title: Lacrimal gland carcinoma ex pleomorphic adenoma with chronic lymphocytic leukemia infiltration.
abstract: OBJECTIVE
  To report a rare case of lacrimal gland carcinoma ex pleomorphic adenoma (Ca ex PA) with chronic B-cell lymphocytic leukemia (B-CLL) infiltration in a patient without a previous diagnosis of B-CLL.
  
  
  METHODS
  We report a 66-year-old woman who presented with recent worsening of a long-standing right eye proptosis. Sequential orbital computed tomography imaging was performed over the course of 2 years, and biopsy specimens were analyzed.
  
  
  RESULTS
  Initial computed tomography scans revealed a lacrimal gland lesion with stable dimensions for more than 1 year and no malignancy features on incisional biopsy. Subsequently, lesion volume growth and bone erosion were documented on orbital computed tomography. Lateral orbitectomy and lacrimal gland resection were performed. Pathology and immunohistochemistry detected Ca ex PA with B-CLL infiltration.
  
  
  CONCLUSIONS
  This case highlights the importance of persistent investigation of clinically suspicious orbital lesions. To our knowledge, this is the first description of a case of lacrimal gland Ca ex PA with B-CLL infiltration.
authors.affiliation: Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Couceiro
authors.affiliation: Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Loureiro
authors.affiliation: Department of Pathology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Luís
authors.affiliation: Department of Pathology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Dolores
authors.initials: D
authors.lastname: López-Presa
authors.affiliation: Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Proença
authors.affiliation: Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Fonseca
authors.affiliation: Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monteiro-Grillo
keywords: chronic lymphocytic leukemia; ex pleomorphic adenoma; lacrimal gland malignancy; proptosis