Pleomorphic Adenoma Of Lacrimal Gland Research Articles

Recurrence rate of pleomorphic adenoma of the lacrimal gland: systematic review and meta-analysis

ABSTRACT Purpose The aim is to increase the understanding of lacrimal gland pleomorphic adenoma’s recurrence rate and the factors that influence it. Methods A systematic search of PubMed, SCOPUS, Cochrane Library, and CINAHL was conducted following PRISMA guidelines. The data in the included studies were extracted and analyzed. Results Twenty-two studies were included representing 963 patients from 12 different countries. The pooled analysis of the recurrence rate was 8.83% (95% CI: 5.08–13.50). In the event of recurrence, there was a 75.17% (95% CI: 65.98–82.94) chance of benign recurrence and a 28.35% (95% CI: 19.66–38.41) chance of malignant recurrences, with malignant recurrence occurring almost exclusively after a benign recurrence. The results showed that 47.09% (95% CI: 24.60 to 70.22) of recurrent tumors had a ruptured pseudocapsule and 6.35% (95% CI: 0.82 to 16.54) had an intact pseudocapsule with a significant difference between the two. Of the recurrent tumors, 51.50% (95% CI: 9.28 to 92.39) were biopsied compared to 8.83% (95% CI: 3.40 to 16.49) of the total; the difference between these two proportions was also found to be significant. Conclusion There was a statistically significant difference in the rates of recurrence between tumors that were either biopsied or had a ruptured pseudocapsule compared to those that did not. This evidence adds additional support for excisional biopsy being the procedure of choice for LGPA and reinforces the importance of keeping the pseudocapsule intact during surgical resection.

Clinical and radiologic outcomes of pleomorphic adenoma and adenoid cystic carcinoma of the lacrimal gland.

To compare the radiologic and clinical features of primary lacrimal gland pleomorphic adenoma and adenoid cystic carcinoma. This study retrospectively reviewed imaging findings and medical records of lacrimal gland pleomorphic adenoma and adenoid cystic carcinoma. Eleven patients with pleomorphic adenoma and 16 patients with adenoid cystic carcinoma were evaluated. There were no statistically significant differences between groups regarding age or sex. Proptosis was the most common presenting symptom in both groups. Adenoid cystic carcinomas were more likely to present with a palpable mass, diplopia, pain, and sensory loss than pleomorphic adenomas, although the differences were not statistically significant between groups. Furthermore, there were no significant differences in terms of homogeneity and globe indentation between lacrimal gland pleomorphic adenoma and adenoid cystic carcinoma on computed tomography (CT)(all p>0.05). The rates of bone invasion, tumor calcification, and wedge sign were significantly higher in adenoid cystic carcinomas, and bone remodeling was statistically significantly higher in pleomorphic adenomas, on CT(all p<0.05). Pleomorphic adenomas were significantly more likely to show well-defined margins, lobulated contours, heterogeneous contrast enhancement, and hyperintensity on T2-weighted magnetic resonance images (all p<0.05). When differentiating between lacrimal gland pleomorphic adenoma and adenoid cystic carcinoma, evaluation of radiologic features along with clinical features is of great importance. Lobulated contours may be a significant distinguishing radiologic feature suggesting pleomorphic adenoma.

