Histologically similar, synchronous or metachronous, lacrimal salivary-type and parotid gland tumors: A series of 11 cases.

BACKGROUND: Restricted presentation of malignancy at both lacrimal and parotid salivary glands are unusual occurrences that may pose clinical and diagnostic difficulties. METHODS: We applied certain clinicopathological criteria to distinguish between lacrimal and parotid gland primaries in a series of 11 patients with synchronous and/or metachronous tumors of similar histology at both sites. RESULTS: Of eight patients with primary lacrimal carcinomas, seven had metachronous metastases to parotid glands. All three patients with primary parotid carcinomas had concurrent metastases to lacrimal glands. Patients with primary lacrimal tumors metastasizing to the parotid gland appear to have better clinical outcome in comparison with those with parotid primary with secondary lacrimal metastases. CONCLUSION: Careful examination of parotid glands in the assessment of any lacrimal gland tumor with high-grade adenocarcinoma morphology is recommended to rule out the possibility of a parotid primary.     

Epithelial tumors of the lacrimal gland: Clinico-pathologic correlation and management

Between 1960 and 1987 29 patients underwent surgery at the Munich University Eye Hospital for benign and malignant tumors of the lacrimal gland. Fifteen tumors were classified as pleomorphic adenomas (three of them with malignant transformation), nine as adenoid cystic carcinomas, two as adenocarcinomas, two as oxyphilic adenomas, and one as oxyphilic adenocarcinoma. The clinico-pathologic correlation of these tumors is described. All age groups were involved in both benign and malignant epithelial gland tumors. A fast growing lesion with bone destruction of the lacrimal fossa in association with pain was found to be highly suspicious of a malignant epithelial tumor. Prior to surgery, inflammatory lesions and lymphomas should be ruled out by clinical history, examination, diagnostic imaging techniques, and, occasionally, by a short course of oral corticosteroids. A diagnostic biopsy prior to tumor excision and a transfrontal surgical approach via craniotomy has a negative impact on the prognosis. Thus it is mandatory to remove epithelial lacrimal gland tumors completely at the time of the initial surgical procedure. Craniotomies facilitate recurrences of lacrimal gland tumors by infiltration into the central nervous system. Lateral orbitotomies using the Krönlein technique are the best surgical approach for successful removal of these unusual tumors.     

Ectopic lacrimal gland tissue of the orbit and sclerosing dacryoadenitis

A 28-year-old man with unilateral proptosis was found to have sclerosing dacryoadenitis and ectopic lacrimal gland tissue of the orbit. The unusual combination simulated invasive adenocarcinoma of the lacrimal gland both clinically and histopathologically. Based on clinical and experimental observations, we propose that the acinar gland atrophy and fibrous replacement of the lacrimal gland and of the heterotopic tissue was the result of a primary developmental abnormality associated with obstruction to normal gland outflow. Physician awareness that ectopic lacrimal gland tissue in the orbit can be affected by sclerosing dacryoadenitis is probably the most critical factor in establishing the correct diagnosis.     

Epithelial lacrimal gland tumors: a clinicopathological study of 18 cases.

OBJECTIVE: The aim of this study was to report the clinicopathological features of 18 epithelial tumors of the lacrimal gland treated in a single institution. STUDY DESIGN AND SETTING: Clinical data and treatment were recorded and histological features reviewed. RESULTS: Twelve tumors (66.7%) were adenoid cystic carcinoma (ACC), 5 (27.8%) pleomorphic adenoma (PA), and 1 (5.5%) carcinoma ex pleomorphic adenoma. All patients with ACC presented with advanced clinical stage, and most were treated by wide surgical resection followed by adjuvant radiotherapy. No recurrence was observed in 4 cases of ACC; however, 7 patients died from persistence of disease or by local and/or distant recurrence. All PA patients were successfully treated by surgical resection. CONCLUSIONS: Epithelial lacrimal gland tumors are mainly PA and ACC, and malignancies are more common than benign tumors. Although ACC presented typically with advanced clinical stage, 33% of the patients survived without tumor recurrence or metastasis.     

