eMedicine Specialties > Ophthalmology > Lacrimal System

Lacrimal Gland Tumors: Differential Diagnoses & Workup

Author: Dan D DeAngelis, MD, FRCS(C), Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto
Coauthor(s): Noelene Pang, MD, Fellow in Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, University of Toronto; Jeff Hurwitz, MD, FRCS(C), Director of Ophthalmic Plastic Surgery, Ophthalmologist-in-Chief, Mount Sinai Hospital; Chairman, Professor, Department of Ophthalmology, University of Toronto, Canada
Contributor Information and Disclosures

Updated: Aug 8, 2006

Differential Diagnoses

Dry Eye Syndrome
Exophthalmos
Ptosis, Adult

Workup

Imaging Studies

  • Neuroimaging studies can be of great assistance in making the correct diagnosis.
  • Computed tomography (CT) scan of benign epithelial lesions, such as pleomorphic adenomas, reveals a well-circumscribed, pseudoencapsulated lesion in the superotemporal fossa.
  • Characteristic bony changes include expansion and remodeling in the lacrimal fossa without evidence of bony invasion or erosion.
  • In contrast, malignant epithelial lesions, such as adenoid cystic carcinoma, usually present as an irregular mass, producing bony erosion (70%) and occasional calcification (20%).
  • Lymphoproliferative lesions usually are eccentric in shape with significant contrast enhancement.

Other Tests

  • Immunohistochemistry may be helpful in distinguishing between inflammatory, benign, and malignant lymphoproliferative lesions. Immunohistochemistry is a laboratory modality that uses special markers to demonstrate the presence of specific antigens in target tissues.
  • Benign inflammatory lesions (pseudotumor) have a polyclonal morphology, whereas the lymphoid lesions tend to be monoclonal.

Histologic Findings

Histologic examination of pleomorphic adenomas reveals evidence of both epithelial and mesenchymal differentiation. Proliferation of benign epithelial cells usually is arranged in a double layer to form lumens. Stromal differentiation can be seen in the formation of bone and cartilage.

Adenoid cystic carcinomas are derived from duct cells, and they form spaces into which basement membranelike material is deposited. This confers a cribriform or "Swiss cheese" appearance to the tissue, although growth in tubules and nests also are recognized. Five histologic patterns have been observed in these lesions, as follows: (1) cribriform (the most common subtype), (2) sclerosing, (3) basaloid, (4) comedo, and (5) ductal. The basaloid type has the worst prognosis.

More on Lacrimal Gland Tumors

Overview: Lacrimal Gland Tumors
Differential Diagnoses & Workup: Lacrimal Gland Tumors
Treatment & Medication: Lacrimal Gland Tumors
Follow-up: Lacrimal Gland Tumors
References
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References

  1. Esmaeli B, Ahmadi MA, Youssef A. Outcomes in patients with adenoid cystic carcinoma of the lacrimal gland. Ophthal Plast Reconstr Surg. 2004;20:22-6. [Medline].

  2. Farmer JP, Lamba M, Lamba WR, et al. Lymphoproliferative lesions of the lacrimal gland: clinicopathological, immunohistochemical, and molecular genetic analysis. Can J Ophthalmol. 2005;40:151-60. [Medline].

  3. Font RL, Smith SL, Bryan RG. Malignant epithelial tumors of the lacrimal gland: A clinicopathological study of 21 cases. Arch Ophthalmol. 1998;116:613-6. [Medline].

  4. Forrest AW. Pathologic criteria for effective management of epithelial lacrimal gland tumors. Am J Ophthalmol. Jan 1971;1(1 Part 2):178-92. [Medline].

  5. Gamel JW, Font RL. Adenoid cystic carcinoma of the lacrimal gland: the clinical significance of a basaloid histologic pattern. Hum Pathol. Mar 1982;13(3):219-25. [Medline].

  6. Jakobiec FA, Yeo JH, Trokel SL, et al. Combined clinical and computed tomographic diagnosis of primary lacrimal fossa lesions. Am J Ophthalmol. Dec 1982;94(6):785-807. [Medline].

  7. Jenkins C, Rose GE, Bunce C, et al. Clinical features associated with survival of patients with lymphoma of the ocular adnexa. Eye. 2003;17:809-20. [Medline].

  8. Jones IS. Surgical considerations in the management of lacrimal gland tumors. Clin Plast Surg. Oct 1978;5(4):561-9. [Medline].

  9. Mafee MF, Edward DP, Koeller KK, Dorodi S. Lacrimal gland tumors and simulating lesions. Clinicopathologic and MR imaging features. Radiol Clin North Am. Jan 1999;37(1):219-39, xii. [Medline].

  10. Shields JA, Shields CL, Epstein JA, et al. Review: primary epithelial malignancies of the lacrimal gland: the 2003 Ramon L. Font lecture. Ophthal Plast Reconstr Surg. 2004;20:10-21. [Medline].

  11. Stewart WB, Krohel GB, Wright JE. Lacrimal gland and fossa lesions: An approach to diagnosis and management. Ophthalmol. 1979;86:886. [Medline].

  12. Wright JE, Stewart WB, Krohel GB. Clinical presentation and management of lacrimal gland tumors. Br J Ophthalmol. Sep 1979;63(9):600-6. [Medline].

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Further Reading

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Keywords

neoplastic lesion, orbital lobe, palpebral lobe, epithelial neoplasm

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Contributor Information and Disclosures

Author

Dan D DeAngelis, MD, FRCS(C), Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto
Dan D DeAngelis, MD, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, California Medical Association, Canadian Medical Association, Canadian Ophthalmological Society, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Noelene Pang, MD, Fellow in Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, University of Toronto
Noelene Pang, MD is a member of the following medical societies: American Society of Ophthalmic Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Jeff Hurwitz, MD, FRCS(C), Director of Ophthalmic Plastic Surgery, Ophthalmologist-in-Chief, Mount Sinai Hospital; Chairman, Professor, Department of Ophthalmology, University of Toronto, Canada
Disclosure: Nothing to disclose.

Medical Editor

Jorge G Camara, MD, Chairman, Department of Ophthalmology and Otorhinolaryngology, Director of Fellowship Training Program, St Francis Medical Center; Associate Professor, Department of Surgery, University of Hawaii School of Medicine
Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

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