Clinico-radiological features of primary lacrimal gland pleomorphic adenoma: an analysis of 37 cases

• Published in: Japanese journal of ophthalmology Vol. 60; no. 4; pp. 286 - 293
• Main Authors: Watanabe, Akihide, Andrew, Nicholas H., Ueda, Kosuke, Kinoshita, Shigeru, Katori, Nobutada, Reid, Michael, Pirbhai, Adnan, Selva, Dinesh
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.07.2016; Springer Nature B.V
• Subjects: Adenoma, Pleomorphic - diagnosis; Adult; Aged; Aged, 80 and over; Clinical Investigation; Eye Neoplasms - diagnosis; Female; Follow-Up Studies; Humans; Lacrimal Apparatus Diseases - diagnosis; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Retrospective Studies; Tomography, X-Ray Computed - methods; Young Adult; Pleomorphic adenoma; Lacrimal gland; Radiological variants
• ISSN: 0021-5155; 1613-2246
• DOI: 10.1007/s10384-016-0451-3

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.