Clinical analysis of 109 cases of lacrimal gland pleomorphic adenoma

To monitor the prognosis of patients with lacrimal gland pleomorphic adenoma (LGPA) following surgical resection within the past 10y. The factors affecting patient prognosis are analyzed and the experience of surgical treatment is summarized. In this retrospective, comparative case series, clinical records from 109 cases of LGPA treated chiefly at the same institution between November 2009 and May 2019 were reviewed. All 109 patients underwent surgery, histopathological examination, and imaging examination. For patients who underwent surgery for the first time, LGPA could be resected completely, including tumor and capsule tissues, using a surgical approach via the eyebrow arch or double eyelid crease. The ratio of males to females was 1:1.60, the ages ranged from 19 to 74 years old with a mean age of 43.64±13.07 years old, and the ratio of left to right eyes was 1:1.37. A total of 109 patients underwent surgical excision and five of these received radiotherapy after malignant transformation. Of these patients, 15 were lost to follow up within the April 1, 2020 deadline and 1 was diagnosed as a recurring pathology. The 5-year recurrence rate for 86 patients who underwent initial surgery was 7.27%. Single factor analysis revealed that the course of disease, bone destruction, invasion of surrounding tissues, tumor size, capsule integrity, and expression of Ki-67 were statistically significant (P<0.05). Binomial Logistic regression analysis showed that capsule integrity was a risk factor influencing recurrence (P=0.008). LGPA has a risk of recurrence and potential for malignant transformation. Complete removal of the tumor and capsule in the initial surgery is a key factor in preventing recurrence.

Extensive Sclerosis ("mummification") in Lacrimal Gland Pleomorphic Adenoma May Indicate Neighboring Malignant Transformation.

Salivary gland pleomorphic adenomas not uncommonly show extensive sclerosis ("dense hyalinization," "coagulative necrosis," or "mummification"), which arise spontaneously or after prior surgery, and this change is considered a high-risk factor for malignant transformation of benign salivary adenomas. While minor hyalinization is common in lacrimal gland adenomas, massive sclerosis-where almost all (90% or more) of the tumor is replaced by an amorphous hyaline material-is extremely rare. Four patients (2 males) are described in whom, despite not having an acute inflammatory episode, their lacrimal gland tumor showed marked sclerotic necrosis within the majority of either the benign or malignant parts of the tumor. Three tumors had evidence of malignant change, 2 to adenocarcinoma, and 1 to mucoepidermoid carcinoma, but none of the malignant areas showed perineural or endovascular invasion. Extensive sclerosis in association with a lacrimal gland pleomorphic adenoma (LGPA) is rare (4/110 of the cases) and-as with salivary adenomas-appears to be associated with a high chance of associated malignant change. Both the surgeon and the histopathologist should regard extensive sclerotic necrosis as a harbinger for malignant change in association with benign pleomorphic adenomas of the lacrimal gland.

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.

Retrospective Analysis of Clinicopathological Characteristics of Lacrimal Gland Pleomorphic Adenoma and Mechanism of Tumorigenesis by the Imbalance Between Apoptosis and Proliferation.

BackgroundLacrimal gland pleomorphic adenoma (LGPA) is the most common clinically benign epithelial tumor of the lacrimal gland and is predominantly comprised of epithelial cells and interstitial components. At present, the exact pathogenesis of LGPA remains unclear. Previous research has indicated that the occurrence of LGPA may be related to excessive cell proliferation.Material/MethodsThis study observed the clinicopathological characteristics of LGPA and investigated the tumorigenesis mechanism of cell over-proliferation caused by the imbalance between apoptosis and proliferation. A total of 27 cases were collected from the Department of Ophthalmology of the Affiliated Hospital of Chengde Medical University and the Third Medical Center of Chinese PLA General Hospital from April 2017 to November 2019. Hematoxylin-eosin (HE) staining and immunohistochemical staining were used to observe the pathological characteristics and analyze the expression of bcl-2 and bax in the lacrimal gland.ResultsCompared with normal lacrimal gland tissues, LGPA tumor tissues had obvious changes in pathological morphology. The expression of bcl-2 in LGPA lesion tissues was dramatically higher (P<0.001), the expression of bax was not significantly different between groups (P=0.25), but the ratio of bcl-2/bax was significantly higher in tumor tissues (P=0.01).ConclusionsWe found that the lacrimal gland tumor tissues had obvious excessive proliferation in pathomorphology, which revealed the necessity of complete surgical removal of the capsule from the perspective of pathological morphology and provided a theoretical basis for the hypothesis that the imbalance between apoptosis and proliferation could lead to cell hyperproliferation.

