Clinically the tumors of the lacrimal gland appear as palpable masses of the outer orbital angle of the orbit,
with proptosis,
eyelid protrusion and most noticeably ocular deviation.
Most of the lesions are of an inflammatory type (50%),
being the most representative the acute and chronic dacrioadenitis,
inflammatory pseudotumor and sarcoidosis.
Lymphoproliferative disorders constitute less than 25%.
Among the differentials should be taken into account those of epithelial strain such as pleomorphic adenoma,
cystic adenoid tumor and mucoepidermoid; in addition epidermoid cysts,
dermoids and metastasis.
CT and MR imaging are complementary imaging techniques in the localization and characterization of lacrimal fossa lesions.
Solid or cystic lesions,
well defined or infiltrative process,
the presence of fat or fluid,
bony remodeling or destruction,
and pattern of contrast enhancement all help in making a confident preoperative diagnosis.
Epithelial tumors account for 40% to 50% of all lacrimal fossa masses and the orbital lobe is the most common site.
Little more than half of these are benign mixed tumors and the rest are malignant,
the most common primary malignant tumor being adenoid cystic carcinoma.
Pleomorphic adenoma or BMT
This is the most common tumor of the lacrimal gland and presents as a slow,
progressive,
painless swelling in the upper lid over a year’s period without symptoms or signs of inflammation.
Sudden onset of pain could indicate malignant transformation.
It has an excellent prognosis if treated by complete excision at primary surgery.
If the tumor is
biopsied or incompletely excised,
the recurrence rate can be as high as 28%,
with a higher predisposition for malignant transformation.
Nonepithelial lesions of the lacrimal gland are mostly inflammatory or lymphoproliferative in nature.
They include acute and chronic dacryoadenitis,
idiopathic inflammatory disease,
sarcoidosis,
Sjogren’s syndrome,
and lymphoma.
Lymphoproliferative lesions of the orbit can range from lymphoid hyperplasia to frank lymphoma and have a predilection for the lacrimal gland.
They commonly occur in adults and present as a progressive swelling of the eyelid over a period of several months.
Inflammatory signs and symptoms are rare.
The lacrimal gland is the only structure within the orbit to have native lymphocytes and plasma
cells and,
hence,
mucosa-associated lymphoid (MALT) tissue.
The disease can be primary or secondary to systemic disease.
The limited form of Wegener´s granulomatosis presents with focal disease manifestation,
with few or no systemic manifestations.
Orbital involvement has been reported in 40–50% of Wegener´s granulomatosis patients and can occur in both the classic and limited form.
Involvement of the lacrimal gland is not uncommon.
Orbital WG involvement is generally believed to be associated with adjacent paranasal sinus disease,
but orbital disease without paranasal sinus involvement is relatively common