Lacrimal system

Lacrimal gland neoplasia

• Primary

  • Pleomorphic adenoma: most common epithelial tumour of the lacrimal gland

    • Mixed histopathology
    • Slow-growing: may indent the bone of the lacrimal fossa but does not erode
    • Pseudo-encapsulated: avoid biopsy which can increase risk of recurrence by rupturing pseudocapsule
    • Can undergo malignant change to pleomorphic carcinoma
    • Excision is recommended: the whole tumour should be removed (avoid rupture of the pseudocapsule and leaving remnants behind)

  • Adenoid cystic carcinoma: second most common epithelial neoplasm of the gland

    • Proptosis: non-axial
    • Numbness in temporal region due to perineural infiltration
    • Pain: perineural infiltration
    • Diplopia
    • Early invasion of adjacent structures including nerves and muscles
    • Histology: cribiform “Swiss-cheese” pattern is pathognomonic
      • Basophilic lobulated appearance with pools of mucin
    • Aggressive

  • Mucoepidermoid carcinoma: rare

• Secondary:

  • Sarcoidosis (ie. infiltrative)
  • Sjogren’s
  • Lymphomas/lymphoproliferative (actually most common cause of lacrimal enlargement): 50% of orbital lymphoproliferative lesions are within the lacrimal gland fossa
  • Inflammatory (eg. pseudotumour)

Lacrimal sac malignancy

• Very rare

• Present with

  • Mass above the medial canthal tendon
  • Epiphora
  • Tear drainage obstruction
  • Bloody tears
  • Regional lymphadenopathy

• Most common lesion: inverted or squamous papilloma

  • May undergo malignant transformation to a squamous cell carcinoma

• Transitional cell carcinoma

• Lymphoma

• Management:

  • Biopsy
  • Radiation
  • Exenteration