Adenoma pleomórfico de glándula lagrimal: localización atípica de un tumor salival

Introduction: In daily ophthalmological practice, lacrimal gland tumors are rare. They represent 5 to 7.5% of all intraorbital tumors. The most common epithelial tumor of this gland is the pleomorphic adenoma, with a percentage of 25 to 50% of its tumor lesions. Objective: In this communication we presented a case of lacrimal gland pleomorphic adenoma and study the expression of Ki67 and the location and expression of MUC-1 and its correlation with tumor prognosis. We also carried out a retrospective descriptive study of the literature on the subject published between 1951 and 2020, using the MEDLINE database. Material and methods: The surgical piece examined, was processed according to the paraffin embedding technique, was performed with a histopathological diagnosis of pleomorphic lacrimal gland adenoma. Histological sections were stained with Hematoxylin / Eosin. Immunostaining with Ki67 and MUC-1 was performed with the DAKO LSAB + kit. Results: The diagnosis of hypercellular pleomorphic adenoma with areas of the remaining lacrimal gland was made. Ki67 labeling was low (≤15%). MUC-1 expression was intense, situated to the apical cell membrane of approximately 10% epitheliocytes from pseudoductal and cystic structures.Conclusions: Through histopathological evaluation, the correlation of Ki67 expression and the location and expression of MUC1, we verified that it is a non-recurrent pleomorphic adenoma without malignant transformation.

Malignant Mixed Tumor (Carcinoma Ex Pleomorphic Adenoma) of the Lacrimal Gland.

To review the clinical presentation, treatment, and prognosis of patients with malignant mixed tumor (carcinoma ex pleomorphic adenoma) of the lacrimal gland. Clinical records and radiographic images were reviewed for patients with malignant mixed tumor of the lacrimal gland treated at the center during 2008-2019. The study included 9 patients (6 men, 3 women) aged 17-66 years (median age, 56 years). Six had primary malignant mixed tumor with no history of orbital lesions, and 3 had previously been diagnosed with pleomorphic adenoma. Tumor, Node, Metastasis classification per the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual were T1aN0M0 in 2 patients, T2aN0M0 in 3 patients, T4bN0M0 in 2 patients, and T4cN0M0 in 2 patients. Two patients underwent orbital exenteration, 6 patients underwent eye-sparing surgery, and 1 patient had an unresectable tumor because of cavernous sinus extension. All patients received radiotherapy (intensity-modulated radiotherapy in 3 and proton therapy in 6). All patients received chemotherapy, 8 concurrently with radiotherapy and 1 after radiotherapy. The median follow-up time was 70 months. At last contact, 6 patients were alive without evidence of disease; 2 had died of disease, 1 of distant metastasis, and the other of cavernous sinus invasion. The findings suggest that de novo malignant mixed tumor of the lacrimal gland is more common than disease that results from transformation after incomplete resection of lacrimal gland pleomorphic adenoma. Most cases can be treated with eye-sparing surgery and radiation unless skull base extension is present.

