title: Unusual progression of pleomorphic adenoma of the lacrimal gland: case report.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Shimane University School of Medicine, Izumo, Shimane, Japan. takeshi@med.shimane-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Kouzo
authors.initials: K
authors.lastname: Moritake
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Nagai
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kodama
mesh_terms: D008949:Adenoma, Pleomorphic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D018450:Disease Progression; D005094:Exophthalmos / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007765:Lacrimal Apparatus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D019315:Retrobulbar Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome