|Year : 1967 | Volume
| Issue : 4 | Page : 145-148
Mucoepidermoid tumor of lacrimal gland
IS Jain, Ved Rangbulla
Department of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh, India
|Date of Web Publication||21-Jan-2008|
I S Jain
Department of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Rangbulla V. Mucoepidermoid tumor of lacrimal gland. Indian J Ophthalmol 1967;15:145-8
| Introduction|| |
Lacrimal gland tumors constitute about 7%--Moss and McMillan (1962) and 16%-Das (1963 as a cause of unilateral proptosis in adults and older age groups.
The various types of lacrimal gland tumors as described by Reese are: 1. Mixed tumors. 2. Muco-epidermoid. 3. Carcinoma. 4. Miscellaneous forms. Out of these, the mucoepidermoid variety is by far the least common and only one such case has been reported by Reese (1956) in his series of lacrimal gland tumors.
Because of its rarity the following case merits reporting.
| Report of the Case|| |
A female patient aged 45 years presented in the eye out patient department for the first time on 13.10.1965 with the complaints of (1) gradual protrusion of the left eye ball for the past 1 ½ years, more so, for the last six months. (2) History of attacks of mild pain in the left eye, left temporal and mandibular regions for the last 5 to 6 months. (3) History of `splitting' of vision while looking upwards, inwards, and outwards for the past five to six months. There was no history of excessive sweating, tremors, palpitation. swelling in the neck, or of fever.
Two years back she had injury to the left eye with her own hand resulting in redness, pain, watering which persisted for only 7-8 days. For the last 18 years she has been getting attacks of complete unconsciousness occasionally lasting for a few hours (hysterical according to the opinion of a Neuro-physician). There was also occasional swellings of feet, legs, and face for the same duration.
Personal and Family History
She is a housewife, of good economic status, coming from Abohar, District Ferozepore. Her mother had hypertension and hemiplegia. There was no history of diabetes, tuberculosis or epilepsy in the family.
She was obese. Her pulse was 92 per minute and regular, and her blood pressure 145/80 mm of Hg. There was oedema of her legs upto the junction of middle and upper third which pitted on pressure. There was no significant enlargement of glads anywhere.
Left Eye. The palpebral fissure was wider than the right one. In addition to forward protrusion the eye was directed slightly downwards and inwards also, 1 mm of scleral ring being visible above the limbus [Figure - 1]. The cornea was normal in size, shape, curvature, transparency and sensitivity. The pupil was regular and reacting normally.
Vision: Finger counting from 1 foot, with good projection of light. The patient spoke of a "splitting of image" in up, in and out directions. Eye ball movements were completely restricted on the outer side, while in upward and inward directions very slight movements were present, but in downward direction full movements were full. The sense of touch and pain on the face were equal on both sides. No thickening was noticed of temporal bony area. There was no pulsation in the exophthalmos, no cranial bruit. Fundus was normal.
Right Eye. Nothing abnormal was detected.
Haemoglobin was 11.45 gms%. The total lucocytic count was 10200 p/c mm, the differential count showed no abnormality. E.S.R. was 2 mm, first hr. (Westergreen), serum cholesterol 250 mg X-Ray skull for sphenoidal ridge showed no abnormality. Nothing abnormal was detected in the stools and a trace of albumin was, present in the urine with occasional epithelial and pus cells.
Treatment and Progress
No definite cause of unilateral proptosis was detected, so lateral orbitotomy was done on 20.10.65 with the help of a Neuro-surgeon. A spherical cyst 3/4 of an inch in diameter, was enucleated intact, lying behind and superior-temporally in the orbit. [Figure - 2]. There was no connection with the orbital or palpebral part of the lacrimal gland. On cutting it, only straw coloured fluid came out of the cyst; no hair was seen.
Section shows a fairly well encapsulated tumor. The tumor is made of sheets of epidermoid cells [Figure - 3] with little stroma. In other regions acini containing P.A.S. positive material are seen [Figure - 4],[Figure - 5]. The acini are small and regular, or dilated and cystic. The two elements: epidermoid and mucous secreting glands are intimately mixed up with each other.
Diagnosis: Muco epidermoid tumor.
After the operation, the proptosis subsided and the movements of the eye ball attained almost a normal range. Vision improved to finger counting to 2-3 feet. No splitting of image was complained of.
Edema of lids and of temporal region subsided in about a week's time.
The patient on the 10th day complained of loss of sensation in a small area 2 x 1/2" horizontally above the Zygomatic arch-which was confirmed by the absence of pain and touch sensation in that area. On confrontation test, the field of vision was found to be restricted especially on the outer side. The patient was discharged on 10-11-65.
| Comments|| |
Mucoepidermoid tumor usually arises in the duct of lacrimal gland and contains both mucous secreting and epidermoid cells. It was first described by Steward, Foote and Backer (1945) in the salivary glands. They claim an incidence of little more than 5 % of all salivary gland tumors. According to these authors benign and malignant forms occur. The benign variant is composed of proliferating mucous cells, basket cells and columnar cells. The undifferentiated epidermoid carcinoma is rapidly growing and highly malignant. The classical type of growth may be solid or cystic, may be encapsulated or non-encapsulated and originates from cells of larger and intermediate ducts. Microscopically it is characterised by an abnormal differentiation into mucous cells and epidermoid metaplasia. Keratin pearl formation may occur.
In the present case, the tumor appeared to arise either from the duct of the lacrimal gland or from some aberrant glands in the orbit.
| Summary|| |
A case of unilateral proptosis due to muco-epidermoid tumor of the lacrimal gland is reported which was removed by lateral orbitotomy with satisfactory post operative result.
| Acknowledgements|| |
We are indebted to Dr. D. R. Gulati, Neuro-Surgeon Institute of Post Graduate Medical Education and Research, Chandigarh for his kind help in operative procedure. Our grateful thanks are also due to Prof. B. K. Aikat and Dr. B. N. Datta for doing the histopathological examination of the specimen and providing us the microphotographs.
| References|| |
ANDERSON, W. A. B. (1957). Text Book of Pathology (Third Edition) p. 736-740. The C. V. Mosby Company, St. Louis,
DASS S. P. (1963) J. All India Ophth. Society 11, p. 338-341.
MOSS and McMILLAN H. (1962). Amer. J. Ophthal., 54, 765.
REESE, A. B. (1956) Atlas of Tumor Pathology, Section X-Fascicle 38 Tumors of eye and Adnexa p. 178, Armed Forces Institute of Pathology, Washington D.C.
STEWART, FOOTE and BACKER, (1915) quoted by ANDERSON, W. A. B. in 1.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]