Lacrimal gland masses can be classified into two broad groups - inflammatory (~50%) and neoplastic, either lymphoma (25%) or salivary gland type tumours (~25%).
- affects ~25% of patients with systemic disease
orbital inflammatory pseudotumour
- lacrimal gland is second most commonly affected orbital structure after the extraocular muscles
- Sjögren syndrome
- infectious dacryoadenitis: bacterial or viral aetiology
Most are epithelial in origin, with ~50% benign and ~50% malignant.
Benign epithelial tumours
These lesions are slow-growing masses more commonly found in adults in their fourth to fifth decades of life:
- lacrimal gland pleomorphic adenoma
- benign reactive lymphoid hyperplasia
- lacrimal gland oncocytoma
- dermoid cyst of the lacrimal gland 6
Malignant epithelial tumours
adenoid cystic carcinoma
- most common malignant lacrimal gland tumour
- accounts for 50% of malignant tumours of lacrimal gland and 25% of all lacrimal gland tumours
- adenocarcinoma of lacrimal glands
- acinic cell carcinoma of lacrimal glands
- malignant lymphoma: lacrimal gland involvement with lymphoma
- squamous cell carcinoma
- mucoepidermoid carcinoma (rare)
Most of these cases are seen in the third decade of life, but distribution is bimodal with an earlier peak in the teenage years.
- orbital granulocytic sarcoma (a.k.a. chloroma)
- solitary fibrous tumour
- metastatic or secondary tumours
- leukaemia 5
Other rare causes of lacrimal gland masses include tuberculosis, amyloidosis, thyroid-associated orbitopathy, granulomatosis with polyangiitis. Sickle cell disease is reported to cause lacrimal gland oedema 4.
Extra-lacrimal masses that occur in the superolateral orbit should be considered, e.g. dermoid/epidermoid cyst, subperiosteal abscess 2.
- 1. Bernardini FP, Devoto MH, Croxatto JO. Epithelial tumors of the lacrimal gland: an update. Curr Opin Ophthalmol. 2008;19 (5): 409-13. doi:10.1097/ICU.0b013e32830b13e1 - Pubmed citation
- 2. Harnsberger HR, Glastonbury CM, Michel MA et-al. Diagnostic Imaging: Head and Neck. Lippincott Williams & Wilkins. (2010) ISBN:1931884781. Read it at Google Books - Find it at Amazon
- 3. Sehu KW, Lee WR. Ophthalmic pathology. BMJ Books. ISBN:072791779X. Read it at Google Books - Find it at Amazon
- 4. Gao Y, Moonis G, Cunnane ME et-al. Lacrimal gland masses. AJR Am J Roentgenol. 2013;201 (3): W371-81. doi:10.2214/AJR.12.9553 - Pubmed citation
- 5. Sabundayo MS, Takahashi Y, Kakizaki H. Adult T-Cell Leukemia/Lymphoma With Primary Lacrimal Gland Involvement. (2018) Ophthalmic plastic and reconstructive surgery. 34 (1): e27-e29. doi:10.1097/IOP.0000000000000998 - Pubmed
- 6. Kiratli H, Bilgiç S, Sahin A, Tezel GG. Dermoid cyst of the lacrimal gland. (2005) Orbit (Amsterdam, Netherlands). 24 (2): 145-8. doi:10.1080/01676830590926594 - Pubmed