|Year : 1982 | Volume
| Issue : 5 | Page : 509-511
A Clinico-Pathological study lacrimal gland tumours
PK Agarwal, Raghav Ram, Deepak Kumar, Jitendra Agarwal
Deptt. of Ophthalmology King George's Medical College Lucknow, India
P K Agarwal
Dept. of ophthalmology, K.G. Medical College, Lucknow(U.P.)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwal P K, Ram R, Kumar D, Agarwal J. A Clinico-Pathological study lacrimal gland tumours. Indian J Ophthalmol 1982;30:509-11
Lacrimal gland tumours constitute an im portant cause of unilateral proptosis.
This is an analysis of 24 cases of histologi cally proved laerimal gland tumours where ar attempt has been made at clinicopathologica corelationship, the mode and result of treat ment.
| Materials and methods|| |
24 cases of histologically proved lacrima gland tumours wre drawn from 203 cases of orbital tumours seen at the ophthalmoplasl3 clinic of Department of Ophthalmology, KG Medical College, Lukcknow from January, 1969 to July, 1980.
These case were subjected to detailed history taking, general systemic and ophthalmological examinations. Exophthalmometry and visual field charting was done wherever necessary. Specialist opinion from E.N.T. and Neuro-Surgeons were also taken. Detailed investigations including routine blood, serological urine, stool and radiological examination were done. To localise the mass in early cases and to know its extent, selected cases were subjected to orbitovenograpey. In some cases carotid angiography and ultrasonograpny (AScan) was also done. All case was explored the growth excised and subjected to histopathological examintion. In few cases radiotherapy was given. The results were analysed.
The overall percentage of lacrimal gland tumours among orbital tumours was found to be approximately 12%, which is well in the range of 2 to 23% reported in different series. The following were the pathological varieties among the 24 cases of lacrimal gland tumours. Mixed lacrimal gland tumours, benign-16 ; M.L. G. tumours, malignant -3 ; Adenocarcinoma -2 ; Adenoid cystic carcinoma-2 and Plasmacytoma -1. The male to female ratio was 7:5.
The maximum number of tumours of lacrimal gland occured between the age groups of 31 to 50 years specially the malignat variety. Upto the 31 years of age the tumours were mainly benign.
The commonest of tumours in this series is mixed tumour of the lacrimal gland presenting 10 cases out of which 3 were histologically diagnosed as malignant. These 3 cases, mainly 31 to 50 years of age, indicates that chances of malignancy may be a little more in advanced go in mixed tumours.
The most common presenting feature in these cases specially the young ones was epiphora as a constant starting complaint. Pain was not a frequedt feature unless the proptosis was marked.
Proptosis was constant presenting feature in all cases of mixed tumours. The earlier cases showed mild axial proptosis which in later biger masses showed a `down and in displacement. Two cases showed an `up and out' displacement of the eye ball which could be explained due to a posterior position of the mass. Fullness of the upper lid and a palpable mass in the superior temporal quadrant of the orbit were seen in 14 of the benign and 3 of malignant mixed tumours. No lymph node metastases were encountered in either variety of mixed tumours.
Other symptoms like diminution of vision, fundus changes, conjunctival congestion and corneal changes due to exposure were directly related to the size of the tumour mass. Restriction of eye rnovemeet was mechanical with no actual involvement of muscle or nerves.
There were no radiological changes in 10 of the benign mixed tumours while 5 showed increase in the size of lacrimal fossa and one showed bony sclerosis. Two cases of malignant mixed tumours showed no change while one had an enlargement of the lacrimal fossa and bony sclerosis. These changes were, however, found to be directly related to the size of the tumour and were presumably due to pressure rather than invasion.
Two cases of adenoid cystic carcinoma our series were females, presenting with huge proptosis with marked limitation of ocular movement. Pain was a very notable feature and the uision was markedly diminished due to optic atropy. Radiology showed maked destruction of laerimal fossa and adjacent soft tissue.
Of the 2 cases of adeno carcinoma in their series one was a male and the other female. They had marked proptosis, diminution of vision, pain in eye, oedema of lids. Palpable masses in orbit could be felt and restriction of eye movement was observed. Vision was lost because of invasion of the optic nerve. The male case presented with mild axial proptosis with recurrent pain and signs of inflammation which led to an initial diagnosis of an inflammatory mass. He was treated with antibio tics and corticosteroids resulting in complete regression of the mass and improvement in vision. Subsequently; however, he came back after 1-12' years with severe loss of vision and proptosis. Later, it proved to be a case of adenocarcinoma of the lacrimal gland. The other case was a female who who had had an operation some where also before presenting to us with proptosis, palpable mass in the upper lid, skin involvement, severe loss of vision and complete restriction of eye movements. Radiology showed marked destruction cf bones of lacrimal fossa, zygomatic bone and soft tissues in the temporal foisa.
The case of plasmocytoma of lacrimal gland in our series was a 48 years old female who came to us with a rapidly increasing swelling on posterolateral side of right eye, epiphorn, diplopia and pain in eye. On examination, proptosis restriction of eye movement, conjuctival congestion and a firm diffuse palpable mass in right orbit were detected. All investigations including routine blood and uriue examination were normal. Benz Jones proteins in urine were absent. X-ray skull showed multiple osteolytic areas in the lateral part of right orbital cavity.
The mass was excised piecemeal through a lateral orbitatomy. It could not be removed completely since it was extensively involving the adjacent bone. Proptosis and pain subsided but the patient returned with a recurrence of the same feature after 2 months. Radiotherapy was attempted with little response and the
patient expired after 3 months.
| Treatment|| |
Orbital exploration with removal of the tumour masses- through lateral orbitomies was done in 21 cases. Three cases had to undergo exenteration at the out set, since at the time of exploration obvious signs of malignancy with gross destruction of adrenal structures were observed. The first 21 cases were followed up for 1-8 years, of these 15 cases had no recurrence. While 6 cases came back with recurrences. These cases were of benign mixed tumoars, 2 of adenocarcinoma, 2 of adenoid cystic carcinoma and i of plasmacytoma. The case of benign mixed tumour was again opened up and the remaining mass exersed. The other 5 cases were subjected to exenteration with removal of involved bone, followed by radiotherapy.
| Summary|| |
The commonest lacrimal gland tumour encountered is a benign mixed tumour, followed in that order by malignant mixed tumour, adeno carcinoma and adenoid cystic carcinoma and adenoid cystic carcinoma. The possibilities of an isolated plasmacytoma should also be kept at the back of the mind as an uncommon occurence.
The chief presenting features in all primary lacrimal gland timours are epiphora, proptosis, limitation of movement. A palpable mass in the vicinity of the lacrimal gland is usually detectable. A diminution of vision is not so common and occurs as a late manifestation. Age seems to be no bony, but malignant tumours are seen in older people.
The treatment of choice seems to be an early exploration of the orbit and a complete removal of tumour masses within ite capsule. In cases where malignancy is observed either during exploration or in subsequent pathologi. cal examination, an exenteration of the orbit with removal of bone if indicated followed by radiotherapy is recommended.