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ARTICLES
Year : 1979  |  Volume : 27  |  Issue : 2  |  Page : 49-51

Mixed tumour of the lacrimal gland presenting with proptosis and retinal striations


Army Hospital New Delhi-110010, India

Correspondence Address:
M S Boparai
Army Hospital New Delhi-110010
India
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Source of Support: None, Conflict of Interest: None


PMID: 232082

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How to cite this article:
Boparai M S, Chakraborty M, Sharma R C. Mixed tumour of the lacrimal gland presenting with proptosis and retinal striations. Indian J Ophthalmol 1979;27:49-51

How to cite this URL:
Boparai M S, Chakraborty M, Sharma R C. Mixed tumour of the lacrimal gland presenting with proptosis and retinal striations. Indian J Ophthalmol [serial online] 1979 [cited 2020 Jun 1];27:49-51. Available from: http://www.ijo.in/text.asp?1979/27/2/49/31240

Tumours of the lacrimal gland are relatively rare. Their proportion in various studies has been found to be between 5 to 7 per­cent[1]. They have a long history and present with proptosis and restriction of ocular move­ments but do not generally press on the globe. A case of mixed tumour of the lacrimal gland producing mild proptosis which presented early due to retinal striations affecting vision is re­ported.


  Case Report Top


A christian famale of 23 years age reported with protrusion of the left eye of 8 months duration. She had dull frontal ache and blurred vision of 3 months duration. Examination revealed 5 mm axial proptosis [Figure - 1]a. There was no restriction of ocular movements and no mass was palpable in the orbit. Vision was 6/12 blurred which came down to 6/24 over three weeks period of investigations. There was hypermetropia +4.50 dioptre. Right eye vision was 6/6 and fundus was normal. Left fundus examination showed striations of the retina extending from above the disc to the temporal side partially involving the macula [Figure - 2]. X-ray was normal.

As the vision was deteriorating fast, a lateral orbitotomy was performed. A well defined and encap­sulated tumour 2.5 x 1.7 x 0.6 cms was removed. It was lying above and lateral to the optic nerve. Tumour was pressing on the globe. Normal looking lacrimal gland was found in its normal location in fossa lacrimalis.

Histopathology revealed the neoplasm to be well encap­sulated. The capsule was fairly robust and contained a few compressed strands of lymphocytes. The main bulk of the tumour was made up of proliferating ductules lined by a double layer of epithelium, the inner layer being columnar to cuboidal and the outer layer polyhydral. The ductules were embedded in a hyaline matrix which shows pseudo-cartilagenous transforma­tion. Some of the ductules showed presence of colloid secretion. Foci of hyalinisation were present. In some areas the cells showed evidence of squamous metaplasia. In other areas the epitbelial proliferation was well marked and formed more or less compact sheet and at places there was formation of mature connective tissue. Formation of myoepithelial elements was also noticed. The whole picture was of mixed lacrimal tumour (Pleomorphic adenoma) comprising of a mixture of epithelial and connective tissue elements [Figure - 3].

Postperatively, retinal striations disappeared over a period of 4 months and mild pigmentary changes were left behind. Vision improved to 6/6 with 1 diopter convex cylinder axis 90°. Figure [Figure.1]b shows the position of the eyes 6 weeks after surgery.


  Discussion Top


According to Duke-Elder[1] the first and most typical feature of a lacrimal gland neoplasm is proptosis of slow evolution with eventual dis­placement of the globe and limitation of ocular movements. Our patient of mixed lacrimal tumour had proptosis but there was no limitation of movements which can be explained on the basis of the location of the tumour above the temporal to the optic nerve deep in the orbit and not in the normal location of the lacrimal gland. Further more the patient sought help comparatively early due to visual symptoms which generally are late to come. Fundus is affected only when the tumour is of long duration and has attained a sufficiently big size to displace and press on the globe. In this case the neoplasm due to its situation had produced retinal striations which were responsi­ble for visual symptoms. Once the neoplasm was removed, the striations disappeared and corrected vision improved to 6/6. Sanders[5] reported one case in a series of twelve proved cases of mixed tumour of lacrimal gland who had pigmented striations of the fundus. Histologically, they proved to be folds in the retinal pigment layer. Last[3] also reported similar striations in the retina due to the mixed tumour. Ziporkes[7] reported choroidal detachment, in addition to retinal folds in a case of mixed tumour which also disappeared after removal of the growth.

Another feature of this case is a relatively younger age; Reese[4] found the mixed tumours between the age of 40 and 50 years and Zimmerman[6] and co-workers found the mean age around 35 years. However, mixed tumours have been found even in children and people much past the age of 50 years.

Location of the tumour suggests its possible origin in an aberrant lacrimal gland in the orbit. Aberrant lacrimal gland in the conjunc­tiva and lids is well known but in the orbit it is not common. Green and Zimmerman[2] reviewing 35 cases of aberrant lacrimal gland found 8 cases in which ectopic lacrimal gland was found deep in the orbit. In all eight cases there was proptosis and they found gland to be showing chronic inflammation in all but two cases. They did not come across mixed tumour of the gland but found hamartomatous mal­formation in one case and adenocarcinoma associated with ectopic lacrimal gland in another.


  Summary Top


A case, of mixed lacrimal tumour with proptosis presenting comparatively early due to visual affection as a result of retinal striations is reported. The possibility of neoplasm having arisen from an ectopic lacrimal gland in the orbit is discussed.

 
  References Top

1.
Duke-Elder, S., 1974, System of ophthalmology, Vol XIII 643, Henry Kimpton, London.  Back to cited text no. 1
    
2.
Green, W.R., and Zimmerman, L.E., 1967, Arch. Ophthal., 78, 318.  Back to cited text no. 2
    
3.
Last, M.A., 1935, Arch. Ophthal., 13, 812.  Back to cited text no. 3
    
4.
Rees, A.B., 1963, Tumours of the Eye, 2nd Ed. 485, Harper and Row, New York.  Back to cited text no. 4
    
5.
Sanders, T.E., 1939, Arch. Ophthal., 21, 239  Back to cited text no. 5
    
6.
Zimmerman, L.E., Sanders, T.E., and Ackerman, L.V., 1962, Int. Ophthal. Clinics., 2, 337.  Back to cited text no. 6
    
7.
Ziporkes, J, 1937, Arch. Ophthal., 18, 933.  Back to cited text no. 7
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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