Title: Lacrimal gland Neoplasms: A 10 Year Retrospective Study

Authors: Dr Suguna Belur Venogopal, Dr Sneha Ashok Motwani, Dr Sruthi Prasad, Dr Geethamani V

 DOI: https://dx.doi.org/10.18535/jmscr/v8i1.03

Abstract

Background: The orbit is home to many tumors, but the lacrimal gland which anatomically is a part of the orbit is a rare site for both primary and secondary tumors. Incidence of lacrimal gland tumors is only 1 in 1 million people per year.1 The tumors affecting the lacrimal gland can be broadly classified into epithelial, mesenchymal, lymphoid and metastatic.

Objectives

  • To assess the histomorphological features of various lacrimal gland neoplasms.
  • To classify them into benign and malignant neoplasms.
  • To describe the age and sex distribution of various lacrimal gland neoplasms.
  • To find out the frequency of various lacrimal gland neoplasms in our study population and compare it with the previous studies.

Materials and Methods: This retrospective study was carried out in a tertiary care hospital. A total of 37 lacrimal gland tumors were studied over a period of 10 years from January 2010 to October 2019. Tissues were fixed in formalin, routinely processed, stained with Hematoxylin and Eosin stain and studied for histomorphological features.

Results: The most common neoplasms in our study were epithelial neoplasms, of which, pleomorphic adenomas (benign) had the highest frequency followed by adenoid cystic carcinoma(malignant). These were followed by lymphoid tumors which included reactive lymphoid hyperplasia and malignant lymphomas. Mesenchymal tumors included neurofibromas and lymphangioma. There was one case of metastatic breast carcinoma.

Conclusion: Histopathology is critical in diagnosing and classifying neoplastic lesions of the lacrimal gland. Histopathology along with radiological findings provides an insight into the malignant potential and prognosis of the tumor. Thus, histopathological examination in addition to clinical and radiological findings aids in the accurate diagnosis and rational management of lacrimal gland neoplasms.

Keywords: Lacrimal gland, Neoplasms, Histomorphology.

References

  1. https://www.cancer.net/cancer-types/lacrimal-gland-tumor/statistics
  2. Klintworth GK, Cummings TJ. Normal eye and ocular adnexa. In: Stacey E Mills. Histology for Pathologists.4th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.p.394-397
  3. Weis E, Rootman J, Joly TJ, et al. Epithelial Lacrimal Gland Tumors: Pathologic Classification and Current Understanding. Arch Ophthalmol.2009;127(8):1016–1028.
  4. Alkatan HM, Al-Harkan DH, Al-Mutlaq M, Maktabi A, Elkhamary SM. Epithelial lacrimal gland tumors: A comprehensive clinicopathologic review of 26 lesions with radiologic correlation. Saudi J Ophthalmol. 2014;28(1):49–57.
  5. Ramon L. Font MD, J.OscarCroxatto MD, Narsing A. Rao. MD. Tumors of the eye and ocular adnexa- AFIP Atlas of tumor pathology- Series 4.p.223-242.
  6. Rose G, Wright J. Pleomorphic adenoma of the lacrimal gland. British Journal of Ophthalmology. 1992;76(7):395-400.
  7. Kennedy R E. An evaluation of 820 orbital cases. Trans Am Ophthalmol 1984; 82:134-157
  8. Duck Kim Y. Lacrimal gland tumors. In:Karcioglu ZA. Orbital Tumors, Diagnosis and Treatment. New York: Springer, 2005:204-220.
  9. Klintworth GK, Cummings TJ. The eye and ocular adnexa. In: Stacey E Mills Sternberg's Diagnostic Surgical Pathology, 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.p989-990.
  10. Von Holstein S, Coupland S, Briscoe D, Le Tourneau C, Heegaard S. Epithelial tumours of the lacrimal gland: a clinical, histopathological, surgical and oncological survey. Acta Ophthalmologica. 2012;91(3):195-206.
  11. Forrest AW. Epithelial lacrimal gland tumors: pathology as a guide to prognosis. Trans Am AcadOpthalmol. 1954;58:848.
  12. Ni C, Cheng SC, Dryja TP, et al. Lacrimal gland tumors: a clinicopathologic analysis of 160 cases. Int Ophthalmol Clin 1982;22:99–120.
  13. Gamel JW, Font RL. Adenoid cystic carcinoma of the lacrimal gland: the clinical significance of a basaloid histologic pattern. Hum Pathol 1982;13: 219–225.
  14. Bernardini FP, Devoto MH, Croxatto JO. Epithelial tumors of the lacrimal gland: an update. Curr Opin Ophthalmol. 2008;19(5):409-13.
  15. Persson M, Andren Y, Mark J, Horlings HM, Persson F &Stenman G (2009): Recurrent fusion of MYB and NFIB transcription factor genes in carcinomas of the breast and head and neck. Proc Natl Acad Sci USA 106: 18740– 18744.
  16. Andrew NH, Coupland SE, Pirbhai A, Selva D. Lymphoid hyperplasia of the orbit and ocular adnexa: A clinical ​pathologic review. Surv Ophthalmol. 2016;61(6):778-790
  17. Farmer JP, Lamba M, Lamba WR, et al.  Lymphoproliferative lesions of the lacrimal gland: clinicopathological, immunohistochemical and molecular genetic analysis.  Can J Ophthalmol. 2005;40(2):151-160.
  18. Rasmussen P, Ralfkiaer E, Prause JU, Sjö LD, Siersma VD, Heegaard S. Malignant Lymphoma of the Lacrimal Gland: A Nation-Based Study. Arch Ophthalmol. 2011;129(10):1275–1280
  19. McDonald P, Jakobiec F, Hornblass A, Iwamoto T. Benign Peripheral Nerve Sheath Tumors (Neurofibromas) of the Lacrimal Gland. Ophthalmology. 1983;90(12):1403-1413.

Corresponding Author

Dr Sneha Ashok Motwani

Address: 439/A, 1st A Cross, 4th Block, Koramangala, Bengaluru – 560034, India