Adenoid cystic carcinoma of the lacrimal gland with wide and severe myoepithelial differentiation

Imaging of Lacrimal Gland Pathologies: A Radiological Pattern-Based Approach

Despite their unassuming size, lacrimal glands can have a variety of pathologies affecting them which often poses a diagnostic challenge clinically in view of their nonspecific presentation as palpable lump in the superolateral aspect of the orbit. There are a myriad of pathological entities ranging from inflammatory to neoplastic lesions that can affect the lacrimal glands. Cross-sectional imaging is must for the detection, characterization, and mapping of these lesions. In this pictorial review, we propose a radiological pattern-based approach for various lacrimal gland lesions that provides a working algorithm for radiologists in the evaluation of lacrimal gland pathologies.

Salivary gland myoepithelial carcinoma

Salivary gland myoepithelial carcinoma (MC) or malignant myoepithelioma is a rare entity. MC usually presents as a slow-growing painless mass arising in the parotid gland, but may involve other salivary glands. This tumour may be particularly locally aggressive, but its clinical and biological features are not yet fully understood. MC may arise from pre-existing benign lesions, such as pleomorphic adenomas or benign myoepitheliomas, or may arise de novo. It usually affects patients over 50 years old, with no gender preference. Because it is often asymptomatic, the presentation and diagnosis can be delayed by months, even years. The current WHO classification considers MC to be an intermediate- to high-grade malignancy. Other published data suggest it is likely to be a high-grade neoplasm, consistent with its aggressive behaviour. Its epidemiology, histopathological features, immunohistochemical profile, clinical behaviour and optimal management are not well understood. Following review of the current literature we aim to address these.

Orbital lobe resection provides a definite diagnosis of lacrimal gland lesions: a report of three cases

BACKGROUND

Entities of lacrimal gland lesions comprise almost inflammatory and lymphoproliferative processes as well as benign and malignant solid tumors and usually cannot be differentiated by magnetic resonance imaging (MRI) exclusively. Hence, representative tissue samples are needed to arrive at sufficient histopathological diagnosis for further treatment decisions.

CASE REPORT

Three women aged between 18 and 67 years were admitted to our center with clinical signs of a space-occupying mass in the lacrimal fossa. MRI revealed a circumscribed lacrimal gland lesion in all three cases. The orbital lobe was resected through a lateral orbitotomy approach for histopathological evaluation. Findings confirmed the diagnoses of pleomorphic adenoma, dacryoadenitis, and low-grade B cell non-Hodgkin's lymphoma. Further surgery was not necessary. No recurrence or symptoms of "dry eye" were observed over the course of a 1-year follow-up.

CONCLUSION

In cases of non-specific masses in the lacrimal gland on MRI, histopathological diagnoses are vital and can be sufficiently provided by resection of the orbital lobe. Symptoms of dry eye are uncommon, and secondary surgical intervention can be avoided in cases of the presented entities. Further studies with larger patient cohorts are warranted to confirm these findings.

The radiological spectrum of orbital pathologies that involve the lacrimal gland and the lacrimal fossa

CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.

Carcinome adénoïde kystique de la glande lacrymale chez une enfant âgée de 14ans

The discovery of unilateral exophthalmia requires multidisciplinary care made all the more difficult in the case of a 14-year-old girl living in a tropical environment. The child, C.A., resident of the town of Djenné in Mali, was examined for nonpulsate, nonretractile, left lateral unilateral exophthalmia, painful upon palpation of a left upper-external mass under the orbital rim. The initial examination highlighted the existence of an intraorbital tumor with a moderate effect on visual function. In view of the slow and progressive development over 2 years, and with the assistance of an association, the child was transferred to a specialized medical structure where the tumorous nature was confirmed after surgical exeresis. The diagnosis was cylindroma, or adenoid cystic carcinoma. Neither chemotherapy nor radiation were used. At 15 months after surgery, the child showed no clinical sign of recurrence. Intraorbital tumors in children present diagnostic and therapeutic problems in countries with limited medical resources. Cylindromas or adenoid cystic carcinomas of the lachrymal gland are the second most common cause of epithelial tumors in this gland, which are characterized by a high degree of malignancy, a very high rate of recurrence, and a low survival rate at 5 years. In a tropical environment, diagnostic and therapeutic difficulties are compounded by limits to comprehensive care for the child.