Pleomorphic adenoma in lacrimal gland: Histopathological study

Introduction: The lacrimal gland is non-capsulated, multilobulated secretory gland situated in the lacrimal gland fossa. Lesion and tumors of lacrimal gland occupy almost 18% of all orbital tumors. Pleomorphic adenoma of lacrimal gland also known as mixed tumour of lacrimal gland it is the most common tumor as well as most common benign tumor of lacrimal gland and very critical to differentiate between adenocystic and pleomorphic adenoma of lacrimal gland because of different prognosis. Aims and Objectives: To study the prevalence of pleomorphic adenoma in to the lacrimal gland tumors and to study the histopathological pattern of pleomorphic adenoma in lacrimal gland, its distribution into the age, sex and its outcome in to different condition. Materials and Methods: A retrospective study of 38 cases of pleomorphic adenoma in lacrimal gland during period of 10 years were studied at tertiary care institute. A detailed history of patients were taken with special attention to the age, sex, macroscopic (gross examination) and microscopic features of tissue. Microscopic examination is done under standard H & E staining procedure. Microscopic examination is focused on specifically tumour cells size, shape, nucleus characteristics and cytoplasm and arrangement of cells. Result: Total 57 cases of lacrimal gland tumor were studied among them 38 cases (66.66%) of pleomorphic adenoma were diagnosed. Among 38 cases of pleomorphic adenoma 26 cases (68.4%) were in Female and 12 cases (31.6%) were in male. Among them most number of cases are seen in the age group of 21-40 years almost 18 cases (47.3%), and second common frequency in to the 41-60 years age group contain 13 cases (34.2%). When studied according to histological features, then Myxoid differentiation are seen in 33 (94%)cases, Squamous metaplasia are seen in 18 cases(47%), Chondroid differentiation are seen in 16 cases(42%), Cystic degeneration are seen in 12 cases (33%), Calcification are seen in 3 cases (8%), Cellula

Histopathological study of adenoid cystic carcinoma in lacrimal gland

Introduction: The lacrimal gland is secretory gland situated in the lacrimal gland fossa. Adenoid cystic carcinoma of lacrimal gland is most common malignant tumor of lacrimal gland and very crucial to differentiate between adenocystic carcinoma and pleomorphic adenoma of lacrimal gland because of different outcome. Aims and Objectives: To study the incidence, histopathological pattern, and distribution into the age, sex of Adenoid cystic carcinoma in to the lacrimal gland. Materials and Methods: A Retrospective study of 14 cases of Adenoid cystic carcinoma in lacrimal gland during period of 10 years were studied A detailed history of patients were taken with special attention to the age, sex, macroscopic (gross examination) and microscopic features of tissue. Microscopic examination is done under standard H & E staining procedure. Result and Conclusion: Total 57 cases of lacrimal gland tumor were studied among them 14 cases of adenoid cystic carcinoma, its most common malignant tumor of lacrimal gland. It’s most common age for presentation is 4th to 6th decade, and most common histological pattern present in mixed pattern. And its incidence are slightly more common in female. Other detail discussed in to the result and discussion section. Keywords: Adenoid cystic carcinoma, Lacrimal gland, Histological patterns, Age, Sex.

Lacrimal gland pleomorphic adenoma: a review of 52 cases, 15-year experience

Background: Lacrimal gland (LG) tumours are rare neoplasms. Pleomorphic adenoma (PA) is the most common histologic variant, representing ∼20% of all LG tumours. PA tends to recur leading to great morbidity.Aims: We carried out this study to share our experience and provide recent data on the clinical aspects, radiologic findings, management and outcome after treatment.Methods: We realised a hospital-based retrospective case review including data collected from 52 patients, managed over 15 years.Results: The mean age was 39.8 ± 2 years. Unilateral painless proptosis was the most constant sign (51.9%). CT-scan showed predominantly isodense lesions (96.2%), with regular borders (94.2%), measuring on average 2 cm. MRI showed isointense lesions on T1-weighted images in 96.2% of cases. No pre-operative biopsy was done. Surgical management was mainly external lateral orbitotomy (94.2%). There was no recurrence, considering a mean follow-up period of 12.6 years. Size of tumour at the time of diagnosis increased with age (r = +0.36, p = .01).Conclusions: Clinical and radiologic characteristics are consistent with literature. Older patients seem to present larger tumours. We believe that biopsy is not necessary if appropriate imaging is done. Complete, intact resection is generally sufficient to minimise the risk of recurrence.

Color Doppler ultrasound and contrast-enhanced ultrasound in the diagnosis of lacrimal apparatus tumors.

