lacrimal pathology

Lacrimal pathology : 

Lacrimal pathology

Lacrimal gland lesions : 

Infiltrative: inflammatory lymphoma Structural disorders cysts Epithelial tumors(25%) All lacrimal gland lesions result in mass effect with medial displacement of the globe Lacrimal gland lesions

Frequency of lacrimal fossa lesions : 

Dacryoadenitis 50% Pleomorphic adenoma 20% Reactive lymphoid hyperplasia 10% Adenoid cystic carcinoma 7% Dacryops 5% Lymphoma 4% Mucoepidermoid carcinoma 3% Pleomorphic adenocarcinoma 1% Frequency of lacrimal fossa lesions

Tumors of lacrimal gland : 

Tumors of lacrimal gland Benign T Pleomorphic adenoma Myoepithelioma (rare) Malignant T Adenoid cystic carcinoma(75%) Malignant mixed T Mucoepidermoid carcinoma(2%) Adenocarcinoma (rare)

Pleomorphic adenoma(benign mixed cell tumor) : 

Mainly orbital lobe 5% of orbital tumors 25% of lacrimal gland lesions 50% of epithelial lacrimal gland tumors Male\female:1.5\1 Mean age:40 ys Pleomorphic adenoma(benign mixed cell tumor)

Slide 8: 

Facial asymmetry due to pleomorphic adenoma of the right lacrimal gland

Clinical picture : 

Painless exophthalmos,axial downward displacement of globe,diplopia,retinal striae, palpable lid mass.slowly progress over a year Clinical picture

pleomorphic adenoma : 

CT scan showing left lacrimal gland enlargement with molding around the globe with no bone destruction pleomorphic adenoma

Macroscopic examination : 

Macroscopic examination a single solid pale-grey mass with a bosselated surface. The cut surface show solid tumour with mucoid cystic spaces and areas of

Microscopic examination : 

the tumour to consist of two different components. 1 Epithelial: glandular pattern in which cords and ducts resemble the ducts in a normal lacrimal gland . The lumen of some of the ducts may be filled with an eosinophilic proteinaceous secretion. 2 Stromal: this tissue is formed by myoepithelial cells which break away from ducts and proliferate to form connective tissue . The componentsare primarily fibrous with myxoid areas but the tumour may also contain fat and cartilage. the pseudocapsule is merely a fibrous condensation which contains infiltrating tumour. It is the responsibility of the pathologist to take multiple samples of the pseudocapsule to avoid incomplete clearance Microscopic examination

Adenoid cystic carcinoma : 

the most common malignant lacrimal gland carcinoma Commonly 4th decade More in females Short duration of symptoms Orbital pain is common(perineural spread) Adenoid cystic carcinoma

Adenoid cystic carcinoma : 

Adenoid cystic carcinoma Poorly demarcated irregular lesion with bone destruction

Microscopic examination : 

Microscopic examination solid cords of hyperchromatic cuboidal cells with a high mitotic rate, proliferating around cystic spaces containing myxoid material ( “Swiss cheese” appearance). ability for perineural invasion explains the common symptom of pain and leads to difficulties in assessing clearance margin.

prognosis : 

Adenoid cystic carcinoma prognosis