative disease were the most common causes of lacrimal gland masses in our cohort. Younger patients with bilateral involvement and a longer symptom period were more likely to have chronic dacryoadenitis than lymphoproliferative disease. Associated systemic involvement was not rare in patients with IgG4-RD or lymphoma. Our results suggest that biopsy of chronic lacrimal gland masses should be performed for proper evaluation and management.

Application of Rose and Wright’s algorithm in the diagnosis of lacrimal gland masses: a study of 93 cases

ObjectiveTo investigate the application of Rose and Wright’s algorithm in diagnosing lacrimal gland masses. DesignRetrospective observational cases series. ParticipantsA total of 93 consecutive patients with primary masses within the orbital lobe of the lacrimal gland were reviewed. MethodsBefore treatment, patients’ detailed history was collected verbally and all patients underwent image examination (computed tomography and magnetic resonance imaging). The clinical and radiological features of every patient were evaluated by experienced orbital surgeons. Based on Rose and Wright’s criteria, patients were scored and then treated using surgery with radiotherapy and/or chemotherapy. The final diagnoses were based on the histopathologic results. Based on the histopathologic diagnosis, the data from Rose and Wright’s algorithm were evaluated. ResultsThe accuracy of Rose and Wright’s algorithm for benign and malignant tumour diagnoses was 75% and 50%, respectively. The diagnostic sensitivity, specificity, and accuracy of Rose and Wright’s algorithm were 64%, 93%, and 86%, respectively. The algorithm demonstrated significant accuracy in the clinicoradiological criterion in differentiating between benign tumours and malignant tumours (p < 0.05). ConclusionsRose and Wright’s algorithm has great advantages in distinguishing benign from malignant tumours within the orbital lobe of the lacrimal gland. However, the algorithm should be used with great caution because of its low diagnostic sensitivity for malignant tumours.

Alveolar Rhabdomyosarcoma of the foot metastasizing to the Iris: report of a rare case

BackgroundIntraocular iris rhabdomyosarcoma is extremely rare, and in the 3 cases reported to date occurred as the primary site of tumour growth. We report a case of rhabdomyosarcoma of the foot metastasizing to the iris.Case presentationAn 18-year-old white female was referred to the London Ocular Oncology Service for management of a metastatic rhabdomyosarcomatous deposit in the iris, a metastasis from alveolar rhabdomyosarcoma of the foot. She was diagnosed nearly 2 years earlier with the primary sarcoma with extensive systemic spread and treated by resection of the foot lesion and chemotherapy, and achieved a partial remission. The left iris deposit was noted while she was receiving systemic chemotherapy, heralding a relapse. However, anterior uveitis and raised intraocular pressure developed and she was referred to our service for further management. A left iris secondary rhabdomyosarcoma deposit was noticed and in addition a lacrimal gland mass, as indicated by ultrasound B scan of the eye and orbit. The patient was treated with external beam radiotherapy to the globe and orbit, but died 2 months after treatment completion.ConclusionRhabdomyosarcoma of the iris is very rare and was previously documented only as a primary malignancy in this location. We report that secondary spread to the iris can also occur, in this case as the first sign of widely disseminated systemic relapse.

Clinico-radiological features of primary lacrimal gland pleomorphic adenoma: an analysis of 37 cases.

To present the radiological and clinical features of primary lacrimal gland pleomorphic adenoma (PLGPA). Thirty-seven consecutive PLGPAs presenting to two hospitals in Japan were reviewed. PLGPA cases had 15 men and 22 women with a mean age of 51.9years. Common presenting features were ptosis (83%), diplopia (78%) and globe displacement (78%). Twenty-two percent of cases reported symptom duration of less than 6months, but only 5.6% of cases had pain. Sixteen percent of PLGPAs were centered in the palpebral lobe; none of which were associated with globe indentation or lacrimal fossa expansion. Bony excavation was observed in 84% of orbital lobe PLGPA; the bone margin was well demarcated and the character of excavation was more frequently smooth than scalloped (2:1). The presence of globe indentation or bony excavation was associated with increased tumor size (p=0.003). An enhancing rim was visible on T1-weighted fat-suppressed gadolinium-enhanced magnetic resonance imaging (T1FS-Gad MRI) in 27%. Five (19%) enclosed cystic spaces were bright on T2-weighted MRI and non-enhancing. Calcification of tumor parenchyma was common in cystic cases but rare in non-cystic cases (p=0.01). PLGPAs have varied clinical and radiological features. Common radiological features are a heterogeneous internal architecture on T2-weighted MRI, an enhancing rim on T1FS-Gad MRI, smooth or scalloped bony excavation with intact cortical bone, and globe indentation. Cystic spaces, calcification, and symptom duration less than 6months are common, but pain is rare. Awareness of the clinico-radiological variants of PLGPA is important when considering incisional biopsy of a lacrimal gland mass.

A Case Report of Neurosarcoidosis Presenting as a Lymphoma Mimic.

