Lacrimal Gland-Pleomorphic Adenoma

Case Report: Young patient with painless swelling in the left orbit of 4 years duration with FNAC suggesting pleomorphic adenoma  shows on Plain CT smoothly marginated lobulated well-defined soft tissue density SOL measuring approximately 2cm in the lacrimal gland location with no bony scalloping or fat or necrosis or calcification suggesting lacrimal gland origin.

Teaching points by Dr MGK Murthy

ü Pleomorphic adenoma is most common (50%) variety of lacrimal gland neoplasms. However pleomorphic adenomas most common in parotid salivary gland(84%)

ü It has epithelial and myoepithelial components. Three types histologically  are Myxoid(most common with high recurrence rate),Cellular, and classic varieties

ü CT shows encapsulated appearance (due to pseudocapsule),however microextensions seen on dissection

ü MR shows Low signal on T1 , Bright on T2 with peripheral low signal due to fibrous capsule and homogenous enhancement of small tumours and delayed enhancement  of large tumours  is typical. Necrosis and calcification  can also be seen.

ü Enucleation is the treatment of choice and recurrence is variable (1-50%)

ü Malignant Transformation is possible (1.5% in first 5 years and 9.5% when it is 15 years old)