|Year : 1985 | Volume
| Issue : 1 | Page : 47-49
Lacrimal gland tumours
SP Dhir, VP Munjal, K Venkata Chalam, IS Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
S P Dhir
P.G.I. Chandigarh 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhir S P, Munjal V P, Chalam K V, Jain I S. Lacrimal gland tumours. Indian J Ophthalmol 1985;33:47-9
Epithelial lacrimal gland tumours constitute 70% of the orbital lesionsl,. Approximately one half of these are benign mixed cell tumours, one third are adenocystic carcinomas and the remainder are malignant mixed and other carcinomas. The symptomatology and clinical signs most of the time help in arriving at a diagnosis and sorting out cases of benign and malignant tumours as well as other lesions of the lacrimal fossa. Excisional biopsy in cases of benign mixed tumours is an established procedure. We face problem in treating lacrimal gland tumours because, the cases turn up in a very advanced stage. This paper presents an analysis of seven cases of lacrimal gland tumours and problems in their management.
| Material and methods|| |
Clinical records of seven patients of lacrimal gland tumours which were seen by us over the last 8 years at this department. The data includes, detailed history of patients regarding symptoms, whether painful or painless, measurements of proptosis, digital examination of the orbit for the palpable mass, examination of the anterior segment, fundus examination to see the pressure effect on the globe, roentgenographic findings, surgical procedure like incisional biopsy, exenteration of the orbit were done in accordance with the indication in each case. The materials available were subjected to histopathological examination. In the follow-up period irradiation was given in cases with recurrence and in malignant tumours where the surgical incision passed through the tumour mass.
| Observations|| |
The clinical details of the seven cases are enumerated in [Table - 1].
One patient died three years after the surgery and second (Case No. 3) is still being followed up for the last one year and had developed matastasis to the preauricular, submandibular and cervical lymph nodes and block dissection of these glands was done by the E.N.T. surgeon. Third patient (Case No. 2) was seven months pregnant and was having rapidly progressing proptosis with severe pain. There was a big mass filling the temporal fossa, X-ray showed erosion of the temporal bone.
| Discussion|| |
Clinical features of the lacrimal gland tumours are well described by various authors,, and the plan to solve the prob1em of a lacrimal fossa mass is well illustrated by Stewart et a1. While dealing with the mixed lacrimal gland tumours one should be very careful in deciding about the type of surgery because unwarranted incisional biopsy or incomplete removal of the mass may lead to a recurrence of the tumour or a malignant change later. Two of our cases met with this fate; in one case (Case No. 3) malignant change occurred 10 years later after the incomplete removal and in the second case (Case No. 1), it happened 7 years after the first surgical procedure. In both the cases the progress was very rapid and they fast reached the inoperable stage. No period after the incomplete surgical removal can be considered as safe for recurrence as malignant change has been reported after a period as long as 40 years. The prognosis of the malignant tumours of the lacrimal gland is extremely poor.
The prognosis of malignant pleomorphic adenoma is considered to be better than other types of carcinomas of the lacrimal gland.
One of our case (case No. 2) bad a very rapidly growing tumour which in two months time attained a massive size [Figure - 1]. She was seven months pregnant. This tumour on histopathology turned out to be a malignant pleomorphic adenoma. She delivered normal baby and six month later when she was seen again, though the tumour was still growing but the progress was much slower as compared to the progression during pregnancy. It does show that there is adverse affect of hormones on the growth of tumour during pregnancy as seen in meningiomas etc. In general prognosis of lacrimal gland tumours is poor and early wide though mutilating surgical excision is recommended. A long follow-up is warranted.
| Summary|| |
Clinical presentation of seven cases of lacrimal gland tumours is described. There are greater chances of recurrence of mixed lacrimal gland tumour with a malignant change if it is incompletely removed. Pregnancy seems to have an adverse effect on the progression of the malignant lacrimal gland tumours. A wide though mutilating early surgical excision is recommended.
| References|| |
Hendersan, J.W., 1978, Orbital Tumours Philladelphia, W.B. Saunders. P. 77, 86, 345, 409.
Reese, A.B. 1963, Tumours of the eye, Ed. New York, Harper and Row, Publishers Inc. 544.
Stewart, W.B., Krobel, G.B., Wright, J.E., 1979 Ophthalmology 86. 886.
Zimmermal, L.E., Sanders, T.E. Ackerman, L.V. 1962 Inn. Ophthalmol. Clin. 2: 337
Davies, S. 1964, Trans., Am. Ophthalmol Soci 52, 467.
[Figure - 1]
[Table - 1]