title: Pleomorphic adenocarcinoma of the lacrimal gland with multiple intracranial and spinal metastases.
abstract: BACKGROUND
  Pleomorphic adenoma of the lacrimal gland is known to undergo malignant transformation when incompletely excised. Even if such a malignant change occurs, intracranial direct invasion and leptomeningeal seeding are seldom encountered.
  
  
  METHODS
  A 50-year-old woman presented with malignant transformation associated with both intracranial invasion and multiple intracranial and spinal disseminations in the third recurrence of pleomorphic adenoma of the lacrimal gland, 6 years after initial treatment. MRI demonstrated increased extent of orbital mass, extending to the cavernous sinus. The patient underwent intensity-modulated radiation therapy (IMRT) and Gamma Knife radiosurgery. Follow-up MRI showed multiple leptomeningeal disseminations to the intracranium and spine.
  
  
  CONCLUSIONS
  It is important to recognize that leptomeningeal intracranial and spinal disseminations of pleomorphic adenocarcinoma can occur, although it is extremely rare. To our knowledge, we report the first case of pleomorphic adenocarcinoma of the lacrimal gland presumably metastasizing to the intracranium and spine.
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea. jyahn@yumc.yonsei.ac.kr
authors.forename: Jung Yong
authors.initials: JY
authors.lastname: Ahn
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Chang
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Kyu Sung
authors.initials: KS
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy; D008949:Adenoma, Pleomorphic / Q000473:pathology* / Q000628:therapy; D001707:Biopsy, Needle; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy; D018450:Disease Progression; D005134:Eye Neoplasms / Q000473:pathology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007765:Lacrimal Apparatus / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods; D018570:Risk Assessment; D013125:Spinal Neoplasms / Q000473:pathology / Q000628:therapy