title: Clinico-radiological features of primary lacrimal gland pleomorphic adenoma: an analysis of 37 cases.
abstract: OBJECTIVE
  To present the radiological and clinical features of primary lacrimal gland pleomorphic adenoma (PLGPA).
  
  
  METHODS
  Thirty-seven consecutive PLGPAs presenting to two hospitals in Japan were reviewed.
  
  
  RESULTS
  PLGPA cases had 15 men and 22 women with a mean age of 51.9 years. Common presenting features were ptosis (83 %), diplopia (78 %) and globe displacement (78 %). Twenty-two percent of cases reported symptom duration of less than 6 months, but only 5.6 % of cases had pain. Sixteen percent of PLGPAs were centered in the palpebral lobe; none of which were associated with globe indentation or lacrimal fossa expansion. Bony excavation was observed in 84 % of orbital lobe PLGPA; the bone margin was well demarcated and the character of excavation was more frequently smooth than scalloped (2:1). The presence of globe indentation or bony excavation was associated with increased tumor size (p = 0.003). An enhancing rim was visible on T1-weighted fat-suppressed gadolinium-enhanced magnetic resonance imaging (T1FS-Gad MRI) in 27 %. Five (19 %) enclosed cystic spaces were bright on T2-weighted MRI and non-enhancing. Calcification of tumor parenchyma was common in cystic cases but rare in non-cystic cases (p = 0.01).
  
  
  CONCLUSIONS
  PLGPAs have varied clinical and radiological features. Common radiological features are a heterogeneous internal architecture on T2-weighted MRI, an enhancing rim on T1FS-Gad MRI, smooth or scalloped bony excavation with intact cortical bone, and globe indentation. Cystic spaces, calcification, and symptom duration less than 6 months are common, but pain is rare. Awareness of the clinico-radiological variants of PLGPA is important when considering incisional biopsy of a lacrimal gland mass.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan. awatanab@koto.kpu-m.ac.jp.
authors.forename: Akihide
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Andrew
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
authors.affiliation: Department of Ophthalmic Plastic and Orbital Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
authors.forename: Nobutada
authors.initials: N
authors.lastname: Katori
authors.affiliation: Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Reid
authors.affiliation: Department of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Adnan
authors.initials: A
authors.lastname: Pirbhai
authors.affiliation: Department of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D008949:Adenoma, Pleomorphic / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005134:Eye Neoplasms / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: Lacrimal gland; Pleomorphic adenoma; Radiological variants