Color Doppler ultrasound and contrast-enhanced ultrasound (CEUS) in the diagnosis of lacrimal apparatus tumors were investigated. In total, 48 patients undergoing preoperative two-dimensional and color Doppler ultrasound and CEUS examinations were included in this study. Conventional ultrasound and CEUS characteristics of 48 patients pathologically and clinically diagnosed with lacrimal apparatus tumors were retrospectively analyzed. Results of conventional ultrasound of 29 cases with pleomorphic adenoma of lacrimal gland showed moderate-hypoechogenic solid masses in lacrimal gland; CEUS displayed two enhancement modes: High, fast-developed slow-extinct and overall uniform enhancement (20/29, 68.97%) and high, fast-developed slow-extinct, centripetal, uniform or non-uniform enhancement (9/29, 31.03%); after enhancement, the mass edge was clear without changes in size. Results of conventional ultrasound of 6 cases with adenoid cystic carcinoma of lacrimal gland showed hypoechogenic solid masses with unclear edge, irregular form, non-uniform echo, and abundant blood flow signals; the CEUS displayed high, fast-developed fast-extinct and overall uniform enhancement; after enhancement, mass edge was unclear and masses were larger than that in two-dimensional ultrasound. Results of conventional ultrasound of 10 cases with lacrimal sac cyst showed non-uniform, hypoechogenic masses, or cystic solid mixed masses with clear edge but no blood flow signal; the CEUS displayed peripheral circular enhancement and no enhancement inside. Results of conventional ultrasound of 3 cases with adenocarcinoma of lacrimal sac showed hypoechogenic solid masses with unclear edge, irregular form, non-uniform echo inside, and abundant blood flow signals in lacrimal sac; CEUS displayed high, fast-developed fast-extinct and overall uniform enhancement; after enhancement, masses with irregular shapes were obviously larger than that in two-dimensional ultrasound. CEUS shows the microcirculation of tumors and surrounding tissues. Combination of two-dimensional and color Doppler ultrasound can improve the preoperative qualitative diagnosis of tumors and provide references for the selection of operation methods and determination of tumor resection scope.

Lacrimal gland pleomorphic adenoma and malignant epithelial tumours: clinical and imaging differences

AimsTo investigate the clinical and imaging features of primary and recurrent lacrimal gland pleomorphic adenoma (LGPA), as well as lacrimal gland malignant epithelial tumours (LGMET).MethodsRetrospective comparative case series from September...

Recurrent rearrangements of the PLAG1 and HMGA2 genes in lacrimal gland pleomorphic adenoma and carcinoma ex pleomorphic adenoma.

Lacrimal gland tumours constitute a wide spectrum of neoplastic lesions that are histologically similar to tumours of the salivary gland. In the salivary gland, pleomorphic adenoma (PA) is frequently characterized by recurrent chromosomal rearrangements of the PLAG1 and HMGA2 genes, a genetic feature retained in carcinoma ex pleomorphic adenoma (ca-ex-PA) that makes it possible to distinguish ca-ex-PA from de novo carcinomas. However, whether PLAG1 and HMGA2 gene rearrangements are found in lacrimal gland PA and ca-ex-PA is not known. Twenty-one lacrimal gland PAs and four ca-ex-PAs were retrospectively reviewed and subjected to break-apart fluorescence insitu hybridization (FISH) for rearrangements of the PLAG1 gene. Cases without PLAG1 abnormalities were subjected to HMGA2 break-apart FISH. Immunohistochemical staining for PLAG1 and HMGA2 protein was performed and correlated with gene status. Sixteen of 21 PAs showed rearrangement of PLAG1 and were all positive for PLAG1 protein. Two of the remaining five PAs showed rearrangement of HMGA2 and were the only cases positive for HMGA2 with immunohistochemistry. The three FISH-negative PAs expressed PLAG1 protein. All four ca-ex-PAs showed rearrangement of PLAG1 and expressed PLAG1 protein. None of the de novo carcinomas showed rearrangement of either of the two genes or expression of the two proteins. Rearrangement of PLAG1 and HMGA2 and expression of the corresponding proteins are frequent and specific findings in lacrimal gland PA and ca-ex-PA. The mechanism for PLAG1 overexpression in FISH-negative PAs is yet to be clarified.

