J Korean Ophthalmol Soc.  2019 Apr;60(4):369-373. 10.3341/jkos.2019.60.4.369.

A Case of Adult Orbital Lymphatic Malformation in the Lacrimal Gland

• Song WS
• Cho SJ
• Choi YJ

• KMID: 2443154
• DOI: http://doi.org/10.3341/jkos.2019.60.4.369

Abstract

PURPOSE
When there is a mass in the superior temporal orbit area, a lacrimal gland tumor should be suspected. We report a rare case of orbital lymphatic malformation that was histologically diagnosed in a patient with typical clinical features of the lacrimal gland.
CASE SUMMARY
A 55-year-old female with no underlying disease and no ophthalmic history visited our clinic with a right upper eyelid edema associated with an enlarged painless eyelid mass 1 month prior to her visit. The patient stated that she discovered the mass 1 year previously.The palpebral lobe of the lacrimal gland protruded slightly with congestion of the surrounding conjunctiva. Enhanced computed tomography showed a 3 cm well-defined heterogeneous mass in the right lacrimal gland area and several well-defined round calcifications within the mass. Orbital tissue or bone involvement was not observed. The pleomorphic adenoma of the lacrimal gland was the most clinically suspicious, so complete resection of the mass was performed using lateral orbitotomy. Histopathologically, lymphangioma (lymphatic malformation) originating from the lacrimal gland was diagnosed.
CONCLUSIONS
Orbital lymphatic malformation can occur in the lacrimal gland. The present case showed that differential diagnosis can reveal the presence of an adult lacrimal gland tumor.

Keyword

Lacrimal gland tumor; Orbital lymphangioma; Orbital lymphatic malformation

MeSH Terms

Adenoma, Pleomorphic
Adult*
Conjunctiva
Diagnosis, Differential
Edema
Estrogens, Conjugated (USP)
Eyelids
Female
Humans
Lacrimal Apparatus*
Lymphangioma
Middle Aged
Orbit*
Estrogens, Conjugated (USP)

Figure

• 

  Figure 1 Clinical photograph. (A) Moderate firm, palpable mass with eyelid swelling (black arrow) is seen at right upper eyelid. (B) Prominent palpebral lobe of lacrimal gland with mild conjunctival injection (white arrow) is seen.

• 

  Figure 2 Preoperative enhanced computed tomography images of coronal view (A) and axial view (B). A 3 cm well-defined heterogeneous mass at right lacrimal gland area, and several well-marginated round calcifications within mass.

• 

  Figure 3 Gross findings and pathologic findings of the excised mass. (A) Gross findings of the excised mass measuring approximately 2.0 × 1.5 cm in diameter. (B–D) Pathologic findings. Microscopic examination of the removed tumor showed multiple dilated cystic spaces (red arrows) lined with thin-walled endothelium (yellow star) with myxoid degeneration. Note that normal lacrimal glandular cells (black arrows) are observed in the mass (B: Hematoxylin and eosin stain [H&E stain], ×10, C: H&E stain, ×40, D: H&E stain, ×100).

• 

  Figure 4 Post-operative enhanced computed tomography images of coronal view (A) and axial view (B). Orbital tumor was completely removed after the operation.

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