Technique for incisional biopsy of a lacrimal gland mass when the diagnosis of benign mixed tumor cannot be excluded clinically

In most cases of a lacrimal gland mass, the management course can be defined clearly based on an accurate history supported by characteristic radiographic features. There are, however, certain cases that do not fit cleanly into management algorithms and, on occasion, it may be necessary to obtain an incisional biopsy into a lacrimal gland mass when the diagnosis of benign mixed tumor cannot be excluded conclusively. We report a technique for incisional lacrimal gland biopsy under these circumstances. To prevent tumor spillage in the event of benign mixed tumor, the incision site into the gland is covered with several drops of butyl-2-cyanoacrylate. The biopsy specimen is submitted for frozen section examination. If the frozen section reveals benign mixed tumor, the entire gland may be removed, with the cyanoacrylate bond protecting the lacrimal gland contents from contaminating the orbit. The technique and its indications are described in detail.     

Mucinous Myoepithelioma,a Recently Described New Myoepithelioma Variant

Adenoid cystic carcinoma (AdCC) is the most frequent malignant neoplasm of the lacrimal glands. Like its salivary gland counterpart, lacrimal AdCC can rarely undergo high-grade transformation (“dedifferentiation”). We herein report the clinical, radiographic and microscopic findings of a lacrimal gland AdCC with high grade transformation, occurring in a 39-year-old female patient. In contrast to salivary gland AdCC with high-grade transformation, which usually shows a high grade component with “ductal” differentiation, in the case presented, the “dedifferentiated” component showed morphologic and immunohistochemical features of myoepithelial differentiation.     

A case of extramedullary plasmacytoma arising from the lacrimal gland: a case report

A rare case of extramedullary plasmacytoma (EMP) arising from the lacrimal gland of a 33-year-old woman is presented. The left lacrimal gland tumor was suspected, and tumorectomy was performed. Histopathological examination with immunostaining revealed it to be positive for IgG and chains, demonstrating monoclonality. However, no abnormality was observed on serum protein electrophoresis, immunofixation, or skeletal survey and bone marrow aspiration, and the tumor was diagnosed as EMP. Postoperative radiation was given to the left orbit by a linear at a dose of 40 Gy. One year and 10 months have passed since the operation, and the patients general condition is good, without local recurrence of tumor, lymph node metastasis, or remote metastasis. The EMP should be considered in the differential diagnosis of lacrimal gland tumor.     

A new technique for the treatment of lacrimal gland prolapse in blepharoplasty

The lateral temporal fullness of the upper eyelid in patients presenting for a blepharoplasty is sometimes due to a prolapse of the lacrimal gland. The operative procedures that attempt to reposition the migrated lacrimal gland have been either dangerous in that they cause a dry-eye syndrome or unsatisfactory in that they have a high rate of recurrence or other complications. A new and different operative approach to a herniated or prolapsed lacrimal gland deals with an extraglandular concept of repositioning the gland that corresponds to the general principles of hernial surgery.Presented at the 29th Annual Meeting of the Austrian Society of Plastic, Aesthetic and Reconstructive Surgery, Graz, Austria, October 1991Presented at the Annual Meeting of the Swiss Society of Plastic Surgery, Arlesheim, Basel, May 1992     

重睑成形术联合泪腺复位术治疗眼睑松弛症的临床效果

目的 探讨重睑成形术联合泪腺复位术治疗眼睑松弛症的临床效果.方法 10例（20只眼）眼睑松弛症患者均在停止发作并静止1年以上手术.按照切开法重睑成形术设计手术切口,酌情去除上睑松弛的皮肤和部分眼轮匝肌,以及疝出的眶隔脂肪,泪腺脱垂全层缝合泪腺组织固定于眶泪腺窝处的骨膜上,上睑下垂视上睑提肌腱膜有无断裂,采取上睑提肌腱膜修复或折叠术,睑裂横径缩短将外眦韧带缝合固定于外侧眶缘骨膜.结果 10例术后均取到满意治疗效果,皮肤松弛得到明显改善,并形成满意的重睑形态,泪腺复位,其中上睑下垂、睑裂横径缩短也均得到满意矫正.随访3个月至1年,1例术后3个月于颞上方穹窿下仍可见到脱垂的部分泪腺,其余脱垂泪腺均得到良好复位,无复发.结论 眼睑皮肤松弛症可通过手术治疗得到有效矫正,经双重睑切口联合脱垂泪腺复位手术效果良好,可达到美容与功能治疗的目的.     

