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| ARTICLE |
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| Year : 1961 | Volume
: 9
| Issue : 4 | Page : 97-99 |
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Mixed tumor of the lacrimal gland
ML Agarwal, RP Dhanda
Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore, India
| Date of Web Publication | 7-Apr-2008 |
Correspondence Address:
M L Agarwal
Department of Ophthalmology, Mahatma Gandhi Memorial Medical College, Indore
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Agarwal M L, Dhanda R P. Mixed tumor of the lacrimal gland. Indian J Ophthalmol 1961;9:97-9 |
Among the tumors of the lacrimal gland, mixed tumors, constitute the large majority. These are pleomorphic in nature. Both epithelial and mesenchymal elements are present and in some cases there may be transitional tissue.
| Theories Regarding the Nature of Mixed Tumors | |  |
1. One of the earliest was that the parenchyma of the tumor is derived from endothelium.
2. The tumor is derived from embryonic rests.
3. The parenchyma of the tumor is epithelial and the apparent mesenchymal element is not really mesodermal but represents ectodermal products which have undergone metaplasia.
4. A recent view, advocated by Hemplemann and Womack, is that the parenchyma of the tumor is epithelium which, through its so called "organizer action" induces abnormal differentiation of the undifferentiated mesoderm.
5. More recently the theory of Notochordal origin of these tumors has been presented by Hellwig.
Viewing all these theories, there exists little difference of opinion regarding the origin of the precursor cells of the mixed tumor since it is agreed that these cells represent an embryonic displacement or rest. During the developmental period some of the cells destined to form the lacrimal gland become isolated and remain dormant until the time when an unknown stimulus reactivates them and they become neoplastic.
One who believes in the metaplasia hypothesis, these rests are only epithelial cells. To those who believe in dual origin, both ectodermal and mesenchymal cells are present in the embryonic displacement. To those who believe in the organizer theory the epithelial cells represent the tumor matrix and the mesenchymal elements are secondary to the organizer effect of the epithelium on the undifferentiated mesoderm.
| Histologically | | |
The tumors are composed of epithelium arranged in alveoli, cords or islands. Between the epithelial elements there is a myxomatous stroma. The tumors are usually definitely encapsulated.
These tumors, some times lie free and encapsulated in neighbourhood of the mother tissue having no direct connection with the gland from which they isolate.
| Case Report | | |
Mrs. D., aged 50 years attended Eye Department on 14-5-1959. She had a swelling of 1½" x 1" in the upper left lid. This swelling was first noticed 3 years before and was of the size of a pea. Since then it is growing in size, reaching to the present size in 3 years. No treatment was sought for this.
| Examination | | |
There was a swelling of 1 ½"x 1" in the upper lid. It was rubbery hard in consistency. The skin over it was freely mobile. It was painless. No signs of inflammation were noticed.
Kahn's floculation test was negative and the X-ray and haemocytological examinations were non-contributory.
Aspiration Biopsy:
It was done on 3-6-1.959. It was reported to be fluid rich in lipoid. The fluid was sterile upto 96 hours.
Operation Notes:
The tumor was removed on 16-6-1959 through a horizontal incision in the lid. It was shelled out completely encapsulated.
Histopathology Report:
The specimen received consists of a cystic mass measuring 1½" in diameter. The cyst is filled with blood. The capsule surface is slightly lobulated.
In the section, only a small area shows a solid structure, the rest of it is all haemorrhage. The former bears the features of a mixed tumor of the lacrimal gland.
| Comments | | |
Cases of mixed tumor of lacrimal gland are rare. No one has adequate knowledge regarding its histologic types and clinical course. This case presented here is our first case diagnosed as a case of mixed tumor of lacrimal gland.
Course of the Disease:
This case had a nodule in the lid for 3 years and increased gradually, progressing rapidly in size 6 months before excision. Benedict's (1939) patient had a nodule for thirty years before an increase in size occurred over a period of one year prior to surgery.
One of Reese's (1953) patient's was operated six years after onset of exophthalmos. Thus, the course of the disease is insidious, may remain dormant for thirty years, may become operable in 3 years, as has been the case in our patient.
Presenting Complaints:
Reese's (1953) states that his 80",, cases had exophthalmos as the presenting complaint with diplopia and swelling of the upper lid causing mechanical ptosis. This patient did not complain of diplopia for the reason that she had a mature cataract in the affected eye. Exophthalmos was absent, as the growth did not occupy any space of orbit and mostly protruded forward.
Bony Involvement:
80 per cent of Reese's (1953) cases had bony involvement, it was absent in our case. X-ray did not show any bony involvement, neither it was recognised by palpation on the operation table.
Recurrence:
Sanders (1939) reports 100 per cent recurrences in 12 cases he studied. Reese also states, recurrence in all cases in which a local excision was done. Forrest's (1949) 9 cases out of 10 follow up, had recurrence necessitating a second operation. In our case, uptil now, there is no sign of recurrence, for the last one year.[4]
| Summary | | |
A case of mixed tumor of lacrimal gland, occurring in a female aged 50 years, of three years' duration is presented. The tumor was shelled out completely encapsulated. There was no bony involvement. Follow up for one year does not shown any sign of recurrence.
| References | | |
| 1. | Benedict, W. L. Discussion of sanders T. E.: (1939). Mixed Tumor of the lacrimal gland. Arch. Ophth. 21, 258.  |
| 2. | Forrest, A. W.(1949): Intraorbital tumors. Arch. Ophth. 41, 198. |
| 3. | Reese's :A. B. (1953) : Tumors of the eye p. 472, Paul B. Hoeber. Incorporation New Fork 16 N. Y. |
| 4. | Sanders, T.E.:(1939). Mixed tumor of the lacrimal gland. Arch. Ophth. 21, 239. |
[Figure - 1], [Figure - 2]
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