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Lacrimal gland tumors are neoplasms arising from the epithelial or lymphoid tissue of the lacrimal gland, located in the superolateral orbit. They may be benign or malignant, and present with painless or painful mass, globe displacement, and proptosis. Epithelial tumors are most common, followed by lymphoid tumors.
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(A) The lacrimal apparatus anatomy—illustration. (B) Coronal contrast-enhanced T1-weighted MR image with fat saturation depicting the normal aspect of the lacrimal gland localized in the superolateral region of the orbit (extraconal) and its lobe divisions.
Muntean DD, Bădărînză M, Ștefan PA, Lenghel ML, Rusu GM, Csutak C, Coroian PA, Lupean RA, Fodor D. The Diagnostic Value of MRI-Based Radiomic Analysis of Lacrimal Glands in Patients with Sjögren’s Syndrome. International Journal of Molecular Sciences. 2022; 23(17):10051. https://doi.org/10.3390/ijms231710051
Epithelial tumors (20–50%):
| Type | Behavior | Notes |
|---|---|---|
| Pleomorphic adenoma | Benign | Most common benign epithelial tumor |
| Adenoid cystic carcinoma (ACC) | Malignant | Most common malignant epithelial tumor |
| Carcinoma ex pleomorphic adenoma | Malignant transformation | Aggressive |
| Mucoepidermoid carcinoma | Malignant | Less common |
| Adenocarcinoma | Malignant | Rare |
Non-epithelial tumors:
| Type | Notes |
|---|---|
| Lymphoma (MALT type) | Most common non-epithelial lacrimal gland tumor, especially in elderly |
| Inflammatory pseudotumor (IOI) | Painful, acute onset; mimics tumor but is benign |
| Sarcoidosis, GPA | Inflammatory; systemic involvement |
| Symptom | Description |
|---|---|
| Superolateral orbital mass | Common presentation |
| Globe displacement | Inferomedial, due to mass effect |
| Proptosis | Axial or non-axial depending on lesion size |
| Pain | • Absent in pleomorphic adenoma |
| • Present in ACC, inflammatory, or infiltrative lesions | |
| Diplopia | Due to mass effect on EOMs |
| Ptosis or eyelid swelling | May accompany anterior extension |
| Duration of symptoms: | • Slow-growing, painless = likely benign |
| • Rapid, painful = likely malignant or inflammatory |
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Imaging (CT/MRI) is critical to distinguish benign pleomorphic adenomas (well-defined, painless) from malignant tumors like adenoid cystic carcinoma (painful, irregular, bony invasion).
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CT findings:
| Tumor | Features |
|---|---|
| ‣ | • Well-circumscribed |
| • Round or oval mass in lacrimal fossa | |
| • Smooth bony remodeling | |
| • No bone destruction | |
| ‣ | • Irregular, infiltrative margins |
| • Bone erosion or destruction | |
| • Perineural spread (may involve orbital apex or superior orbital fissure) | |
| Lymphoma | • Molded to surrounding structures |
| • Homogeneous soft tissue mass | |
| • No bony erosion | |
| ‣ | • Diffuse swelling, muscle involvement |
| • Painful, T2-hyperintense, enhances with contrast |
MR findings:
| Sequence | Findings |
|---|---|
| T1 | • Iso- to hypointense mass |
| T2 | • Pleomorphic adenoma: hyperintense |
| • ACC: variable signal | |
| • Lymphoma: mild hyperintensity | |
| Post-contrast | • Pleomorphic adenoma: homogeneous or heterogeneous enhancement |
| • ACC: irregular, heterogeneous | |
| • Lymphoma: homogeneous, intense | |
| Perineural spread | • ACC: Enhancement along trigeminal nerve (V1/V2), cavernous sinus involvement |