Lacrimal and salivary gland inflammation in the C3H/Ipr autoimmune strain mouse: a potential mode for Sj?gren's syndrome.

Sj?gren's syndrome is an autoimmune inflammatory disease that affects the lacrimal and salivary glands. To identify a potential animal model for study of Sj?gren's syndrome, an evaluation was made of lacrimal and salivary glands in the C3H/Ipr autoimmune strain mouse at ages before (2 months) and after (5 months) systemic autoimmune disease onset at 3 to 4 months. Quantitative and qualitative analyses of C3H/Ipr lacrimal and salivary (parotid, submandibular, and sublingual) gland histopathology were performed using age-matched C3H/HeJ nonautoimmune mice to control for inflammation of nonautoimmune origin. No lacrimal or salivary gland inflammation was seen in either of the strains at 2 months of age and measures of systemic autoimmune disease were negative. At 5 months of age, the nonautoimmune C3H/HeJ controls showed a slight increase in lacrimal gland inflammation, but this was not significantly different from the 2 month old controls. A significant increase in lacrimal gland inflammation was found in the 5 month old C3H/Ipr autoimmune mice in a histologic pattern similar to that of Sj?gren's syndrome in human beings. Furthermore, the degree of inflammation was positively correlated with serum immune complexes and spleen weight. Sporadic inflammation of the submandibular gland was seen in both autoimmune and control mice, but this was neither statistically significant nor correlated with measures of autoimmunity. No significant inflammation was seen in the parotid or sublingual glands.     

Accessory lacrimal gland fistula secondary to ptosis surgery

This is a case report of the development of a lacrimal fistula following repeated anterior levator resections for severe ptosis. The fistula was excised and pathologically traced to an accessory lacrimal gland. This patient represented the first documented case following an accessory lacrimal gland as the source for a fistula following levator resections for ptosis.     

Malignant mixed tumor of the lacrimal gland.

This paper reports a case of carcinoma arising in a benign mixed tumor of lacrimal gland following multiple recurrences. The patient had eight recurrences of the benign lesion and after 32 years developed an adenocarcinoma associated with recurrent nodules of still recognizable benign mixed tumor. The literature on malignant mixed tumors of the lacrimal gland is reviewed noting the confusion in diagnostic terminology in early reports. Our patient illustrates the resemblance between malignant mixed tumor (carcinoma arising in pleomorphic adenoma) of lacrimal and salivary gland both clinically and pathologically.     

Bilateral lacrimal duct cyst

Reports of lacrimal gland cysts have been rare, and mostly of small, unilateral cysts of the palpebral lobes. An unusual case of bilateral, large acquired cysts of the orbital lobe of the lacrimal glands is presented. Pathologic examination showed chronic inflammation and fibrosis of the lacrimal gland structures. We suggest that prolapse of the lacrimal glands with obstruction of the lacrimal ducts, combined with chronic dacryoadenitis, led to cyst formation.     