Objective. To describe a unique presentation of neurosarcoidosis. Background. Central nervous system involvement is rare in sarcoidosis. Sarcoidosis can be severe and can be mistaken for systemic lymphoma. Case Description. A 55-year-old right-handed white male with past medical history of obstructive sleep apnea, Raynaud's disease, and Hashimoto's thyroiditis was noted to have cognitive decline over a duration of few weeks and 20 lb weight loss. His neurologic exam (including cranial nerves) was normal except for five-minute recall. Head CT revealed a lacrimal gland mass, confirmed on brain MRI, which was suspicious for lymphoma on brain PET/MRI. Subsequent whole-body FDG PET/CT scan showed multiple enlarged lymph nodes. Bone marrow biopsy was negative. Serum and CSF ACE levels were within normal limits. Supraclavicular lymph node biopsy before steroids therapy was initiated and revealed multiple noncaseating granulomas, diagnostic of “sarcoidosis.” He was treated with daily prednisone for two months, followed by weekly infliximab. Brain MRI two months after treatment with prednisone showed decrease in size of lacrimal lesion, and brain PET/MRI showed normal brain metabolism pattern after five months. Neurocognitive evaluation three months after diagnosis demonstrated improvements in memory abilities. Discussion. Both clinically and radiographically, neurosarcoidosis can mimic systemic lymphoma. Biopsy in these types of cases is necessary to establish the diagnosis.

GCDFP-15, AR, and Her-2 as biomarkers for primary ductal adenocarcinoma of the lacrimal gland: a Chinese case and literature review.

PurposePrimary ductal adenocarcinoma (PDA) of the lacrimal gland is a rare malignant epithelial tumor, and its clinicopathological characteristics are still unclear. This study aimed to report a novel case of PDA of the lacrimal gland in the People’s Republic of China, as well as to determine its histopathological and immunohistochemical characteristics to support early diagnosis and direct further therapy.Patient and methodsClinical data (including ocular examination, computed tomography, magnetic resonance imaging, positron emission tomography, mammography, and serum tumor marker examination) and treatment of a 49-year-old woman with a left lacrimal gland mass, which was diagnosed as PDA of the lacrimal gland, were reported. Histopathological and immunohistochemical studies were performed. Eleven papers regarding this uncommon neoplasm were reviewed.ResultsHistopathologically, most of the tumor cells featured abundant granular eosinophilic cytoplasm, while few of them had a frothy appearance. The mass showed breast ductal carcinoma-like structural features, which most commonly demonstrated central necrosis, while less of these features showed cord-like infiltration. Immunohistochemically, the tumor cells were positive for GCDFP-15, CK 18 (++), AR (90%), Her-2 (+++), P53 (100%), and Ki-67 (with a proliferation index approximately 60%), while they were negative for ER, PR, P63, calponin, and CD 117.ConclusionThis was the first Chinese case of PDA of the lacrimal gland that had been reported. We suggested that GCDFP-15, AR, and Her-2 should be tested as biomarkers for ductal adenocarcinoma of lacrimal gland to confirm diagnosis, guide therapy, and further predict prognosis.

Unusual presentation of ciliary body melanoma - a case report

Background: Ciliary body melanoma rarely grows transclerally by direct extension and can metastasize locally into the orbit or conjunctiva. Objective: To report a case of ciliary body melanoma presenting clinically as a mass in the lacrimal gland region. Case: A 40-year-old female presented to the ophthalmic out-patient department with the complaint of a swelling in the right upper and outer lid region for 4 years. Ocular examination revealed a phthisical right eye. A firm, non-tender mass was palpable in the temporal quadrant of the right supraorbital region. Ultrasonography showed retinal detachment of the right eye. The CT-scan of the orbit was reportedly suggestive of a right lacrimal gland mass. Superolateral transperiosteal orbitotomy was planned for excision of the lacrimal gland mass. Intraoperatively, a well defined mass arising from the supero-temporal region of the right globe was noticed. The procedure was converted to enucleation of the right eye. Histopathological examination of the mass showed features of ciliary body melanoma. Conclusion: Extrascleral extension of ciliary body melanoma can present as a mass in the lacrimal gland region. DOI: http://dx.doi.org/10.3126/hren.v11i3.9657 Health Renaissance 2013;11(3):287-289

Cytodiagnosis of extranodal natural killer/T-cell lymphoma, nasal type: Report of two cases

Extranodal natural killer (NK)/T-cell lymphoma, nasal type (NK/T) is relatively rare, associated with aggressive behavior and poor prognosis. Histopathological findings, immunohistochemical study, and Epstein-Barr virus-encoded ribonucleic acid in situ hybridization are essential for the diagnosis. There are a few case reports in the literature describing the cytological findings of these uncommon lymphomas. We herein describe cytological findings in two cases of extranodal NK/T-cell lymphoma, nasal type presenting as lacrimal gland and/or nasal masses. Fine-needle aspiration smears revealed small to medium-sized lymphoid cells showing irregular nuclear outline, moderate amounts of light basophilic cytoplasm containing fine azurophilic granules in most of the cells. Some of these atypical lymphoid cells showed tongue-like projections of cytoplasm from one or both sides of the cells. Histopathological examination revealed typical angoicentric, angiodestructive growth pattern of these lymphomas.