Lacrimal gland tumor are a group of neoplasms of the lacrimal gland, mainly of epithelial origin. Localized in the outer part of the upper eyelid, painless. Benign tumors of the lacrimal gland develop for many years, during the growth process they can cause exophthalmos and thinning of the eye socket wall. Malignant neoplasms progress rapidly, disrupt the mobility of the eyeball, provoke pain and increased intraocular pressure. Germination of surrounding tissues and distant metastasis is possible. The diagnosis is made on the basis of an ophthalmological examination and data from instrumental studies. The treatment is operative.
Lacrimal gland tumor are a group of tumor lesions of the lacrimal gland of heterogeneous structure. They originate from the glandular epithelium, are represented by the epithelial and mesenchymal components. They belong to the category of mixed neoplasms. They are rare, diagnosed in 12 out of 10,000 patients. They make up 5-12% of the total number of orbital tumors. The question of the degree of malignancy of such neoplasms is still debatable. Most specialists conditionally divide lacrimal gland tumors into two groups: benign and malignant, resulting from malignancy of benign neoplasms. In practice, there may be both “pure” and transitional options. Benign processes are more often detected in women. Cancer and sarcoma are diagnosed with the same frequency in both sexes. The treatment is carried out by specialists in the field of oncology and ophthalmology.
Benign tumors of the lacrimal glands
Pleomorphic adenoma is a mixed epithelial tumor of the lacrimal gland. It makes up 50% of the total number of neoplasms of this organ. Women suffer more often than men. The age of patients at the time of diagnosis can range from 17 to 70 years, the largest number of cases of the disease (more than 70%) falls on 20-30 years. It arises from the cells of the epithelial ducts. Some experts suggest that abnormal embryonic cells are the source of the neoplasm.
It is a node of a lobed structure, covered with a capsule. The tissue of the lacrimal gland tumor on the incision is pink with a grayish tinge. It consists of two tissue components: epithelial and mesenchymal. Epithelial cells form chondro- and mucus-like foci located in an inhomogeneous stroma. At the initial stages, very slow progression is characteristic, the period of time from the moment of the appearance of a lacrimal gland tumor to the first visit to the doctor can range from 10 to 20 years or more. The average time interval between the onset of the first symptoms and seeking medical help is about 7 years.
For some time, the tumor of the lacrimal gland exists without causing any particular inconvenience to the patient, then its growth accelerates. Inflammatory edema appears in the eyelid area. Due to the pressure of the growing node, exophthalmos develops and the displacement of the eye inside and down. The upper-outer part of the orbit is thinning. The mobility of the eye is limited. In some cases, a tumor of the lacrimal gland can reach gigantic sizes and destroy the wall of the eye socket. Palpation of the upper eyelid determines a fixed, painless, dense smooth node.
On the survey radiography of the orbit, an increase in the size of the orbit is revealed, due to the displacement and thinning of its upper-outer part. Ultrasound of the eye indicates the presence of a dense node surrounded by a capsule. CT of the eye allows you to more clearly visualize the boundaries of the neoplasm, assess the continuity of the capsule and the state of the bone structures of the orbit. Surgical treatment – excision of the lacrimal gland tumor together with the capsule. The prognosis is usually favorable, but patients should remain under medical supervision throughout their lives. Relapses can occur even several decades after the removal of the primary node. In more than half of the patients, signs of malignancy are detected already at the first relapse. The shorter the remission period, the greater the probability of malignant recurrence of the tumor.
Malignant tumors of the lacrimal glands
Adenocarcinoma is a mixed epithelial neoplasm with several morphological variants with an identical clinical course. It is almost evenly distributed in different age groups. It is characterized by faster growth compared to benign tumors of the lacrimal gland. Usually, patients turn to an ophthalmologist a few months or 1-2 years after the onset of symptoms. The first manifestation of the disease is often neurological pain in the forehead, caused by the impact of neoplasms on the branches of the trigeminal nerve.
A typical sign of this lacrimal gland tumor is an early onset and rapidly increasing exophthalmos. The eye shifts inwards and downwards, its movements are limited. Astigmatism develops, there is an increase in intraocular pressure. Folding appears in the fundus area. The phenomena of a stagnant disk are noted. In the upper outer corner of the eye socket, a rapidly growing formation is determined. The tumor of the lacrimal gland sprouts nearby tissues, spreads deep into the orbit, penetrates into the cranial cavity, and metastases to regional lymph nodes and distant organs.
Treatment – exenteration of the eye socket or organ-preserving operations in combination with postoperative radiation therapy. When the bones of the eye socket germinate, surgical intervention is ineffective. The prognosis is unfavorable due to a high tendency to relapse and distant metastasis. A tumor of the lacrimal glands usually metastases to the spinal cord and lungs. The time period between the appearance of the primary tumor and the occurrence of distant metastases can range from 1-2 to 20 years. Most patients fail to overcome the five-year survival threshold.
Cylindroma (adenocystic cancer) is a malignant tumor of the lacrimal glands of adenomatous-alveolar structure. Clinical manifestations are similar to the symptoms of adenocarcinoma. There is less aggressive local growth, a more pronounced tendency to hematogenous metastasis, the possibility of prolonged existence of metastases and a slow increase in the size of secondary tumors. The spinal cord is most often affected, the second most common is metastases to the lungs. Tactics of treatment of an adenocystic tumor of the lacrimal gland – as in adenocarcinoma. The prognosis is unfavorable in most cases. About 50% of patients die within 3-5 years after diagnosis. The cause of death is distant metastases or the germination of a neoplasm into the cranial cavity.