Unusual progression of pleomorphic adenoma of the lacrimal gland: case report

A 72-year-old female complained of acute pain on left eye movement followed by progressive exophthalmos. Neuroimaging revealed a large well-demarcated lesion consisting of solid and cystic parts, as well as bone destruction and hemorrhage, within the left orbital cavity. The preoperative diagnosis was pleomorphic adenoma with or without malignant transformation, or cavernous angioma. En bloc excision including adjacent tissues was planned to resolve the progressive symptoms and to obtain a histological diagnosis. The transcranial route was chosen since tumor invasion to the cranial base was possible. The histological diagnosis was pleomorphic adenoma. Pathological and preoperative radiological examinations indicated that repeated intratumoral hemorrhage had caused the orbital bone destruction and acute orbital pain. Neoplasms should be differentiated from a wide spectrum of other possible pathologies. Accurate clinical diagnosis of neoplasm in the orbital cavity is important for correct therapeutic management. Malignancy is generally suspected if painful and progressive signs and symptoms are associated with an orbital mass lesion. The present case suggests that pleomorphic adenoma should also be considered in the differential diagnosis. The therapeutic strategy for lacrimal gland tumors remains controversial, so a flexible management approach is required.     

Surgical management of malignant tumors of the lacrimal gland

Malignant lacrimal gland tumors are rare but serious and life-threatening neoplasms. Patients frequently present with symptoms of less than 1 year duration, often demonstrating rapid change during the 6 months preceding diagnosis. Pain and periorbital sensory changes are also reported by patients. Radiographically, bone destruction is a strong indication of a lacrimal gland malignancy as is ophthalmoplegia. Radical three-dimensional resection utilizing a cranioorbital approach offers the best chance for total tumor removal. Immediate reconstruction with a scalp flap is essential for primary healing, as well as esthetic balance of the orbital region.     

Adenoid cystic carcinoma of the lacrimal gland: report of a case

Adenoid cystic carcinoma of the lacrimal gland is rarely reported in Japan compared with other countries in Europe and the U.S.A. Here is a report of this rare case. A 26-year-old female had complained of left visual disturbance and left exophthalmos with orbital pain. CT scan and MRI revealed a lacrimal gland tumor in that eye. The tumor was removed via a left frontal craniotomy, and diagnosed as adenoid cystic carcinoma. After operation, she was locally irradiated with a total dose of 5,000 rads using 15 MeV Lineac source. Chemotherapy was started with 5-FU after radiation therapy. An abnormal uptake was observed in the sternum in the bone scintigraphy performed after operation, suggesting metastasis. Visual disturbance improved and exophthalmos and orbital pain disappeared. At the last follow-up at 8 months after operation, she had no signs and symptoms of recurrence or metastasis. Adenoid cystic carcinoma is reported to be the most frequent among the malignant tumors of the lacrimal gland in the Western countries. Prognosis is generally unfavorable with the mortality of 45% to 70%. The 5-year and 10-year survival rate are 45% and 25%, respectively. The mean post-operative survival time is 4.5 years. Since the tumor grows infiltratively into the surrounding tissues, radical excision with total exenteration of the orbit is the treatment of choice. However, it is a difficult decision whether or not to remove the eye with the intact visual function. As for operation, an approach from above through the frontal craniotomy provides a wider operative field and an easier access to the tumor than the lateral approach employed by ophthalmologists.     

Dry Eyes and Superficial Punctate Keratitis: A Complication of Treatment of Glabelar Dynamic Rhytides with Botulinum Exotoxin A

Background. Dry eyes and superficial punctate keratitis are potential complications of periocular botulinum exotoxin A treatment.
Objective. To report a patient who had these side effects after being treated with botulinum exotoxin A for glabelar rhytides and discuss possible causes including excessive paralysis of the orbicularis oculi leading to lagophthalmos and direct paralysis of the lacrimal gland.
Methods. A case report and brief literature review is presented.
Conclusion. Paralytic lagophthalmos caused dry eyes and superficial punctate keratitis in our patient. To avoid this complication, if an injection is to be done in the lateral brow area, it should be done 1 cm above the orbital rim.     

