A gentleman came to the clinic with complaints of long standing protrusion of the eye and who had developed double vision a few months back. His scans revealed a lacrimal gland (gland producing tears) mass which was eroding bone in the right orbit pushing the eyeball forward (Proptosis).
The MRI and CT images shows the size of the mass as well as the bone around the mass has eroded.
The mass was removed via a small incision on the eyelid crease. (lateral orbitotomy ). Cryoextraction was used to remove the tumour. In cryoextraction, the tumour is held with a steel probe which is at sub-zero temperature which makes it stick to the tumour. This enables traction on mass without having to bite into the tumour and causing damage to the capsule of the tumour while easing it out of the eye socket (Orbit). The collage of the surgery below.
He made an uneventful recovery from the surgery while his proptosis and diplopia resolved immediately after surgery. Once the incision wound had completely healed, it was like he never had a surgery. Even the patient himself couldn’t locate the scar. The is the benefit of a minimally invasive surgery and aesthetically planned surgery. Even though the entire orbital lobe of the lacrimal gland was excised, there was no dry eye in the patient. This is because most of the regular lacrimation is by minor lacrimal glands spread out throughout the conjunctiva (transparent layer on the eyeball).
The mass was sent for histopathological analysis. The histopathology revealed that it was a pleomorphic adenoma of the lacrimal gland and there was no malignant cells within the tumour. So it was all good news for the patient and needed only regular annual follow up after that.
Pleomorphic adenoma of the lacrimal gland is a benign tumor of the lacrimal gland. This usually presents as unilateral painless proptosis. The patient themselves may not be aware of the onset of proptosis because it usually grows very slowly. It is important to differentiate this mass from Adenoid Cystic Carcinoma which has different prognosis and treatment because ACC is a malignant tumour. Diagnosis of Pleomorphic Adenoma is usually made on clinical characteristics and radiological imaging confirms the diagnosis. Long standing Pleomorphic Adenomas can cause bony erosion and remodelling and does not necessarily indicate malignancy. Definitive treatment is complete in toto excision along with the capsule. Incomplete or capsular breach can cause recurrence and malignant transformation to Carcinoma Ex Pleomorphic Adenoma.
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