Primary squamous cell carcinoma of the lacrimal gland

Incidence, clinical features, and survival outcomes of primary malignant lacrimal gland tumors: A population-based analysis

BACKGROUND

Studies on the epidemiological information and prognosis of primary malignant lacrimal gland tumors (MLGTs) are rare for its low occurrence. The goal of our research was to investigate the epidemiological characteristics and survival outcomes of patients with MLGTs.

METHODS

Incidence and demographic information of patients with MLGTs were collected from the Surveillance, Epidemiology, and End Results (SEER) database. To identify independent prognostic factors for disease-specific survival (DSS) and overall survival (OS), univariate and multivariate Cox regression analysis were performed.

RESULTS

The overall incidence of primary MLGTs from 1975 to 2020 was 0.413/1,000,000 (according to the 2000 American standard population), with a steadily increasing incidence over years. A total of 964 patients with primary MLGTs were diagnosed, with an average age of 59.3 years. Of these, 53.2% were aged ≥60 years, 57.4% were female, and 77.1% were whites. Multivariate Cox regression analysis demonstrated that year of diagnosis, age, sex, histological type, SEER stage, surgery, and chemotherapy were independent prognostic factors of DSS or OS.

CONCLUSIONS

Although primary MLGT is rare, its incidence has steadily increased in the past 46 years, and surgery was related to a better prognosis.

Epithelial lacrimal gland tumors in dogs and cats: Is the human WHO classification appropriate for animals?

Lacrimal gland tumors (LGTs) in dogs and cats are rare neoplasms that can affect either the nictitans (NLG) or the main lacrimal gland (MLG). A consistent classification scheme for canine and feline LGTs is lacking; however, the importance of a classification scheme for LGTs has been emphasized in the human literature, and an update to the World Health Organization (WHO) classification has recently been published. The aim of this study was to investigate the occurrence of different subtypes of canine and feline LGTs in accordance with the human WHO classification system. Epithelial LGTs (n = 46 tumors; 38 dogs, 8 cats) were reviewed and immunophenotyping for p63, CK14, SMA, calponin, CKAE1/AE3, and CK19 was performed. Consistent with previous literature reports, lacrimal carcinomas outnumbered adenomas in dogs and cats. Based on the WHO classification of human LGTs, the most common subtypes identified in dogs were pleomorphic, ductal, adenoid cystic, and epithelial-myoepithelial carcinoma. In cats, a lower number of subtypes was observed, and adenocarcinoma "not otherwise specified" (NOS) was the most frequent diagnosis. An uncommon case of feline epithelial-myoepithelial carcinoma was also observed. The application of the human WHO-LGT classification scheme to canine and feline tumors increased the diversity of diagnoses and allowed for the identification of numerous subtypes. Further studies to identify possible correlations between pathological subtypes and prognosis are warranted.

Rare Diseases of the Orbit

This article provides an overview of rare orbital diseases. Congenital malformations, inflammatory diseases, benign and malignant neoplasias are described. Although it represents a relatively small area of the body the orbit contains multiple different tissues. Therefore, a great variety of diseases can be found within the orbital space. That is the reason, why both the completeness and the level of detail in the description of particular diseases must be somewhat limited. Nevertheless, clinical manifestations, important aspects of diagnosis, treatment strategies, and, when specific data are available, the prognosis are described. The authors tried to highlight the most characteristic aspects of the different diseases to describe their relevant aspects in spite of the brevity of the subsections.

Lacrimal Gland Intravascular Micrometastasis From a Human Papillomavirus-Driven Anorectal Squamous Cell Carcinoma With a Review of Metastatic Disease to the Lacrimal Gland

PURPOSE

To document a unique case of anorectal squamous cell carcinoma that was metastatic to the microvasculature of the lacrimal gland in a patient with human immunodeficiency virus and to review previously reported cases of metastases to the lacrimal gland.

METHODS

Both a retrospective chart review and comprehensive literature review were performed. The unusual histopathologic pattern of the current case was illustrated with immunohistochemical studies (CD31, D2-40, pancytokeratin, p16, and p63) and in situ hybridization studies for high-risk human papillomavirus types 16 and 18.

RESULTS

The authors describe the first case of metastatic anorectal squamous cell carcinoma to the lacrimal gland. Only 24 cases of metastatic disease to the lacrimal gland have been reported, the majority from breast carcinomas. The metastasis did not form a macroscopic lesions, instead was composed of microscopic intravascular and intraparenchymal tumor deposits, a subtle phenomena. Immunohistochemistry confirmed the presence of the intravascular neoplastic cells. p16 served as a surrogate marker for human papillomavirus-associated squamous cell carcinoma and was confirmed with in situ hybridization for human papillomavirus 16 and 18. This testing, combined with the clinical history, defined the diagnosis and confirmed human papillomavirus as the tumor driver.

CONCLUSIONS

Metastases to the lacrimal gland remain rare, but clinicians and pathologists alike must be attuned to the possibility of subtle microscopic foci of tumor as a pattern of metastasis in scenarios without a discrete mass-forming lesion, as this may portend a poor prognosis.

Squamous carcinoma ex pleomorphic adenoma of the lacrimal gland

We present a very rare case of squamous cell carcinoma (SCC) ex pleomorphic adenoma of the lacrimal gland. Our patient presented with a 12 month history of painful proptosis of his left eye associated with severe headache. Imaging showed a left lacrimal gland lesion with extensive orbital disease extending into lateral and superior rectus muscles, cavernous sinus and the greater wing of the sphenoid. A lacrimal gland biopsy showed a combination of small bland glandular structures and sclerotic, elastin-containing stroma showing that the SCC had arisen on a background of a probable pleomorphic adenoma. Treatment with cisplatin and 5-Fluorouracil proved efficacious with a significant reduction of orbital and post-orbital disease on interval scanning.

