Clinical Analysis of Epithelial Tumors of the Lacrimal Gland

Jae Yon Won; Su Kyung Jung; Ji Sun Paik; Suk Woo Yang

doi:10.3341/jkos.2014.55.6.795

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Won, Jung, Paik, and Yang: Clinical Analysis of Epithelial Tumors of the Lacrimal Gland

Original Article

J Korean Ophthalmol Soc 2014;55(6):795-800.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.6.795

Clinical Analysis of Epithelial Tumors of the Lacrimal Gland

Jae Yon Won, MD, Su Kyung Jung, MD, Ji Sun Paik, MD, Suk Woo Yang, MD, Phd

Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Suk Woo Yang, MD, PhD, Department of Ophthalmology, Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea, Tel: 82-2-2258-1188, Fax: 82-2-599-7405, E-mail: yswoph@catholic.ac.kr

Received 13 September 2013 Revised 6 January 2014 Accepted 1 May 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the clinical and radiologic findings and to evaluate the treatment and prognosis of epithelial tumor patients.

Methods

We retrospectively reviewed clinical and radiologic findings of 36 patients who had been histopathologically diagnosed with epithelial tumors of the lacrimal gland after biopsy and surgery at Seoul St. Mary's Hospital from May 2005 to October 2012.

Results

Among the patients with epithelial tumors of the lacrimal gland based on histopathological findings, there were 21 cases of pleomorphic adenoma, seven cases of dacryops, four cases of adenoid cystic carcinoma, two cases of adenocarcinoma, one case of benign oncocytoma, and one case of mucoepidermoid carcinoma. The characteristic clinical finding of epithelial tumors of the lacrimal gland was proptosis (52.7%). In contrast with benign epithelial tumors of the lacrimal gland, the characteristic clinical findings of malignant epithelial tumors of the lacrimal gland were limitation of motion (57.1%), diplopia (57.1%), ocular pain (42.9%), and decreased visual acuity (42.9%). The mean duration of the symptoms of malignant epithelial tumors (5.0 ± 4.2 months) was shorter than that of benign epithelial tumors (11.2 ± 11.1 months) (t-test, p = 0.034). In radiologic CT and MRI findings, there was minimal bony destruction in two cases of pleomorphic adenoma and calcification in one case of pleomorphic adenoma. Malignant epithelial tumors of the lacrimal gland, in contrast to benign tumors, showed characteristic bony destruction (57.1%), poorly marginated tumor outline (42.9%) and calcification (14.3%). The 57.1% of patients in this study with malignant tumors were treated with chemotherapy and radiotherapy after surgical treatment, and there was one case (14.3%) of recurrence after treatment.

Conclusions

Careful analysis of clinical and radiologic findings can lead to early diagnosis of malignant tumors.

Keywords: Clinical findings, Epithelial tumors of the lacrimal gland, Radiologic findings

References

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Figure 1.

(A) Pleomorphic adenoma. CT shows a well-marginated round mass with isodensity in the Rt lacrimal gland. There is no bone destruction and caldification. (B) Pleomorphic adenoma. CT shows a well-marginated round mass with isodensity in the left lacrimal gland. Subtle bony erosive changes is seen on the wall of the left lacrimal fossa. (C) Adenoid cystic carcinoma. T1W MR imaging shows a ill-defined mass and bony destruction at the right orbital wall. (D) Adenocarcinoma. T1W MR imaging shows a heterogeneously enhancing mass and bony destruction at the left orbital wall. CT = computed tomography; Rt = right; T1W MR = T1 weighted magnetic resonance.

Table 1.

Symptoms, signs and duration of symptom of epithelial tumors in the lacrimal gland

	Malignant tumor				Benign tumor				p-value^*
	ACC (4)	AC (2)	MEC (1)	Total (7)	PA (21)	DA (7)	BO (1)	Total (29)	p-value^*
Exophthalmos	4	2	1	7 (100%)	11	0	1	12 (41.4%)
Pain	2	0	1	2 (66.6%)	1	0	0	1 (3.4%)
Epiphora	0	0	0	0 (0%)	1	0	1	2 (6.9%)
Limitation of motion	2	2	0	4 (57.1%)	5	0	0	5 (17.2%)
Diplopia	2	2	0	4 (57.1%)	1	0	0	1 (3.4%)
Decreased visual acuity	1	1	1	3 (42.9%)	0	0	1	1 (3.4%)
Palpable mass	1	0	0	1 (14.3%)	8	7	0	15 (51.7%)
Duration (months)		5.0 ± 4.2				11.2 ± 11.1			0.034

Values are presented as mean ± SD.

ACC = adenoid cystic carcinoma; AC = adenocarcinoma; MEC = mucoepidermoid carcinoma; PA = pleomorphic adenoma; DA = dacryops; BO = benign oncocytoma.

^* t-test.

Table 2.

Computed tomography and magnetic resonance imaging findings of epithelial tumors in the lacrimal gland

	Malignant tumor				Benign tumor
	ACC (4)	AC (2)	MEC (1)	Total (7)	PA (21)	DA (7)	BO (1)	Total (29)
Bone destruction	3	1	0	4 (57.1%)	2	0	0	2 (6.9%)
Calcification	1	0	0	1 (14.3%)	1	0	0	1 (3.4%)
Outline
Well marginated	2	0	1	3 (42.9%)	19	7	1	27 (93.1%)
Poorly marginated	1	2	0	3 (42.9%)	2	0	0	2 (6.9%)

ACC = adenoid cystic carcinoma; AC = adenocarcinoma; MEC = mucoepidermoid carcinoma; PA = pleomorphic adenoma; DA = dacryops; BO = benign oncocytoma.

Table 3.

Treatments of epithelial tumors in the lacrimal gland

	Malignant tumor			Benign tumor
	ACC (4)	AC (2)	MEC (1)	PA (21)	DA (7)	BO (1)
Exenteration + RTx	1	0	0	0	0	0
Removal + CCRTx + cyberknife	1	0	0	0	0	0
Removal + CCRTx	0	1	0	0	0	0
Removal + CTx	0	1	0	0	0	0
Removal	2	0	1	21	7	1

ACC = adenoid cystic carcinoma; AC = adenocarcinoma; MEC = mucoepidermoid carcinoma; PA = pleomorphic adenoma; DA = dacryops; BO = benign oncocytoma; RTx = radiotherapy; CCRTx = concurrent chemoradiotherapy; CTx = chemotherapy.

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