Abstract
Purpose
To present the radiological and clinical features of primary lacrimal gland pleomorphic adenoma (PLGPA).
Methods
Thirty-seven consecutive PLGPAs presenting to two hospitals in Japan were reviewed.
Results
PLGPA cases had 15 men and 22 women with a mean age of 51.9 years. Common presenting features were ptosis (83 %), diplopia (78 %) and globe displacement (78 %). Twenty-two percent of cases reported symptom duration of less than 6 months, but only 5.6 % of cases had pain. Sixteen percent of PLGPAs were centered in the palpebral lobe; none of which were associated with globe indentation or lacrimal fossa expansion. Bony excavation was observed in 84 % of orbital lobe PLGPA; the bone margin was well demarcated and the character of excavation was more frequently smooth than scalloped (2:1). The presence of globe indentation or bony excavation was associated with increased tumor size (p = 0.003). An enhancing rim was visible on T1-weighted fat-suppressed gadolinium-enhanced magnetic resonance imaging (T1FS-Gad MRI) in 27 %. Five (19 %) enclosed cystic spaces were bright on T2-weighted MRI and non-enhancing. Calcification of tumor parenchyma was common in cystic cases but rare in non-cystic cases (p = 0.01).
Conclusions
PLGPAs have varied clinical and radiological features. Common radiological features are a heterogeneous internal architecture on T2-weighted MRI, an enhancing rim on T1FS-Gad MRI, smooth or scalloped bony excavation with intact cortical bone, and globe indentation. Cystic spaces, calcification, and symptom duration less than 6 months are common, but pain is rare. Awareness of the clinico-radiological variants of PLGPA is important when considering incisional biopsy of a lacrimal gland mass.
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A. Watanabe, None; N. H. Andrew, None; K. Ueda, None; S. Kinoshita, Consultant (Santen Pharmaceutical, Otsuka Pharmaceutical); N. Katori, None; M. Reid, None; A. Pirbhai, None; D. Selva, None.
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Watanabe, A., Andrew, N.H., Ueda, K. et al. Clinico-radiological features of primary lacrimal gland pleomorphic adenoma: an analysis of 37 cases. Jpn J Ophthalmol 60, 286–293 (2016). https://doi.org/10.1007/s10384-016-0451-3
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DOI: https://doi.org/10.1007/s10384-016-0451-3