Lacrimal Gland Tumors Treatment & Management

  • Author: Dan D DeAngelis, MD, FRCS(C); Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 3, 2011
 

Medical Care

Radiation therapy is the mainstay of treatment for lymphoid lesions, ranging from 2000-3000 cGy of total radiation. Antineoplastic agents, administered under the direction of an oncologist, usually are required for systemic disease.

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Surgical Care

The treatment of lacrimal gland tumors can be divided largely into 2 categories based on the duration of symptoms, clinical evaluation, and radiographic features of the lesion.

  • Patients with a long-standing, painless, slowly growing mass with a well-circumscribed appearance on imaging studies are presumed to have a pleomorphic adenoma.
    • Treatment is extirpation, consisting of a lateral orbitotomy with intracapsular removal of all lesional tissue with careful attention to prevent violation of the pseudocapsule.
    • Incisional biopsy of these lesions is contraindicated because, although histologically benign, incomplete excision often leads to repeated recurrences (as high as 30% in some studies) and malignant transformation.
    • Small, fingerlike protuberances outside the main tumor bulk with subsequent seeding of the residual tumor are believed to be responsible for this phenomenon.
    • Painful lesions of short duration (>4-8 wk), especially with concomitant bony involvement, require an incisional biopsy of the lacrimal gland lesion and careful histopathologic evaluation to rule out a malignant neoplasm.
    • If pathologic evaluation of the permanent sections of the lesion reveals adenoid cystic carcinoma, prognosis for survival is poor.
    • Treatment modalities are difficult to evaluate prospectively because of the low incidence and the tendency for long-term recurrences.
    • The classic treatment consists of radical exenteration with frontal bone excision, maxillectomy, and temporalis fossa excision as an attempt at a curative modality in these patients (because of the diffusely infiltrative nature of these lesions and the tendency for perineural spread).
    • If a malignant lesion is suspected preoperatively, complete extirpation as the initial procedure (as per a pleomorphic adenoma) and follow-up radiotherapy of 6400-6800 cGy may produce a long-term survival no worse than radical exenteration with significantly less morbidity.
    • According to one study, when intra-arterial chemotherapy is used as an adjunct to radiation treatment and/or surgery, there is some benefit to overall disease-free survival.[1]
    • Mortality is increased, if bony involvement is present.
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Consultations

  • Appropriate hematology and oncology consultations are indicated to exclude systemic involvement, if a diagnosis of lymphoma is confirmed.
  • Coordinated treatment with a radiation oncologist often is used for malignant and lymphoid lesions.
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Contributor Information and Disclosures
Author

Dan D DeAngelis, MD, FRCS(C)  Lecturer, Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Ophthalmologist, Department of Ophthalmology and Vision Sciences, Hospital for Sick Children

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 K Pang, MD  Ophthalmic Plastic and Reconstructive Surgery

Noelene K Pang, MD is a member of the following medical societies: American Academy of Ophthalmology and 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.

Specialty Editor Board

Jorge G Camara, MD  Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

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.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A 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 Honoraria Speaking and teaching

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.

References

  1. Tse DT, Benedetto P, Dubovy S, Schiffman JC, Feuer WJ. Clinical analysis of the effect of intraarterial cytoreductive chemotherapy in the treatment of lacrimal gland adenoid cystic carcinoma. Am J Ophthalmol. Jan 2006;141(1):44-53. [Medline].

  2. Rasmussen P, Ralfkiaer E, Prause JU, et al. Malignant lymphoma of the lacrimal gland: a nation-based study. Arch Ophthalmol. Oct 2011;129(10):1275-80. [Medline].

  3. Ahmad SM, Esmaeli B, Williams M, Nguyen J, Fay A, Woog J. American Joint Committee on Cancer classification predicts outcome of patients with lacrimal gland adenoid cystic carcinoma. Ophthalmology. Jun 2009;116(6):1210-5. [Medline].

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

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

  6. Font RL, Smith SL, Bryan RG. Malignant epithelial tumors of the lacrimal gland: a clinicopathologic study of 21 cases. Arch Ophthalmol. May 1998;116(5):613-6. [Medline].

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

  8. 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].

  9. 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].

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

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

  12. 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].

  13. Perez DE, Pires FR, Almeida OP, Kowalski LP. Epithelial lacrimal gland tumors: a clinicopathological study of 18 cases. Otolaryngol Head Neck Surg. Feb 2006;134(2):321-5. [Medline].

  14. Shields JA, Shields CL, Epstein JA, Scartozzi R, Eagle RC Jr. Review: primary epithelial malignancies of the lacrimal gland: the 2003 Ramon L. Font lecture. Ophthal Plast Reconstr Surg. Jan 2004;20(1):10-21. [Medline].

  15. Snaathorst J, Sewnaik A, Paridaens D, de Krijger RR, van der Meij EH. Primary epithelial tumors of the lacrimal gland; a retrospective analysis of 22 patients. Int J Oral Maxillofac Surg. Jul 2009;38(7):751-7. [Medline].

  16. Stewart WB, Krohel GB, Wright JE. Lacrimal gland and fossa lesions: an approach to diagnosis and management. Ophthalmology. May 1979;86(5):886-95. [Medline].

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

 
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