Lacrimal Gland Tumors

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 by Christine López Yang, MD on January 14, 2017.


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Lacrimal gland tumors

Disease and distribution Lacrimal gland tumors are very rare, representing only 10% of orbital space-occupying lesions.(2004 Shields, Ramon L Font lecture) They have an estimated incidence of 1 per 1 million people per year. (2013 von holstein) The incidence rate for malignant lacrimal gland tumors in the US is estimated to be at 0.43 per million person-years.(2016 Hassan) Many kinds of tumors may arise from the lacrimal gland. These neoplasms are generally classified into two types: epithelial and non epithelial. Non epithelial lesions are by far the most common, corresponding to 80% of solid lacrimal gland masses whereas only 20% are of epithelial origin (2004 Shields, Ramon L Font lecture). Non epithelial tumors include lymphoid tumors, plasmacytoma, fibrous histiocytoma, orbital granulocytic sarcoma, hemangioma, solitary fibrous tumor, lipoma, neurofibroma, schwannoma, metastatic or secondary tumors, and inflammation (eg. sarcoidosis, orbital inflammatory pseudotumor, Sjogren syndrome, dacryoadenitis). (Gao, 2013, 2008 Bernardini) In a survey conducted by Shields et al. (2004, Shields survey) the most common nonepithelial mass of the lacrimal gland was dacryoadenitis, in the form of orbital inflammatory pseudotumor confined to the lacrimal gland. Most orbital lymphomas are non Hodgkin of the B cell lineage and represent the most common malignant orbital tumor in older patients, almost 1/4 of all orbital malignancies in the group above 60 (Shields, 2008 book, 2004 survey). Primary epithelial lesions of the lacrimal gland may be subdivided into benign and malignant lesions. 55% of reported epithelial tumors are benign and 45% are malignant (2004 Shields, Ramon L Font), and the proportional difference may be even greater in Asian populations, with studies which have reported up 72-76% pertaining to benign epithelial tumors (2013 Chawla, 2010 Zeng). Benign epithelial lesions include ductal epithelial cyst and pleomorphic adenoma (also called benign mixed tumor), the latter being the most common benign epithelial tumor of the lacrimal gland (2008 Bernardini, 2013 Gao). Other less common benign epithelial tumors include oncocytoma, Warthin's tumor, myoepithelioma, and sialoblastoma. (2008 Bernardini) Of the malignant epithelial lesions, 'adenoid cystic carcinoma comprises approximately 60%, 20% are pleomorphic adenocarcinoma, 10% are primary (de novo) adenocarcinoma, 5% are mucoepidermoid carcinoma, and 5% are miscellaneous malignant epithelial neoplasms'.(Shields, review 2003)

Etiology

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Risk Factors

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General Pathology

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Pathophysiology

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Primary prevention

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Diagnosis

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History

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Physical examination

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Signs

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Symptoms

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Clinical diagnosis

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Diagnostic procedures

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Laboratory test

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Differential diagnosis

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Management

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General treatment

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Medical therapy

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Medical follow up

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Surgery

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Surgical follow up

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Complications

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Prognosis

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Additional Resources

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References

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