Focal Necrosis in Orbital Pleomorphic Adenoma

Lacrimal gland tumours are rare entities that only comprise 9% of orbital lesions. Of those 9% of cases, only 10% are pleomorphic adenomas. Pleomorphic adenomas (PA) are the most common benign tumours of the lacrimal gland, which exhibit pleomorphism of epithelialcomponents. However there are certain histological characteristics in pleomorphic adenomas, which may raise suspicion of atypia and prompt further investigation. Auclair and Ellis et al has noted that areas of necrosis, hypercellularity, hyalinization, cytological atypia, capsule extension or violation may be predictors of malignancy.

44-year-old Caucasian lady presented with residual painless left upper lid swelling 6 months after being poked in the left eye by her infant son. A firm cystic lesion was palpated in the superior lateral orbital rim. The rest of the ocular examination was normal. Computer Tomographic scan of the orbits revealed a large encapsulatedcystic mass extending from the inferior portion of the left lacrimal gland. A posterior orbitotomy with excisional biopsy of the lesion was performed. This yielded histology of pleomorphic adenoma with cellular myoepithelial areas containing focal necrosis. Cytological atypia and mitotic activity were absent. The patient recovered well post operatively with no complications.