Tumours of the lacrimal gland are uncommon orbital tumours, each year my clinic sees about 8 new cases. Half of them are caused by lymphoma and the rest are true tumours of the lacrimal gland.
This patient was referred by a private ophthalmologist for treatment. She had progressively swelling of the right upper eyelid for about 6 months. The swelling was painless. The CT scan performed in the private centre revealed lacrimal gland swelling.
Right upper eyelid swelling.
CT scan shows lacrimal gland swelling.
The CT scan and the history suggested this was most likely to be pleomorphic adenoma which is a benign lacrimal tumour. Although benign, this tumour can grow to a big size causing disfigurement and problem with eye movement and sometimes visioin. It is important to remove the tumour completely, as any residual lesion can cause recurrence and worse transform into cancerous lesion. The tumour was approached through incision through the double eyelid (skin crease) and removed in whole.
Preparing the operation. Local anaesthetic with adrenaline
was given to reduce bleeding during the operation. The
skin marking was at the skin crease (double eyelid).
Tumour identified.
Tumour isolated.
The tumour was freed from the surrounding tissue.
The whole tumour excised and sent for histology.
Appearance of the eye 24 hours post-operation.
I was expecting it to be a pleomorphic adenoma but the histology returned as non-Hodgkin's lymphoma so the patient was referred to haematologist for further treatment. The haematologist requested thorax and abdomen CT scan and further immunostaining of the speciment. In addition, she asked us to start the patient for chlamydia treatment which is something new to me apparently recent study shows that orbital lymphoma is associated with chlamydial infection.
ReplyDelete