Hyperfunctioning intrathyroid parathyroid gland: a potential cause of failure in parathyroidectomy

BACKGROUND: The surgical success rate of parathyroidectomy is 95%. However, in rare patients, ectopic hyperfunctioning parathyroid glands may be located in the thyroid but missed on imaging studies or during surgery. The aim of the present study was to evaluate the perioperative findings in 6 patients with intrathyroid parathyroid glands treated for hyperparathyroidism in our center over a 5-year period and to review the relevant literature. METHODS: Of the 426 patients who underwent parathyroidectomy for hyperparathyroidism between 1998 and 2003 in our center, 6 (1.4%) were found to have intrathyroid glands. Their files were reviewed for clinical features, surgical approach, intraoperative findings, parathyroid gland location, and morphologic and histopathologic characteristics. RESULTS: The group included 2 men and 4 women of mean age 66 years. The diagnosis in all patients was based on an increase in serum calcium concentration (10.1-13 mg/100 mL) and parathyroid hormone level (102-320 pg/mL). The clinical symptoms were kidney stones, gastrointestinal complaints, hypertension, and osteopenia. Localization studies included ultrasonography in all patients and sestamibi in 4. When the parathyroid glands were not identified, bilateral neck and mediastinum were explored. Adenoma was diagnosed histologically in 4 patients; 2 had a double adenoma. CONCLUSION: Intrathyroid parathyroid gland is a rare condition in patients with hyperparathyroidism. In these patients, imaging may miss the pathologic gland. Despite its rarity, the possibility of an intrathyroid parathyroid should be kept in mind, and, when meticulous bilateral exploration of the neck fails to identity the hyperfunctioning gland, the surgeon should consider hemithyroidectomy.     

Aesthetic and Functional Outcomes of Dacryoadenopexy

Forty patients underwent bilateral lacrimal gland suspension concomitant with upper and lower lid blepharoplasty. All surgery was performed by the same surgeon (BG). Twenty-eight (70%) patients were available for a mean follow-up period of 19.9 months, and 12 (30%) patients were available only for an early follow-up period (mean = 3.6 months). Of the 40 patients, 20 underwent both preoperative and postoperative Schirmer’s testing. Two patients exhibited “dry eye” symptoms preoperatively. Two (5%) patients had epiphora develop postoperatively, which resolved spontaneously and six (15%) patients complained of “dry eyes,” four of whom had complete resolution of their symptoms within 6 months postoperatively. Only two (5%) patients had persistent mild “dry eye” symptoms. Overall, 38 (95%) of the 40 patients were asymptomatic at their final follow-up evaluations. A correlation between Schirmer’s scores and patients’ symptoms could not be established. No recurrences of lacrimal gland prolapse were found in any of the 28 patients who were available for long-term follow-up.     

Malignant transformation of benign mixed tumor of lacrimal gland to squamous cell carcinoma 19 years after initial surgery: report of a case]

A case of malignant transformation of benign mixed tumor (pleomorphic adenoma) arising from the right lacrimal gland is reported. A 63-year-old man was referred to our clinic because of visual disturbance and protrusion of the right eye in January, 1989. His past history revealed that he had had a benign mixed tumor of the right lacrimal gland resected 19 years ago. On CT scan, an iso-density lesion homogeneously enhanced with contrast medium was found in the right orbit. This tumor was partially cystic and invaded the cranial cavity. On T1 and T2 weighted MRI, the tumor appeared as an iso-intensity area. At surgery, the tumor was subtotally resected via the combined fronto-orbital approach on February 3, 1990. Histological diagnosis of the tumor was squamous cell carcinoma, and it was construed to be a malignant transformation of mixed tumor of the lacrimal gland. Postoperatively he was placed on a course of external radiation therapy (63 Gy in total) in combination with intra-carotid Cisplatin injection therapy. The first sign of the recurrence was seen as multiple metastatic lesions in both lungs about 4 months after the surgery. In December, 1990, protrusion of the left eye and disturbance of ocular movement became progressively worse. On CT scan, recurrent metastatic tumor was seen in the left orbit and paranasal sinuses. Although additional chemotherapy and irradiation brought about a short period of symptomatic relief he succumbed to pneumonia in April 18, 1990. Metastatic squamous cell carcinoma was confirmed in the lung at autopsy.(ABSTRACT TRUNCATED AT 250 WORDS)