Primary ductal adenocarcinoma of lacrimal gland: Two case reports and review of the literature

Unveiling a distinctive presentation: Benign manifestation of primary ductal adenocarcinoma of the lacrimal gland

OBJECTIVE

To report the case of a man with well-demarcated cystic lesion in the right lacrimal gland, subsequently diagnosed as primary ductal adenocarcinoma of the lacrimal gland.

METHODS

We report the clinical presentation, histopathologic, immunohistochemical features and treatment of this unique primary ductal adenocarcinoma of the lacrimal gland. Additionally, we analyze the factors contributing to the tumor's presentation and review the current literature regarding this uncommon neoplasm.

RESULTS

The patient underwent total resection of the mass, revealing primary ductal adenocarcinoma of lacrimal gland. Histopathological examination revealed a solid nested, sieve-like (with observed acne-like necrosis), tubular, and small nested arrangement of the tumor. The tumor cells exhibited marked heterogeneity, and vascular tumor thrombi were observed in the stroma, along with evidence of neurological invasion. The immunophenotype analysis showed positivity for androgen receptor, GATA binding protein 3, gross cystic disease fluid protein 15 and cytokeratin-7, which is considered a ductal adenocarcinoma of lacrimal gland. Subsequently the patient underwent local radiotherapy. No local recurrences or metastases were reported during the 1-year follow-up.

CONCLUSIONS

Primary ductal adenocarcinoma of lacrimal gland is a rare tumor of the lacrimal gland. The manifestation of ductal adenocarcinoma of the lacrimal gland may include well-demarcated cystic lesions, indicative of distinct subtypes. Various treatment options are adapted to different subtypes of ductal adenocarcinoma of the lacrimal gland.

The poor prognosis of lacrimal gland adenocarcinoma: a clinical study and literature review

PURPOSE

The incidence of lacrimal gland adenocarcinoma is low. This study was designed to analyze the clinical and prognostic characteristics of lacrimal gland adenocarcinoma.

METHODS

This was a clinical study and literature review; 25 patients diagnosed with lacrimal gland adenocarcinoma by histopathology were enrolled and their medical history data were collected.

RESULTS

The incidence of bone destruction and surrounding tissue invasion was 52% and 44%, respectively. The incidence of distant metastasis of lacrimal gland adenocarcinoma was about 50%. The 5-year overall survival rate of death or metastasis was 33.5%. Age, sex, laterality, tumor size, pathology type, bone destruction, nerve or perineural invasion, invasion of peripheral tissue, T stage, AR, Her-2 and treatment had no significant correlation with lacrimal adenocarcinoma's prognosis (P > 0.05), while the higher expression of Ki-67 may have higher risk of death or metastasis (P = 0.020).

CONCLUSION

The incidence of bone destruction and distant metastasis of lacrimal adenocarcinoma is high and the imaging examination is necessary to assess the risk of distant metastasis. The 5-year survival rate of death or metastasis is 33.5% and the high expression of Ki-67 predicts poor prognosis of lacrimal adenocarcinoma.

Metastatic HER2 lacrimal/salivary gland duct adenocarcinoma

In this report, we present a case of a patient with a 30-year history of orbital asymmetry who presented with metastatic human epidermal growth factor receptor 2 (HER2) positive lacrimal/salivary gland ductal adenocarcinoma. The patient was treated with chemoradiotherapy and trastuzumab. Tumours of lacrimal gland origin are rare, and unfortunately can frequently present in late stage. There are no current guidelines on the optimal treatment of metastatic lacrimal gland tumours, in particular those with HER2 amplified malignancy. This case highlights a unique presentation of a rare disease, and the potential for targeted therapy.

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.

De novo adenocarcinoma of the lacrimal gland: Case report

Adenocarcinoma of the lacrimal gland is an epithelial malignancy with an incidence according to the literature of 5-7%. It is clinically revealed by an upper palpebral mass often associated with an inflammatory exophthalmos. It is a high-grade malignancy and there are no pathognomonic clinical or radiological signs. The Core 14G needle biopsy technique is now the simplest procedure to remove tissue from the mass to be analyzed. This allows a precise histological and immunohistochemical study, to establish a diagnosis of certainty and to institute a rapid and adequate therapeutic management in order to improve the prognosis. We report the case of a de novo lacrimal gland adenocarcinoma diagnosed in a 55-year-old patient. The patient presented with a subpalpebral mass, located in the superior-external angle of the globe, which was very inflammatory. The radiological work-up revealed a left intra-orbital tumor process, extra-conical, developed at the expense of the lacrimal gland, in contact with the external wall of the orbit with local cortical effractions. The anatomopathological examination of the specimen obtained by Core 14G needle biopsy, under local anesthesia and on an outpatient basis, was in favor of a moderately differentiated and infiltrating adenocarcinoma of the lacrimal gland. The extension workup did not reveal a metastatic focus. A total exenteration was performed with complementary postoperative radiotherapy. The patient was followed up after 2 years without recurrence.

Primary ductal adenocarcinoma of the lacrimal gland: A review and report of five cases

Primary ductal adenocarcinoma (PDA) is a rare epithelial tumor of the lacrimal gland. Herein we report 5 cases and review 29 published cases of PDA of the lacrimal gland. Among these 5 cases, the most common clinical presentation was painless swelling and/or proptosis of their eye. The size of the lesions ranged from 1.6 to 2.5 cm. Histopathologic examination revealed proliferations of ductal or gland-like cells with vesiculated pleomorphic nuclei and prominent nucleoli. Tumor cells stained positive for epithelial and apocrine differentiation markers. Immunohistochemistry for human epidermal growth factor 2 was positive in 2 of the 4 cases. Four of the five patients were alive at the last follow-up visit. One died with bone metastases, which were diagnosed 25 months after exenteration and then survived an additional 51 months. On reviewing of twenty-nine previously published cases of PDA, the mean age of diagnosis was 58 years, with a male predominance (75%). Fifteen patients (54%) had distant metastases, 1 (4%) had local recurrence, and 10 (37%) suffered from a PDA-related death. PDA is a high-grade aggressive epithelial tumor of the lacrimal gland. Although rare, awareness and recognition of this malignancy are important to help determine prognosis and treatment options.