Request PDF on ResearchGate | Adenoma pleomórfico de glándula lagrimal ectópica | The pleomorphic adenoma is one of the most frequent neoplasia that. RESUMEN: El adenoma pleomórfico es el tumor más frecuente de las glándulas salivales, con componentes epiteliales y mesenquimales. Su complejidad. ARTIGO DE REVISÃO. O papel da ressonância magnética no diagnóstico do adenoma pleomórfico: revisão da literatura e relato de casos. The role of magnetic.
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An unusual presentation of lacrimal gland pleomorphic adenoma. Tumors of the lacrimal gland are rare in clinical practice. Among all of them, the most common epithelial tumor is the lacrimal gland pleomorphic adenoma, which is a benign indolent tumor that usually affects adults in the third and fourth decades of life.
We present an unusual case of lacrimal gland pleomorphic adenoma. Its management, radiological findings and outcomes are also described, along with a brief review of the literature. Adenoma; Lacrimal apparatus; Orbit; Oculomotor muscles; Magnetic resonance imaging.
Tumors of the lacrimal gland are rare in clinical practice 1,2.
Adenoma pleomórfico pulmonar. A propósito de un caso
Among all of them, the most common epithelial tumor is the lacrimal gland pleomorphic adenoma LGPA 3which is a benign indolent tumor that usually affects adults in the third and fourth decades of life The most frequent symptom is a painless palpable mass in the upper external quadrant of the orbit, with slow growth and inferonasal displacement of the globe 1,2,4.
Radiological investigation may be done either by computerized tomography CT or magnetic resonance imaging MRI. The treatment is the complete excision of the tumor and adjacent tissuesand the prognosis is good when the lesion is completely excised with an intact capsule We present below an unusual case of lacrimal gland pleomorphic adenoma. This is pldomorfico case report of a year old woman with diplopia and an orbital mass of progressive growth.
External examination showed a soft tumor in the left superolateral orbital rim, with supraversion and abduction restriction. MRI showed adenoa expansive heterogeneous lesion with regular and well defined margins, pleomprfico 6. The patient underwent tumor exeresis by craniotomy xdenoma lateral orbitotomy.
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Left orbital exenteration, orbital roof and frontal bone resection and partial maxillectomy were also performed. Histopathological examination Figure 5 revealed a lacrimal gland pleomorphic adenoma, with myoepithelial cell preponderance myxoid areas. Among all of them, the most common epithelial tumor is the lacrimal gland pleomorphic adenoma LGPAaccounting for more than half of the epithelial forms 30. LGPA is a benign indolent tumor, consisting of a very firm mass that leads to compression atrophy of the normal gland, displacement of residual lacrimal tissues, and is surrounded by a ‘pseudocapsule’ into which small sprouts of adenoma may projected 6.
LGPA is most frequent in adults 6 in the third and fourth decades mean age: The clinical presentation is usually characterized by a painless palpable mass 1,4 in the upper external quadrant of the orbit 2,8with slow growth and inferonasal displacement of the globe 1,2,4. There may also be an increase in lacrimation and intrabulbar pressure 8visual impairment and diplopia Malignancy is suspected when there is a fast onset of symptoms, pain, and radiographic evidence of bone destruction 1as in our case.
Both are similar in terms of providing information on anatomic extent, configuration, margins, and angulation features of a lacrimal gland fossa mass. However, CT provides more details about bone destruction and presence of calcification, while MRI provides better internal tissue features and intracranial extension 3,9.
On MRI, pleomorphic adenoma appears as an isointense lesion with regular margins and angles, when comparing with extraocular muscle and cerebral gray matter on T1-weighted images and heterogeneously hyperintense on T2-weighted images, due to higher water content, with moderate contrast enhancement after gadolinium-DTPA injection 9. Although not usual, there may be intratumoral hemorrhage 7bone destruction 4,9 ppeomorfico calcification 4,9, Intracranial extension, as happened in our case, is very rare.
Although the tumor presents characteristic clinical and radiological features, which usually allows preoperative diagnosis 4,5,11the definitive diagnosis is based on the histopathological examination 11which shows cords of well-differentiated epithelial tubules derived from the ducts of the lacrimal gland, within loose myxomatous connective tissue In our case, due to the clinical features and the extension of the tumor, a lpeomorfico tumor epithelial carcinoma would aednoma the most likely diagnosis, however, an extensive histopathological examination was performed and no features of malignancy was found, confirming the diagnosis of LGPA.
Differential diagnosis includes lymphoma, chronic dacryoadenitis, Sjogren’s syndrome, adenoid cystic carcinoma, granulomatous dacryoadenitis sarcoidosisbenign lymphoid hyperplasia, cavernous hemangioma 5intralacrimal schwannoma and hemangiopericytoma 6.
The treatment is the complete excision of the tumor and adjacent tissues, usually by lateral orbitotomy. It is believed that preoperative biopsy and incomplete resection could lead to the tumor recurrence even after yearsas well as to malignant transformation Complications following surgery include orbital hemorrhage, edema, optic nerve compression, orbital infection, lateral gaze palsy 2dry eye, ptosis, lid retraction and transient diplopia 5.
The prognosis is good when the lesion is completely excised with an intact capsule 3,4. Malignant transformation of a benign pleomorphic adenoma into a squamous cell carcinoma has also been reported 19 years after the initial operation 3.
We consider our case unusual due to its presentation at an older age, with bone destruction, invasion of the extraocular muscles and intracranial extension, which are rare features in cases of LGPA. Ten-year follow-up of a case series of primary epithelial neoplasms of the lacrimal gland: Modified lateral orbitotomy approach: Pleomorphic adenoma of the lacrimal gland: Br J Oral Maxillofac Surg.
Rev Soc Bras Cir Plast. Lesions mimicking lacrimal gland pleomorphic adenoma. Pleimorfico crash or not to crash? Probability in the management of benign lacrimal gland tumours.
Unusual progression of pleomorphic adenoma of the lacrimal gland: Neurol Med Chir Tokyo. Pleomorphic adenoma of lacrimal gland in a 5-year-old child: Diagnosed on aspiration cytology. Magnetic resonance imaging of unilateral lacrimal gland lesions.
Adenoma Pleomórfico: Reporte de Caso y Revisión de la Literature
Graefes Arch Clin Exp Ophthalmol. Recurrent lacrimal gland pleomorphic adenoma: Pleomorphic adenoma of the lacrimal gland. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. How to cite this article.