|Year : 1977 | Volume
| Issue : 4 | Page : 52-53
Giant pleomorphic adenoma of accessory lacrimal gland
Shashi Kapoor1, GC Sood1, Manorma S Kapoor1, AL Aurora2
1 Department of Ophthalmology, Jawahar Lal Institute of Postgraduate Medical Education and Research, Pondicherry, India
2 Professor of Pathology, Jawahar Lal Institute of Postgraduate Medical Education and Research, Pondicherry, India
Department of Ophthalmology, J.I.P.M.E.R., Pondicherry-6
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kapoor S, Sood G C, Kapoor MS, Aurora A L. Giant pleomorphic adenoma of accessory lacrimal gland. Indian J Ophthalmol 1977;25:52-3
|How to cite this URL:|
Kapoor S, Sood G C, Kapoor MS, Aurora A L. Giant pleomorphic adenoma of accessory lacrimal gland. Indian J Ophthalmol [serial online] 1977 [cited 2020 Jul 14];25:52-3. Available from: http://www.ijo.in/text.asp?1977/25/4/52/34618
A more appropriate term of pleomorphic adenoma has replaced the old nomenclature of benign mixed tumours which was conventionally used to denote lacrimal gland lesions comprising epithelial and stromal components. The incidence of the tumour varies between 3.4, to 4.8% of the orbital lesions. , The tumour classically presents as eccentric proptosis with limitation of ocular movements in up and out direction. ,
We present a case of pleomorphic adenoma of the accessory lacrimal gland because of its giant size, clinical resemblance to lid and bone tumours, and its rare occurence.
| Case Report|| |
A 55-year-old min was admitted with marked swelling of right upper lid for 6 months. The condition started as a small nodule in the middle of upper lid close to the orbital margins; it was followed by inability to open the right eye.
Ocular examination revealed a hard nodular mass of bony consistency in the right upper lid extending from the medial to the lateral canthus and from the upper orbital border to the upper lid margin The upper lid was stretched down to cover the whole of cornea. The eye ball was slightly proptosed but the downward displacement of the globe was of extreme degree. There was limitation of the ocular movements while looking up. There was marked degree of the conjunctival chemosis. Examination of the ocular fundus and recording of intraocular pressure could not be carried out as the lids were not retractable [Figure - 1]. The examination of the left eye was unremarkable.
A wedge biopsy of the tumour was performed under local anaesthesia. Histopathology revealed the diagnosis of pleomorphic adenoma of the lacrimal gland [Figure - 2].
| Discussion|| |
Pleomorphic adenomas originate from the lacrimal gland,  and accessory lacrimal glands in the conjunctival sac, plica semilunarie and lacrimal caruncle  . Mixed lacrimal tumours arising from the ectopic lacrimal tissue have also been seen in the orbit, eyebrows and upper lid having no connection with the lacrimal gland. ,, Their origin has been postulated from salivary gland foetal rests or accidentally sequestrated undifferentiated cells of buccal or branchial clefts. 
The tumours of the lacrinial gland classically present the triad of features viz. downward and medial displacement of the globe with proptosis, mechanical limitation of the ocular movement in up and out direction and palpable mass in the upper outer angle of the orbit. Direct compression of the globe causes refractive changes of the eye, exposure keratitis, papilloedema or compression of the central retinal vessels. In absence of the classical picture described above, the origin of the tumours can be from the accessory lacrimal glands when they are adherent to the tarsal plate or the ectopic lacrimal gland tissue when these are non-adherent to the deep structures at an unfamiliar site.
The tumours in relation with the accessory lacrimal gland of Krause because of their anatomical location at the top of conjunctival cul-de-sac can present as proptosis, displacement of the globe but the main mass is not at its classical site. The tumours in relation with the glands of Wolfring because of their location at or near the upper end of the tarsus present as lid tumours. Our patient had a pleomorphic adenoma of the accessory lecrimal gland probably originating from the glands of Wolfring because of its presentation as a lid tumour; however the possibility of its origin from the glands of Krause can not be ruled out because of the marked downward displacement of the globe which is not expected to be of that extreme degree with the tumours arising from the glands of Wolfring.
| Summary|| |
A case of giant pleomorphic adenoma of the accessory lacrimal gland is described which mimicked a lid tumour. The tumour had probably originated from the glands of Wolfring.
| References|| |
Duke-Eider, S., 1974, System of Ophthalmology,
12, Henry Kimpton, London, 650.
Green, W.R. and Zimmerman, L.E., 1967, Arch. Ophthal,, 78,
Henderson, J.W., 1973, Orbital Tumours, S.B. Saunders, London, 409.
Huges, W.L. and Ballen, P.H., 1956, Arch. Ophthal.,
Jain, B.S., 1964, Amer. J. Ophthal., 57,
Mettier, S.R., 1958, Arch.Ophthal., 60,
Nath, K. and Gogi, R., 1976, Proceedings 6th. Afro-Asian Congrss (In Press)
Reese, A.B., 1963, Tumours of the Eye, 2nd. ed., Harper and Row, New York.
[Figure - 1], [Figure - 2]