High-risk human papillomavirus positive primary squamous cell carcinoma of the lacrimal gland: a case report

A 78-year-old Caucasian female presented with a painless mass in the right orbit that had progressively enlarged over several months. Computed tomography scan of the orbits showed a right lacrimal gland mass with no bony erosion. Histopathologic analysis of the biopsy specimen revealed invasive squamous cell carcinoma positive via in-situ hybridization for high-risk human papillomavirus. The patient underwent successful removal of the right lacrimal gland tumor en bloc, followed by adjuvant radiotherapy. This is an extremely rare case of primary squamous cell carcinoma of the lacrimal gland and the first report describing human papillomavirus positivity in this tumor location.

Case Report: Primary Orbital Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) of the orbit is almost uniformly the result of local invasion from a cutaneous primary, extension by perineural invasion, or the result of metastasis. This is owed to the lack of native squamous epithelium in the orbit. After review of the literature, to date, only 6 reports of 8 patients with primary orbital SCC exist. Of those cases, only 2 reported non-apical orbital SCC. There are 2 reports of orbital SCC after retina surgery with proposed transplanted conjunctival epithelium and subsequent malignant transformation of a conjunctival cyst. The initial signs and symptoms can be vague and lead to delay in diagnosis. We present a case of primary orbital SCC and discuss the workup, imaging, and multidisciplinary management of this rare condition.

Epithelial tumours of the lacrimal gland: a clinical, histopathological, surgical and oncological survey

Epithelial tumours of the lacrimal gland represent a large spectrum of lesions with similarities in clinical signs and symptoms but with different biological behaviour and prognosis. They are rare, but with aggressive malignant potential. Tumours of the lacrimal gland may present with swelling of the lacrimal gland, displacement of the eyeball, reduced eye motility and diplopia. Pain and symptoms of short duration before the first ophthalmic consultation are characteristic of malignant tumours. The histological diagnosis determines the subsequent treatment regimen and provides important clues regarding the prognosis. The purpose of this paper is to describe the various primary epithelial tumours of the lacrimal gland. In the first part of the review, the frequency, demographics, clinical presentation and diagnostic features are described. In the second part, primarily tumour-specific histological characteristics are given. Finally, treatment modalities including surgical procedures and medical oncology as well as prognosis are discussed.

Primary squamous cell carcinoma of the lacrimal gland

A 55-year-old Japanese woman presented with proptosis of the left eye that showed rapid progression with profound lid oedema and chemosis with pain. Magnetic resonance imaging and helical computed tomography demonstrated a large mass of the upper temporal orbit and extended bony destruction of the frontal and zygomatic bones. She was successfully treated with orbital exenteration. A diagnosis of primary squamous cell carcinoma of the lacrimal gland was made, which was confirmed by characteristic findings seen on histopathological examination.

Primary Squamous Cell Carcinoma Arising From an Epithelium-Lined Cyst of the Lacrimal Gland

A 66-year-old man presented with a slowly enlarging, nontender left orbital mass of 2 months' duration. CT and MRI showed a left lacrimal gland mass with enhancement and internal irregularity of cystic structures. Histopathologic analysis of the biopsy specimen revealed a squamous cell carcinoma arising from an epithelium-lined cyst. The patient underwent left orbital exenteration followed by radiation treatment. No evidence of tumor recurrence was observed after a follow-up of 30 months. We believe this primary squamous cell carcinoma may have arisen either from preexisting lacrimal duct cyst (dacryops) with areas of squamous metaplasia or, less likely, from a choristomatous epithelium-lined cyst of the lacrimal gland. Although rare, this entity should be included in the differential diagnosis of cystic lesions of the lacrimal gland.

The Role of Lacrimal Intubation in the Management of Facial Trauma and Tumor Resection

BACKGROUND

Lacrimal drainage dysfunction is a common and problematic consequence of any pathologic process that interferes with the physiology or continuity of the lacrimal drainage apparatus. The literature widely documents several reliable, safe, and consistently well-tolerated techniques of nasolacrimal intubation for the repair of lacrimal system dysfunction; however, the role and the timing of such intubation in primary surgery involving the regional anatomy of the lacrimal system remain controversial. The authors evaluated the role of lacrimal intubation as a therapeutic and prophylactic procedure in complex primary surgery for trauma, tumor, and chronic infection of the lacrimal drainage system.

METHODS

Sixty-one cases of either unilateral or bilateral silicone intubation of the lacrimal drainage system in 54 patients were analyzed retrospectively with respect to diagnosis, indication for intubation (therapeutic or prophylactic), and clinical outcome. Final long-term patency of the system after tube removal was assessed by the absence of epiphora and positive Jones primary dye test.

RESULTS

Lacrimal intubation as part of the primary repair of facial trauma, tumor resection, and relief of lacrimal system obstruction resulted in a patent, functional lacrimal drainage system in all 61 cases, with no associated morbidity. The risks of diagnostic manipulation at the time of surgery were avoided.

CONCLUSIONS

This series demonstrates that prophylactic intubation of the lacrimal system in any trauma or tumor resection near or around the region in addition to those that directly involve these systems should be considered, as the risks of silicone intubation in such cases are relatively negligible compared with the morbidity and nuisance associated with postoperative epiphora and/or recurrent dacryocystitis. Concomitant nasolacrimal intubation in conjunction with the repair of complex midfacial fractures or tumor extirpation is a safe and effective means of ensuring the establishment of a patent, functional drainage system in the absence of direct lacrimal system involvement.