Assessment of the factors reducing operative and postoperative lateral orbitotomy complications

Background: Lateral orbitotomy is a well-known approach for lesions of the lateral, superior, and inferior part of the orbit, especially for extraconal lesions. A surgical technique which includes avoiding temporalis muscle aggressive retraction and cutting but meticulous retraction is used instead accompanied with experience of the surgeon about the anatomy of the orbit and avoiding extensive bleeding with the subsequent high infection predisposition; all these factors contribute to the low percentage of complications. Materials and Methods: Ten cases were operated upon during the period from 2012 to 2016 in medical city, neurosurgical department. In this regard, contrast-enhanced computed tomography scans gives useful information for operative strategy. All patients were approached using lateral orbitotomy procedure utilizing microsurgical technique taking in consideration meticulous retraction of the temporalis muscle, the site of the lesion, and its relation to the important orbital structure. Objective: The objective of this study is to assess of factors that minimize operative and postoperative lateral orbitotomy complications. Results: Ten cases operated with consideration to factors reducing complications of those six patients were female, with age range between 35 and 57 (mean 43 years). In four patients, the lesion was cavernous hemangioma, one patient optic nerve glioma, two patients lacrimal gland pleomorphic adenoma, and three patients exophthalmus due to Grave's disease (thyroid eye disease). With meticulous care during muscle retraction without cutting, it had no significant risk of bleeding intra operatively, one patient had early postoperative infection, and another case had unacceptable scar. Conclusion: The success of surgery can be improved, operative and postoperative complications can be reduced, and cosmetic problems become acceptable if a meticulous care is taken during temporalis muscle retraction and using microsurgical technique. Operation done by an expert surgeon familial with the anatomy of the orbit, avoiding extensive bleeding that need drainage system which predispose to high infection rate, will reduce operative and postoperative complications. In addition good operative field matching with the size and the type of the lesion play a role in minimizing the complications.

Pleomorphic adenoma of palpebral lobe of lacrimal gland masquerading as skin adnexal tumor of eyelid

Occurrence of Lacrimal gland tumorsis rare. Benign epithelial tumors are more common of which pleomorphic adenoma is commonest. They usually occur in the orbital lobe of lacrimal gland however, they mayrarely occur in palpebral lobe. FNAC helps to rule out other pathologies and narrows the differential diagnosis. We describe a case of young female who presented with a nodular right upper eyelid swelling, clinically diagnosed as a skin-adnexal tumor. On FNAC, diagnosis of Chondroidsyringoma of skin adnexawas given. Histopathologically however it was confirmed to be Pleomorphic adenoma of lacrimal gland. Although rare, possibility of both chondroidsyringoma and pleomorphic adenoma of palpebral lobe of lacrimal gland should be considered in case of a mobile, nodular swelling in the upper eyelid. FNAC aids in diagnosis, however, histopathological examination remains the diagnostic gold standard.

A case of mistaken identity: the role of lacrimal gland pleomorphic adenoma tissue diagnosis

Lacrimal gland lesions have diverse pathologies. Bone remodelling on imaging may suggest a benign lacrimal gland pleomorphic adenoma (LGPA) rather than a malignant process. The authors report a case of malignant pleomorphic adenocarcinoma, which was misdiagnosed clinico-radiologically as a benign LGPA. Lesions with bone remodelling on CT imaging were subsequently analysed amongst a cohort of 31 lacrimal gland lesions from a single tertiary centre. 31 lacrimal gland lesions biopsied over a ten-year period featured bone remodeling on CT scan, typical of LGPA. Three diagnoses were of pleomorphic adenocarcinoma. Two of these cases presented classically with unilateral painful eyelid swelling and bone destruction or bone erosion on CT scan. Seven patients (23%) in this ten-year period had bone remodeling on CT scan, typical of LGPA. Of these seven cases, three were LGPA, but the other four cases were a mixture of other diagnoses. Clinical and radiological suspicion of LGPA may be inaccurate and requires prompt histological diagnosis to facilitate appropriate further treatment and prognosis.

