Pleomorphic adenoma of the lacrimal glands

Last revised by Daniel J Bell on 10 Apr 2021

Pleomorphic adenomas of the lacrimal glands, also known as benign mixed tumors (BMTs), are the most common lacrimal gland tumors.

Historically pleomorphic adenomas have also been called benign mixed tumors, however this name is now discouraged. It was previously thought that these were a form of teratoma, however it is now clear that the neoplasm forms from a single layer of germ cells and is purely epithelial in nature 4.

  • slowly progressive and painless proptosis, with inferomedial displacement of the globe
  • visual disturbance possible with large tumors
  • sudden onset of pain may indicate malignant transformation
  • solid or heterogeneous
    • highly cellular and smaller tumors are more homogeneous
    • less cellular and larger tumors may be more heterogeneous from mesenchymal stroma, cystic degeneration, necrosis, or serous/mucous collection
  • well-circumscribed
  • round or oval in shape
  • occasional punctate calcifications
  • bony remodeling of the lacrimal fossa
  • moderate to marked contrast enhancement
  • T1: iso- to hypointense to muscle
  • T2: iso- to hyperintense to muscle
  • T1 C+: moderate to marked enhancement
  • heterogeneity may vary with size/cellularity as with CT

Complete excision is curative, with an excellent prognosis. Incomplete excision is associated with high rates of recurrence.

Risk of malignant transformation is low but cumulative over time.

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