Presentation
Right eye gradual proptosis and anterior bulge of the temporal side of the right upper eyelid.
Patient Data
On this performed orbital and paranasal sinuses non-contrast MDCT with multiple projection reconstructions, there is a relatively isodense with brain and well-defined large solid mass lesion within the right lacrimal gland orbital part which is contrary to lymphoma depressed and deformed adjacent eye uveal-scleral layer and in contrary to adenoid cystic carcinoma impressed and has not eroded the adjacent bony lateral wall of the right orbit.
Notice the right eye proptosis on the sagittal view and the anterior bulge of the temporal side of the right upper eyelid on axial view.
Epithelial ductal component forming the inner layer of the cysts and tubules and nests admixed with marked myoepithelial cells proliferation as the outer layer of the cysts and tubules and scattered within myxochondroid stroma and mitotic figures, marked atypical cells without necrosis compatible with cellular pleomorphic adenoma.
The report was prepared by Dr Nozarian Zahra, the pathologist.
Case Discussion
Pleomorphic adenoma or mixed tumor is the lacrimal gland's most common benign epithelial tumor; it mostly occurs within the orbital part of the lacrimal gland in the 3rd and 4th decades of life.
The common presenting feature of this slow-growing tumor is unilateral painless gradual proptosis and/or a gradual painless enlargement of the temporal part of the upper eyelid. The tumor has a risk of malignant transformation, carcinoma ex pleomorphic adenoma, which has a poor prognosis.
Both computed tomography and/or magnetic resonance imaging have findings suggestive of lacrimal gland pleomorphic adenoma diagnosis. There is usually no need for biopsy as the biopsy of the pleomorphic adenoma increases tumor recurrence and malignant transformation rates.
The definite treatment of the tumor is complete surgical excision; diffusion-weighted magnetic resonance imaging is the imaging modality of choice for following up from the point of recurrence of the tumor.