Clinical characteristics and methods of extirpating surgery of 96 cases with lacrimal gland pleomorphic adenoma

Objective To investigate the clinical characteristics and extirpating surgery for lacrimal gland pleomorphic adenoma. Methods Ninty-six cases of benign pleomorphic adenoma of lacrimal gland were retrospectively studied. The clinical characteristics, extirpating procedure and postoperative recurrence were analyzed. Results All of the patients were confirmed pleomorphic adenoma of lacrimal gland by the pathological examination after the surgery. Of all 96 cases, 74 cases were primary ones and 22 cases were recurrent ones. The common symptoms and signs of primary pleomorphic adenoma were exophthalmos (56 cases, 75.7%), ectopia bulbi (40 cases, 54.1%), limitation of eyeball movement (37 cases, 50.0%), decreased visual acuity (9 cases, 12.2%), diplopia (4 cases, 5.4%) and pain (3 cases, 4.1%). The common symptoms and signs of recurrent pleomorphic adenoma were exophthalmos (16 cases, 72.7%), ectopia bubli (13 cases, 59.1%), decreased visual acuity (9 cases , 40.9%), limitation of eyeball movement (7 cases, 31.8%), diplopia (6 cases, 27.3%) and pain (4 cases, 18.2%). The patients were followed up for 3-10 years. In the 74 primary cases, 1 case recurred (1.4%). In the 22 recurrent cases, 3 cases recurred (13.6%), 2 cases had malignant change (9.1%), 1 case died (4.5%), and 2 cases were lost to follow-up (9.1%). Conclusion Before the operation for lacrimal gland pleomorphic adenoma, the tumor should be accurately located. The size, boundary, range, texture and the relationship with the surrounding tissue should be carefully studied for selecting the reasonable surgical procedure. The biopsy should be avoided. Key words: Lacrimal gland; Pleomorphic adenoma; Clinical observation

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.

The value of conventional and contrast-enhanced ultrasound in the diagnosis of tumors in front of the orbit equator

Objective To explore the value of conventional and contrast-enhanced ultrasound(CEUS) in the diagnosis of tumors in front of the orbit equator. Methods Clinical data included conventional ultrasound and CEUS image of 133 cases (156 eyes) with orbital lesions were analyzed retrospectively. All lesions were confirmed by surgical pathology or clinical cure, which included 26 cases of cystic lesions (epidermoid cysts, dermoid cysts, sebaceous cysts and mucous cysts), 29 cases (30 eyes) of orbital hemangioma, 13 cases (16 eyes) of inflammatory pseudotumor, 11 cases of lacrimal gland pleomorphic adenoma, 3 cases (5 eyes) of lymphoepithelial lesion, 36 cases (53 eyes) of malignant lymphoma, 5 cases of meibomian gland carcinoma, 4 cases of lacrimal gland adenoid cystic carcinoma, 3 cases of malignant melanoma and 3 cases of basal cell carcinoma. Results CEUS of benign cystic lesions showed the tumors were enhanced inhomogenously. Most CEUS of benign tumours displayedslow in and slow out, and high enhancement when reached the peak but the size of images had no change. While CEUS of malignant tumours showedfast in and fast out, homogeneous or inhomogeneous high enhancement and ill-defined or irregular shape, and volume increased compared to two-dimensional ultrasound when reached the peak.Some other former district orbital lesions, such as cystic lesion, cavernous hemangioma, pleomorphic adenoma and malignant lymphoma, had their own ultrasound features. Conclusions CEUS combines with conventional ultrasound may contribute to the qualitative diagnosis of tumors in front of the orbit equator. Key words: Contrast-enhanced ultrasound; Orbital neoplasms