title: Recurrent lacrimal gland pleomorphic adenoma: clinical and computed tomography features.
abstract: OBJECTIVE
  To report the clinical and computed tomography (CT) features of recurrent lacrimal gland pleomorphic adenoma (LGPA).
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Five patients with recurrent LGPA.
  
  
  METHODS
  Clinical records and CT findings in 5 patients with recurrent LGPA were reviewed.
  
  
  METHODS
  Clinical and CT features, malignant transformation, and disease-free survival.
  
  
  RESULTS
  Five patients presented at intervals of 9 to 19 years after initial surgery for LGPA with symptoms and signs of recurrent tumor centered on the lacrimal gland fossa. Four patients underwent surgery to remove recurrent tumor, and 1 patient declined surgical intervention. One of the 4 operated patients was found to have malignant transformation and required craniofacial resection for tumor clearance. One patient had benign recurrence in a previously exenterated orbit and also required a craniofacial resection. Two patients with benign but multifocal recurrence had en bloc resection of tumor, but remain at risk of further recurrence. Computed tomography in all 5 patients revealed irregular bone erosion and remodeling in relation to nodules of recurrent tumor, despite only 1 of these patients having confirmed malignant transformation. Four patients were free of disease at their last follow-up at intervals of 9 months to 18 years, including the patient with malignant transformation (14 years follow-up). One patient who declined treatment has been lost to follow-up.
  
  
  CONCLUSIONS
  Recurrent LGPA tends to develop multifocally and may be widespread in the operative field. Computed tomography shows recurrent tumor nodules that are often associated with irregular bony erosion and remodeling despite these recurrences being usually benign. Repeated recurrence requiring further surgery with potential significant morbidity remains a lifelong risk, and malignant transformation in recurrent LGPA may also occur.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia. amcnab@bigpond.com
authors.forename: Alan A
authors.initials: AA
authors.lastname: McNab
authors.forename: Khami
authors.initials: K
authors.lastname: Satchi
mesh_terms: D008949:Adenoma, Pleomorphic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D005134:Eye Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed