title: A case of mistaken identity: the role of lacrimal gland pleomorphic adenoma tissue diagnosis.
abstract: OBJECTIVE
  Lacrimal gland lesions have diverse pathologies. Bone remodelling on imaging may suggest a benign lacrimal gland pleomorphic adenoma (LGPA) rather than a malignant process.
  
  
  METHODS
  The authors report a case of malignant pleomorphic adenocarcinoma, which was misdiagnosed clinico-radiologically as a benign LGPA. Lesions with bone remodelling on CT imaging were subsequently analysed amongst a cohort of 31 lacrimal gland lesions from a single tertiary centre.
  
  
  RESULTS
  31 lacrimal gland lesions biopsied over a ten-year period featured bone remodeling on CT scan, typical of LGPA. Three diagnoses were of pleomorphic adenocarcinoma. Two of these cases presented classically with unilateral painful eyelid swelling and bone destruction or bone erosion on CT scan. Seven patients (23%) in this ten-year period had bone remodeling on CT scan, typical of LGPA. Of these seven cases, three were LGPA, but the other four cases were a mixture of other diagnoses.
  
  
  CONCLUSIONS
  Clinical and radiological suspicion of LGPA may be inaccurate and requires prompt histological diagnosis to facilitate appropriate further treatment and prognosis.
authors.affiliation: Department of Ophthalmology, University Hospital of Wales, Cardiff, UK. brentskippen@gmail.com.|, 54 Docker Street Wagga, Wagga, NSW, 2650, Australia. brentskippen@gmail.com.
authors.forename: Brent
authors.initials: B
authors.lastname: Skippen
authors.affiliation: Department of Ophthalmology, University Hospital of Wales, Cardiff, UK.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Lane
authors.affiliation: Department of Radiology, University Hospital of Wales, Cardiff, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hourihan
authors.affiliation: Department of Ophthalmology, University Hospital of Wales, Cardiff, UK.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Morris
mesh_terms: D008949:Adenoma, Pleomorphic / Q000175:diagnosis* / Q000601:surgery; D001706:Biopsy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005134:Eye Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007765:Lacrimal Apparatus / Q000000981:diagnostic imaging*; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Lacrimal gland lesion; Malignancy; Pleomorphic adenoma